Background Congenital heart disease (CHD) is the most common congenital disorder at birth. Yagel and colleagues’s method of heart examination has been proved valuable in finding CHD prenatally in single pregnancies. The aim of this study was to detect the accuracy of fetal echocardiography in diagnosing CHD in twin and multiple pregnancies and the sensitivity of the method.Methods: A total of 30 pregnant women with multiple pregnancies were enrolled in this study, including 29 sets of twins and 1 set of triplets. High-risk factors for CHD were considered. Five transverse ultrasound measurements were used for fetal heart examination, including the upper abdomen view, four-chamber view, five-chamber view, pulmonary artery bifurcation view, and three-vessel view. Echocardiography was done to all cases at the age of 3 months after birth. In the fetuses who were diagnosed withCHD postnatally, a close follow-up was conducted by echocardiography within one year after birth.Results: Out of 61 fetuses, 48 only that survived and underwent postnatal examination, 9 cases were born preterms and died while 4 fetuses had abortion. Antenatally, CHD was diagnosed in 5 fetuses, of which 3 were from major congenital anomalies group (4.9%), and 2 from the minor group (3.2%). In 1 pair of the twins, the two fetuses had a different cardiac diseases (1 had small cardiac size and the other had pulmonary insufficiency) and they were conjoined twins. Termination of pregnancy was performed in this set, as permitted by the parents.Another pair had TTTs and one fetus only was affected by Impaired ventricular function and mitral regurge. After birth, heart examinations confirmed the prenatal diagnosis in 2 of the 5, and this was due to death of the affected cases. The diagnosis of CHD was missed antenatally in 9 cases. They all were related to minor cardiac anomaly (ASD, mild PHN, mild pericardial effusion and mild TR).These conditions are usually diagnosed only after birth as they are part of normal fetal physiology, so they were not considered as false negative results. At the age of 1 year echocardiography follow up was done on the affected cases. Only 2 cases were affected with significant ASD and required follow up and the rest were having normal cardiac anatomy. The sensitivity of fetal echocardiography was calculated as 100% in detecting major cardiac disease and 94.8 in detecting minor ones, the specificity was 97.3 %.Conclusions The accuracy of fetal echocardiography in detecting CHD is the same in twins as in single pregnancies. Systemic ultrasound scanning with five transverse views is effective in diagnosing fetal CHD in twin pregnancies.