The application of ultrasound, particularly three-dimensional (3D) ultrasound, has transformed prenatal care, facilitating the early identification of a multitude of fetal anomalies, including congenital heart disease (CHD). The early detection of CHD, one of the most common congenital anomalies, offers significant advantages in prenatal management and postnatal outcomes. This can potentially reduce neonatal morbidity and mortality. While traditional two-dimensional fetal echocardiography is a valuable tool, it is limited by operator dependency and fetal positioning. Advances in 3D and four-dimensional (4D) ultrasound technologies, such as spatiotemporal image correlation (STIC), have addressed these challenges by enabling enhanced visualization of cardiac anatomy, minimizing motion artifacts, and allowing for offline analysis of volumetric data. These technologies enhance the detection rates, diagnostic accuracy, and the provision of detailed information for prenatal counseling and delivery planning, particularly in high-risk populations. Moreover, artificial intelligence (AI) tools such as Fetal Intelligent Navigation Echocardiography (FINE) have demonstrated the potential to enhance the operator’s ability to navigate to complex cardiac structures and automate standard views, thereby improving diagnostic efficiency and reducing operator bias. Notwithstanding these advances, considerable inconsistency in the implementation of fetal echocardiography programs across different regions underscores the necessity for more standardized screening protocols. The future of fetal cardiac assessment will be shaped by the continued development of automated, high-resolution ultrasound technologies and AI-powered systems, which will help address the current challenges and ensure broader access to accurate prenatal diagnosis of CHD.