The article presents guidelines for fetal echocardiography developed by the Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG) using the GRADE methodology. The guidelines recommend referring cases with suspected heart anomalies or high-risk pregnant women for fetal echocardiography. The recommendations are based on a systematic review of guidelines and systematic reviews, and the evidence supports the use of fetal echocardiography in pregnant women with significant maternal or fetal risk factors for congenital heart disease (CHD). The document provides specific indications for when fetal echocardiography should be performed during pregnancy, including maternal, familial, and fetal risk factors. The recommendations are intended to be a useful tool for healthcare professionals and decision-makers, but should be considered in the context of local and national policies. [Extracted from the article]