The introduction of three-dimensional ultrasound (3D US) technology has transformed prenatal care. The application of 3D ultrasound was primarily explored in the second trimester of pregnancy, where it significantly improved the assessment of fetal anatomy and the diagnosis of congenital anomalies. Over time, technological advancements and increased clinical expertise have extended the use of 3D ultrasound into the first trimester, marking a significant leap forward in early prenatal diagnosis and care. This innovative imaging technique provides a comprehensive and detailed visualization of the early anatomic structures, offering substantial advantages over traditional two-dimensional (2D) ultrasound also in terms of early detection and management of potential anomalies. This chapter delves into current research and clinical practices, exploring the technical aspects, clinical applications, and benefits of 3D ultrasound in the first trimester of pregnancy.