South Africa has conducted antenatal care HIV and syphilis sentinel surveillance (ANCHSS) surveys among pregnant women attending antenatal care (ANC) services since 1990. ANCHSS surveys have been an important component of HIV surveillance in the country. The main aim of the annual–biennial surveys was to estimate HIV prevalence by age and location (province and district) over time and to generate input data for models generating national HIV prevalence and incidence estimates. To address ethical and cost considerations, there have been calls to use routine ANC and vertical transmission prevention data for HIV surveillance among pregnant women. We reviewed ANCHSS reports and relevant literature to describe objectives of past surveys and methodological changes to the surveys over the years as well as limitations and challenges in implementing the surveys. We discuss opportunities for use of routine data for HIV surveillance among pregnant women within the sentinel survey sites and beyond.