Prenatal diagnosis of congenital heart disease is crucial to optimal obstetric and neonatal care. In utero identification of heart anomalies allows a variety of treatment options to be considered, including delivery at an appropriate facility, termination of pregnancy, and in some cases in utero therapy. Specific indications and risks have been classified and patients considered at high risk have been offered detailed fetal echocardiography, commonly at a center with appropriate expertise and facilities. However, most children are born to mothers who have no known risk features during pregnancy. Screening in the low-risk population has been reported to have lower accuracy rates then in high-risk population. The most common indication for performing a fetal echocardiogram is a prior family history of congenital heart disease. A number of drugs have been implicated as causes of various malformations, including heart anomalies. Therefore, their use during pregnancy is considered as indication for echocardiography. Several maternal conditions also carry an inherited risk to the fetus and their presence is also indication for this diagnostic procedure. The incidence of congenital heart disease is increased fivefold among infants of diabetic mothers, whereas phenylketonuria has reported risk of 12 to 16%. Chromosomal anomalies, extracardiac malformations and monozigotic twins are also indications for fetal echocardiography.