Fetal cardiac anomalies are increasingly identified during regular obstetric scanning. About 2 pregnancies will have an abnormality of the four chamber view and a further 1 will have an abnormality of the great arteries. These cases can then be referred to the specialist in fetal cardiology for further evaluation and counselling. There is a higher rate of chromosomal and other extracardiac anomalies in fetuses with congenital heart disease, so a careful study of the fetal anatomy, and often an amniocentesis, is indicated, particularly in continuing pregnancies. The natural history of many defects which are identifiable prenatally tends to be worse than that expected postnatally. This is because of an increased rate of spontaneous fetal loss, progression of cardiac disease prenatally and because a more severe spectrum of disease is seen in fetal life. Many parents will choose to interrupt a pregnancy where there is complex disease present. In continuing pregnancies, ideal management includes delivery of the affected infant in a center where postnatal treatment can be expedited immediately and cardiac surgery can take place if indicated.