Purpose To explore the impactors of pregnancy outcomes of fetal heart defects and evaluate the influence of a multidisciplinary team cooperation approach. Methods A retrospective study of fetal cardiac defects diagnosed at our institution from January 2012 to June 2021 was carried out. Clinical data, including types of cardiac malformations, accompanying defects, genetic results, and pregnancy outcomes were analyzed. Results Among 400 fetuses, 122 belonged to group A (single heart defect without extracardiac defect), 115 in group B (single heart defect with extracardiac abnormalities), 100 in group C (multiple cardiac defects without extracardiac abnormalities), and 63 belonged to group D (multiple cardiac defects with extracardiac abnormalities). The termination rate in the four groups was 44.26%, 86.09%, 70%, and 82.54%, respectively (P<0.05). Multiple logistics regression analysis revealed that co-existence of extracardiac defects (OR 7.347, CI 3.674,14.694), with pathogenic genetic anomalies (OR 7.493, CI 2.051,27.372), higher prognosis grades (OR 6.307, CI 3.943,10.088) and diagnosed in later gestational age (OR 0.819, CI 0.753, 0.890)were significantly associated with the termination of pregnancy. The MDT group had a significantly lower rate of pregnancy termination, particularly in groups C and D (p<0.001). Conclusion It is important to process comprehensive cardiac and extracardiac ultrasound assessment and further genetic testing of fetal cardiac defects. Diagnosed gestational age, the severity of heart lesions, combined with extracardiac abnormalities, and identified pathogenic genetic abnormalities influence pregnancy outcomes. Multidisciplinary team cooperation is an effective approach and should be applied in fetal cardiac defects management to reduce unnecessary termination of pregnancy.