Background Placental infarction can result from the partial or complete obstruction of the uterine spiral artery, interrupting maternal blood flow and causing progressive villus tissue necrosis. This, in turn, can adversely impact placental transport, endocrine signaling, metabolic activity, and immune function, resulting in severe fetal growth restriction, fetal ischemic stroke, and even stillbirth. Prenatal magnetic resonance imaging (MRI) can allow clinicians to evaluate the fetus and the structure of the placenta to detect any morphological changes during pregnancy. The present case highlights the advantages of using MRI to diagnose placental and fetal cerebral ischemic lesions, providing clinical guidance to assist with the appropriate management of placental and fetal abnormalities. Case presentation: A 33-year-old female who was 26 weeks and 4 days pregnant presented with blood pressure that was elevated for 1 week detected during prenatal examination and was hospitalized for moderate preeclampsia and fetal distress. MRI examination in our hospital revealed placental infarction, fetal acute cerebral ischemic stroke, and intrauterine distress. Pathological examination confirmed the diagnosis of placental infarction, and a male stillbirth was induced by drug treatment/ Conclusion MRI scans can allow for the qualitative and quantitative diagnosis of circulatory and central nervous system abnormalities in the context of placental disease, providing guidance to support appropriate clinical decision-making and the termination of pregnancy following fetal ischemic stroke.