Fetal echocardiograms were performed in 266 gravidae over a one-year period for a variety of previously identified indications. The largest group consisted of 112 patients referred because of other family members with congenital heart disease (CHD). Of these, only one fetus had CHD. The groups with the highest incidence of CHD were those suspected on general obstetrical scan to have structural cardiac disease (50% abnormal) and those scanned after extracardiac anomalies were found (26% abnormals). Forty rhythm abnormalities were encountered, 85% isolated premature atrial extra-systoles. We conclude that fetal echocardiography should be part of the prenatal evaluation of fetuses with extracardiac anomalies and of those with nonimmune hydrops. Any fetus suspected to have an abnormality of cardiac structure from the four-chamber view of the heart usually visualized while obtaining the abdominal circumference should also be evaluated.