Ultrasonography has been used for decades as a reliable diagnostic tool to detect fetal anomalies. Aside from technological improvements, image quality has become significantly better. The latest form of fetal ultrasonography is four-dimensional (4D) ultrasound that provides real-time imaging capabilities with impressive image quality. As 4D ultrasonography is becoming widely used in the perinatal screening of fetal anomalies and detection of fetal behavior, the debate of this device’s accuracy is still ongoing.One key factor that determines the accuracy of 4D ultrasonography in assessing fetal behavior is the experience of the user in fields of fetal anomalies and the associated behavioral characteristics. This paper will tackle the topic of 4D ultrasound accuracy in detecting fetal behavior and screening for underlying pathologies. Keywords: fetal behavior, fetal anomaly, 4D ultrasonography DOI: 10.7176/JHMN/80-02 Publication date: September 30 th 2020