Prenatal diagnosis of bladder exstrophy-epispadias complex (BEEC) is possible via ultrasound and promotes optimal care of affected infants through improved parental counseling, timely referral to pediatric subspecialists, and parental preparation for a neonate that will require complex care. It also allows delivery to occur in specialized centers with experienced multidisciplinary teams. When BEEC is suspected, a detailed anatomic survey should focus not only on the fetal pelvis, bladder, genitalia, and anus/rectum but should also fully evaluate the spine, brain, limbs, kidneys, and abdominal wall due to the presence of associated anomalies in the most severe cases. Ultrafast fetal magnetic resonance imaging can aid ultrasound in differentiating complex anatomical differences and can provide lung volumes in cases with large abdominal wall defects. Prenatal diagnosis of BEEC does not typically alter obstetric management or delivery timing. Serial growth scans with routine obstetric care are recommended. Evaluation of the amniotic fluid and fetal kidneys is warranted, although they remain normal in the majority of cases. Delivery at term is recommended to facilitate postnatal evaluation and management.