Fetal congestive heart failure (CHF) is a rare but serious condition that may result in intrauterine demise or neonatal death. One of the earliest contributors to this field, Dr. J.C. Huhta, developed the Cardiovascular Profile Score (CVPS), which has been widely adopted by obstetricians to assess fetal well-being, particularly in cases with ascites. This review presents several key scientific statements from the American Heart Association (AHA), the American Society of Echocardiography (ASE), and the American College of Cardiology (ACC), among others. The literature on fetal CHF remains limited, underscoring its rarity. Despite advances in functional fetal heart assessment and various pharmacological approaches, there are currently no reports detailing the identification of the pre-hydropic stage, the full course of fetal CHF progression, or successful pharmacologic reversal. The review summarises the aetiology, pathophysiology, and both pharmacological and non-pharmacological treatment attempts for fetal CHF. Artificial intelligence (AI) (Open Evidence tools) supported the literature review process by providing concise answers to targeted queries, thereby accelerating manuscript preparation. Selected clinical images and cine loops were retrieved from our institutional database, Tricefy4. Separate from manuscript-preparation support, this review now addresses clinical AI as an intelligent assistant during fetal cardiac ultrasound, with potential roles in standard-plane acquisition, automated measurements, Doppler/rhythm analysis, documentation quality control, and CHF risk stratification.