Prenatal ultrasound can aid the clinician in evaluation of the patient with a suspected in utero TORCH infection, particularly toxoplasmosis, syphilis, and CMV. Demonstration of characteristic ultrasound findings in the high risk patient has a high predictive value for fetal infection and also may have prognostic significance. The sonologist should understand the limitations of ultrasound, discuss them with the patient, and document the discussion in the medical record. Patients should be counseled that ultrasound is not a sensitive test for fetal infection and that a normal fetal anatomy survey cannot predict a favorable outcome. In the low-risk patient, fetal infection should be considered when multiple organ system anomalies, fetal growth restriction, placental enlargement, or abnormalities of amniotic fluid volume are demonstrated.