The objective of this study was to assess the accuracy of prenatal ultrasonography and to identify patterns of fetal malformations. All fetal and neonatal autopsies over a 3 year period were compared to prenatal sonographic findings and comparisons were made between the results of the two examinations. We identified 133 fetuses and neonates who had both a complete autopsy and a perinatal autopsy. Approximately 87% of autopsy-demonstrated major abnormalities had been detected by prenatal ultrasonography, with 61% of all malformations detected. Some limitations in accuracy of prenatal diagnosis are unavoidable, but strict attention to a thorough fetal examination should improve accuracy. Autopsy examination remains an important component of the evaluation of perinatal losses, especially if dysmorphology is known or suspected.