Objective To explore the diagnostic value of prenatal echocardiographic in Tetralogy of Fallot (TOF) with pulmonary stenosis (TOF/PS),TOF with pulmonary atresia (TOF/PA) and TOF with absence of pulmonary valve(TOF/PV-AB). Methods The data of 33 fetuses diagnosed as tetralogy of fallot were analyzed retrospectively. The results of prenatal echocardiography were compared with postpartum echocardiography and pathological anatomy after induction of labor. Results Among the 33 cases of fetal TOF, there were 22 cases of TOF/PS, 7 cases of TOF/PA, and 4 cases of TOF/PV-AB.All three sonography had the characteristics of subaortic ventricular septal defect (VSD) and the aortic root straddling the interventricular septum (IVS),the difference lies in the development of the pulmonary artery. On the basis of four-chamber view (4CV) and ventricular outflow tract section (VOT), three-vessel section (3VT) and aortic root short-axis section (AR-SAV), the diagnostic rate of fetal TOF (96.97%) were significantly higher than that of 4CV+ VOTV +3VT (90.90%), 4CV+3VT(84.85%), 4CV+ VOTV (72.73%), 4CV+ AR-SAV (63.64%), and 4CV (33.33%) (P <0.05). Conclusion Fetal TOF have their echocardiographic features. The observation of pulmonary artery development is beneficial to the judgment of fetal TOF classification.Combined application of different sections helps to improve the accuracy of TOF prenatal diagnosis, which is expected to provide important clinical basis for prognosis evaluation and effective intervention after birth.