The development of diagnostic ultrasound has opened the field of invasive ultrasound-guided procedures with a myriad of applications. Developing skills and technique with a phantom will be helpful to gain confidence. The most important aspect of all invasive procedures is experience and teamwork between operator and scanner. Diagnostic amniocentesis was the first ultrasound-guided procedure to be introduced into obstetrics. Following this, additional fetal diagnostic ultrasound-guided procedures have been described, including fetoscopy, Chorionic Villus Sampling, Coelocentesis, Percutaneous umbilical blood sampling, and tissue biopsy. Ultrasound-guided therapeutic procedures have been described for fetal treatment, including therapeutic amniocentesis allows for relief of severe polyhydramnios, amnioinfusion for improvement of the prognosis of some cases of oligohydraminos. Ultrasound-guided Intra uterine fetal transfusion has made possible treatment of fetal anemia and thrombocytopenia. Fetal shunts also described for the management of genitourinary outlet obstruction, progressive hydrocephalus, pleural and peritoneal fluid accumulations. Ultrasound-guided procedures also have been described in the management of some multiple gestations problems as in pregnancy reduction and laser coagulation of placental anastomosis.