Advanced fetal diagnosis with real-time, high resolution ultrasound and fetal therapy with fetoscopic surgery represent the state-of-the-art in the subspecialty of fetal medicine. They allow accurate diagnosis of the fetal condition, multidisciplinary support for management, and in utero treatment, thereby significantly reducing perinatal mortality and morbidity. Such expertise is only available in a small number of advanced fetal medicine centres. We have used telemedicine for tertiary real-time fetal ultrasound consultation and shown not only that it is technically feasible, but that it is welcomed by the clinicians and patients involved. We have also used telemedicine for educational purposes, linking with an advanced fetoscopic centre on another continent to shorten our learning curve for this new form of fetal treatment. With the increasing availability of broadband communication, telemedicine should become an important tool in both clinical practice and education, and enable communities living anywhere in the world to benefit from fetal medicine.