Antenatal diagnosis and treatment are well established. The unborn baby with an anomaly is a patient who requires assessment and potential prenatal intervention. Congenital anomalies now surpass prematurity as the leading cause of perinatal morbidity and mortality but still are rare. The unique needs of abnormal fetuses and their families are best served in specialized centers with focused expertise and extensive clinical experience. This article details the essential components of a center for fetal diagnosis and treatment and describes some of the lessons learned based on our experience at The Children’s Hospital of Philadelphia (CHOP).