Advancing technology of ultrasound imaging has unraveled numerous problems in perinatology. The 1980's is the era of high-resolution real time ultrasonography, enabling the diagnosis of fetal hydrocephaly to be made in midtrimester pregnancy even prior to the age of fetal viability. The findings obtained by full evaluation of hydrocephalic fetuses with serial ultrasounds are helpful in appropriate counseling of parents by the birth defects team and in planning the best time and management of delivery in a perinatal center. Arrest of progression of severe hydrocephaly in the second half of pregnancy prior to fetal lung maturity has been accomplished by intrauterine implantation of ventriculoamniotic shunts. The potential risk of maternal soft tissue injury from delivery of an oversized head of a severely compromised fetus can be minimized by partial and slow decompression of fetal head under ultrasound guidance using a #20 spinal needle. The influence of the recent developments on better fetal diagnosis and survival of infants with neural tube defects in 1981 was compared to that obtained during the previous five years.