Foetal echocardiography has become an established subspecialty in paediatric cardiology. The skills to perform detailed assessment of foetal cardiac anomalies in a tiny, moving foetus surrounded by sometimes challenging layers of maternal tissue are not easy to obtain, and require prolonged periods of specific training and supervised scanning in expert centres. The goal of this overview is to discuss the importance of the awareness of the fact that expert examination of the foetal heart and in-depth knowledge of newborn surgical interventions are only a part of the picture; many cardiac abnormal foetuses do not just have an isolated cardiac defect. The extracardiac malformations, when present, play a major role in determining the treatment and prognosis. The challenge of providing optimal prenatal care to the pregnant woman, who remains the primary patient at least until the umbilical cord is cut, carrying a foetus with a cardiac malformation is to organise rapid, effective, and complete evaluation of all possible foetal anomalies in a multidisciplinary team approach, followed by clear and honest non-directive counselling on all possible options. Only then, with the maximum involvement of the parents, decisions on perinatal management can be taken by the team. Controversies do exist in view of various obstetric, paediatric, and other specialists on how to best organise this multidisciplinary care programme. In this paper, we provide a practical, logical, and efficient path of care for the pregnant woman suspected to carry a foetus with a heart defect.