The American College of Cardiology, in conjunction with the American Heart Association and the American Society of Echocardiography, has issued guidelines for the specific training and maintenance of credentials required to perform fetal echocardiography. The guidelines have specific requirements for physicians who perform and diagnose fetal echocardiograms: they should maintain contact with and receive assistance and advice from specialists in maternal and child medicine, genetics, neonatology, pediatric surgery, pediatric cardiology, and cardiac surgery. The sonographer may be asked to provide parental counseling about the fetus, and the sonographer needs to have background knowledge in making various treatment strategies and be familiar with advances in the treatment of congenital and acquired heart disease. The guidelines recommend that indications for fetal echocardiography be divided into maternal and fetal indications: 1. Maternal indications: Family history of congenital heart disease Elderly pregnant women (age >35 years) History of cold and flu during early pregnancy Metabolic disorders (e.g., diabetes mellitus, phenylketonuria) Exposure to teratogens Exposure to prostatic enzyme inhibitors (e.g., ibuprofen, salicylic acid, indomethacin) Rubella Auto-immune disorders (e.g., systemic lupus erythematosus, dry syndromes) Autoimmune diseases (e.g. systemic lupus erythematosus, dry syndrome) Familial hereditary diseases (e.g. Ellis Van Creveld syndrome, Marfan syndrome, Noonan’s syndrome, etc.) Twin-fetal transfusion syndrome IVF 2. Fetal indications: Abnormalities detected by general obstetric ultrasonography Other than cardiovascular malformations Chromosomal abnormalities Cardiac arrhythmias Fetal hydrops fetalis Early pregnancy Thickening of the nuchal translucency Multifetal pregnancy Twin-fetus transfusion syndrome