Fetal echocardiography began in the late 1970’s with the development of ultrasound imaging and has progressed to be able to make the diagnosis of many forms of structural and functional congenital heart disease. Coupled with the pulsed and color Doppler technique, echocardiography has made advances in determining the prognosis of individual fetuses in utero. The assessment of fetal cardiac function in fetuses continues to evolve including many markers of poor prognosis in the fetus. A tool for this clinical diagnosis is the Cardiovascular Profile Score. This score has become the “heart failure score” and combines echo markers of fetal cardiovascular functional deficits that have been correlated with perinatal mortality. The goal of this score is to detect signs of heart failure before they progress to non-immune-hydrops fetalis. The fetus with hydrops from noncardiac causes may improve spontaneously, or progress to develop heart failure and the score can be used in the early assessment of this fetal clinical picture development. This chapter presents the CVP score for use in fetuses who appear to have heart failure.