 My topic for paper presentation is ultrasound and diagnosis of fetal cardiac anomalies in pregnant women between 18 to 22 weeks of gestation, attending Kravda Rural Hospital Lonely. Congenital heart disease with a prevalence of 5 to 9 per 1000 live births is the commonest of the severe congenital anomalies. There are various risk factors to this. Cardiac anomalies are major diseases that are most frequently missed on prenatal ultrasound examinations which is a reason for concern because undetected congenital heart anomalies increases the risk of early neonatal mortality. The aim of the paper is to find out and study various fetal cardiac anomalies in pregnant women referred to Kravda Rural Hospital Lonely between 18 to 22 weeks of gestation by ultrasound. The objective was to find out types of fetal congenital heart diseases in the study population and to describe the ultrasound findings in the diagnosed cases and to find out the most common fetal congenital heart disease and to find out the proportion of fetuses with congenital heart diseases. It is a descriptive study design which will include a total of 3,600 pregnant women in 18 to 22 weeks of gestation. Patients who meet the eligibility criteria will undergo the prenatal ultrasound screening to look for congenital anomalies and to review important features to improve the diagnosis of CHD by applying ultrasound. It was performed on Toshiba's RU-100 Philips Affinity 70G Ultra Sonography Machines with an inbuilt M mode 2D and color Doppler. It was the study sample is 3,600 cases and it was done for two years. The analysis of the data was correlated compared and evaluated under the guidance from the department of statistics. Coming to my observations and results, a total of 3,600 pregnant women were included in the study out of which 51 cases of fetal CHDs were detected based on abnormal fetal cardiac scan. The incidence of prenatally diagnosed CHD in our study was 14.2 per thousand fetuses. This is a table of proportion of patients with single and multiple cardiac abnormalities. Out of the 51 patients with fetal CHDs, 39 patients had single cardiac abnormality and 12 patients had complex that is more than one cardiac abnormality. This is a spectrum of fetal CHDs that we could see in the present study with a TTOF at frequency of 8 that is whooping 11.94 percent. We came across a wide spectrum of fetal CHDs namely tetralogy of phallid, AVSD, hyperplastic left heart syndrome, persistent left superior venacea, pulmonary stenosis, double outlet tritotracheal, pulmonary atresia with intact ventricular septum, common arterial trunk, transposition of great arteries, isolated ventricular septal defect and a few more. This is a spectrum and percentages of these in our present study. We also saw the association of CHDs with extra cardiac abnormalities. Out of 51 cases, 13 cases were associated with ECAs of which cytos abnormalities were the most common that is 38.46 percent followed by renal abnormalities. Association of congenital heart disease with extra cardiac anomalies was found to be statistically significant. These are the outcomes of fetuses with CHDs. Out of 51 cases, 7 were undelivered, abortion was induced in 29, there were live births with no symptoms in 9 cases, there was spontaneous abortion in 1 and infantile deaths were seen in 5 cases. Among 51 cases, pregnancy was terminated in total of 29 cases which was statistically significant. 14 cases were delivered as live births of which 5 cases died in the infantile period and 9 cases are alive and without symptoms. Out of the 14 live births, the 9 cases which are alive are 4 cases of persistent left superior venacheva, 2 cases of aberrant right subclavian artery, 1 case of TOF, 1 case of aortic coctation, 1 case of muscular VSD. Spontaneous intrauterine death occurred only in 1 case with diagnosis of ectopia cortis. These are my representative cases. This is a 20 year old female, a primae patient, we could see a lobulated almost completely solid lesion arising from the right atrium with gross pericardial effusion. The lesion measured 20 by 10 mm based on the location of the probable diagnosis of pericardial teratoma was given which was confirmed postnatal. An axial sonogram of the fetal thorax reveals heterogeneous hyperequic lesion, this one adjacent to the right atrium with gross pericardial effusion. Case 2, we could see an anterior thoracic wall defect, anterior thoracic wall defect with heart lying outside the thoracic cavity suggesting ectopia cortis. No other abnormalities were found. This is my case number 3 with septum primum atrial septal defect and ventricular septal defect were noted with common atrioventricular valve and no crux. The findings suggest endocardial cushion defect also known as AVST. In this case, the great vessels were noted arising from predominantly right ventricle. Aorta was placed right lateral to pulmonary artery and pulmonary artery caliber was small with raised peak systolic velocity. Considering the ultrasound findings, the diagnosis of double outlet right ventricle with pulmonary stenosis was given. This is my case number 5, perimembranous VSG with overriding aorta was noted, pulmonary trunk was narrower than aorta with raised peak systolic velocity. The findings represent tetralogy of phallus. This is my case number 6, the left ventricle was hypoplastic and hypo-contractile with echogenic walls, mitral wall was dysplastic, aortic wall was atritic with no flow across it. Ascending aorta and aortic arch was small in size with dilated pulmonary artery. All these findings together represent hypoplastic left heart syndrome. This is my case number 7, where we could see a thickened and ecogenic tricuspid wall with no flow across it. Perimembranous ventricular septal defect was also noted. Antigrid flow was noted in both ductile arches and pulmonary arteries. Mitral flow was increased, however, no mitral recurgitation was noted. The constellation of findings suggested tricuspid atresia with ventricular septal defect. This is my case number 8, where we could see the enlargement of right atrium with tricuspid wall leaflet attached to the interventricular septum. Tricuspid wall was dysplastic and there was associated pulmonary stenosis. The findings suggested epsin anomaly. Fetal heart is a difficult organ to examine on ultrasound. In our study, the positive rate of mid-trimester anomaly scan was 14.2 per thousand fetuses. The positive rate of CHD ultrasound screening was 14.6 per thousand fetuses in a previous study. The frequency of various abnormalities is slightly different from reported by previous studies since almost half of the study period was affected by COVID-19 pandemic. Moreover, our hospital is a tertiary referral center for prenatal diagnosis and termination. Considering these factors, most cases referred here are complex cardiac anomalies and not minor CHDs. Fetal CHD includes a wide range of anomalies with varying degrees of severity, many at times associated with extra cardiac malformations, which may occur as a part of certain syndromes. Cases of fetal CHD should be rigorously evaluated to exclude extra cardiac abnormalities. These are the list of extra cardiac anomalies that we saw, which was Cytus ambiguous, heterotaxia syndrome, multi-cystic dysplastic kidney, single umbilical artery, polycystic kidneys, Cytus inversus, semi-loba, oliprosencephaly, dandy worker malformation, renal urgenesis. Coming to the conclusion, ultrasound is useful in diagnosis of fetal congenital heart disease in the routine mid-trimester anomaly scan. The incorporation of multiple cardiac views into the mid-trimester ultrasound scan may improve the sensitivity as well as accuracy of diagnosis of fetal CHDs, which would provide parents with more information and facilitate appropriate prenatal counseling and decision-making. The ability and experience of the sonologist's maternal body fluid built, fetal activity and fetal position are the factors that influence adequate visualization of the fetal cardiac anatomy. In cases where the fetus is in a suboptimal position, adequate views of the heart may not be obtained during the initial examination. The patient should be recalled at another time when the fetus may be in a better position permitting better visualization. These are my references. Thank you.