Fetal magnetic resonance imaging (MRI) has become an important adjuvant to high-quality ultrasound once fetal structural anomaly is identified. There are recently developed advanced techniques such as provision of volumetric data, spectroscopy, and functional MRI. Changes in local susceptibility caused by blood breakdown products, echo-planar imaging (EPI) sequences [i.e., diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC)] are especially sensitive to hemorrhage and edema. These novel sequences are particularly useful for assessment of fetal ischemic and hemorrhagic brain lesions. Prenatal MRI has been increasingly adopted in assessment and follow-up after in utero surgeries of twin–twin transfusion syndrome, congenital diaphragmatic hernia, lower urinary tract obstruction, and myelomeningocele. Development of guidelines to better define the role of fetal MRI in relation to prenatal diagnostic ultrasound can reduce the variation of sequence protocols, magnetic field intensity, as well as the use of gadolinium performed in different centers. Novel sequences may be used for research purposes, but safety concerns of obstetric MRI cannot be overlooked. The current utilities and future prospects of MRI in perinatal medicine are updated in this article.