Fetal imaging is integral to the past, present, and future of fetal intervention. In the early history of fetal intervention, the role of prenatal ultrasound was primarily to identify a fetal lesion, provide a correct anatomic diagnosis, and exclude other anatomic defects. We now depend on ultrasound, and other imaging studies, not only to provide anatomic information, but to provide prognostic, physiologic and functional information prior to, during, and after surgery for optimal selection and management of fetal surgery patients. In the future improvements in imaging and non-invasive technology will drive further expansion of indications and therapeutic options for fetal intervention.