Background: The fetal ductus venosus (DV) is an important vessel that connects the umbilical vein (UV) to the proximal end of the inferior vena cava (IVC). DV abnormality often leads to poor fetal outcome. Thus, careful prenatal ultrasound for the diagnosis of DV abnormality is of major clinical significance. Methods: We conducted a retrospective analysis of 166 cases diagnosed with DV abnormality by prenatal ultrasonography. The type of DV abnormality, aberrant DV connection, and combination with intra- and extra-cardiac malformations were evaluated, together with pregnancy outcomes and chromosomal anomalies. Results: Prenatal ultrasound screening revealed that 137 of the 166 fetal cases with DV abnormality showed an absence of ductus venosus (ADV) accompanied by aberrant drainage of the UV (119 cases with intrahepatic shunt of the UV and 18 cases were extrahepatic shunt of the UV). Another 27 cases showed aberrant DV connections (9 cases with intrahepatic shunt of the UV and 18 cases with extrahepatic shunt of the UV). In addition, one case showed DV bifurcation accompanied by extrahepatic shunt of the UV, and one case showed DV atresia accompanied by intrahepatic shunt of the UV. Moreover, 72 cases were also diagnosed with intra- or extra-cardiac malformations. A total of 105 fetuses were born, including 79 with ADV, 24 with aberrant DV connection, 1 with DV bifurcation, and 1 with DV atresia. These were followed up for an average period of 12 months (range 1 to 24 months). Liver-function tests and cardiac ultrasound were performed postpartum. Pregnancy was terminated in 61 cases due to severe fetal deformities, which were confirmed by pathological anatomy after abortion. Only 28 cases underwent chromosomal examination, of which one case was diagnosed with trisomy 21 and another with trisomy 18. Conclusions: Prenatal ultrasound can clearly show fetal DV abnormalities and aberrant connections, as well as associated intra- and extra-cardiac malformations. This procedure can therefore provide comprehensive support for the diagnosis of fetal DV abnormality. Careful attention should thus be paid during prenatal ultrasound examination in order to obtain valuable information for prenatal consultation and subsequent procedures and care.