Objective To apply combined tissue Doppler imaging and spatio-temporal image correlation to evaluate fetal cardiac function in pregnant women with preeclampsia in late pregnancy with the aim of detecting whether the systolic, diastolic and overall function of the fetal heart is impaired by prolonged exposure of the fetus to a hypertensive intrauterine environment. Methods A combined tissue Doppler imaging (TDI) and spatio-temporal image correlation (STIC) was applied to evaluate the continuous fetal cardiac function in 115 pregnant women with normal pregnancy and 121 pregnant women with PE in late pregnancy (including 61 pregnant women with MPE and 60 pregnant women with SPE) according to three time periods from 28 to 31+6 w, 32 to 35+6 w, and 36 to 40 w of gestation. Result In the three gestational week time periods in late pregnancy, the Sa and Ea/Aa of the mitral and tricuspid annulus in both SPE and MPE groups were smaller than those in the normal pregnancy group (P<0.05), and there was no statistical difference between the two PE groups; in the three gestational week time periods in late pregnancy, the LV-Tei in both SPE and MPE groups was larger than that in the normal pregnancy group (P<0.05), and between the two PE groups in 36-40 w of gestation, the SPE group was larger than that in the MPE group (P<0.05); in the three gestational weeks of late pregnancy, RV-Tei was greater in both PE groups than in the normal pregnancy group, and in the SPE group than in the MPE group (P<0.05); in the three gestational weeks of late pregnancy, LVSF and RVSF were smaller in both SPE and MPE groups than in the normal pregnancy group (P<0.05), and between the PE groups, in the 36-40 w gestation, the SPE group was smaller than the MPE group (P<0.05). Conclusion The TDI combined with STIC-M technique revealed that the systolic, diastolic and overall cardiac functions of fetuses in the two groups of SPE and MPE were reduced in late pregnancy, mainly manifested by the reduction of left and right cardiac function indices Ea/Aa, Sa, SF and the increase of Tei index. The higher the maternal blood pressure and the changes in fetal cardiac function, the greater the maternal blood pressure and the greater the exposure of the fetus to the hypertensive intrauterine environment, the greater the impact on cardiac function.