Ultrasonography in pregnancy is one of the most important advances in antenatal and obstetric emergency care. The benefits of diagnostic ultrasound in a resource-poor setting are well known and undisputed. Routine ultrasound can provide real benefit to patients when it is included in antenatal care programmes designed to improve maternal and neonatal health, and it should become a standard procedure in developing countries. Proper training of the antenatal ultrasound imager is very important. This should include training in ethics, use and misuse of ultrasonography as well as good technique and understanding of implications for clinical care to improve sensitivity. Training should be aimed not only at doctors but also at midwives who conduct most of the antenatal care and skilled deliveries in developing countries. Communication with patients and information about the limitations and benefits of ultrasound are essential to alleviate fear and to discourage irrational expectation and demand. Finally, routine antenatal ultrasound should be monitored closely for possible misuse, such as sex screening and selective abortion of normal female fetuses, and non-indicated overuse by health-care professionals for their own financial benefits.