Objective To discuss the prenatal MRI features and the fetal outcomes of meconium peritonitis (MP).Methods The clinical data of 23 cases with MP were collected.The prenatal MRI features and fetal outcomes were analyzed retrospectively.Results Prenatal MRI features included meconium peritonitis pseudo-cyst (9/23,39.1%),fetal ascites (23/23,100.0%),bowel dilatation (9/23,39.1%), meconium leakage (3/23,13.0%),scrotal effusion (2/23,8.7%)and polyhydramnios (2/23,8.7%).Of the 23 fetuses,2 were induced and 2 1 were delivered.In 2 1 neonates,7 cases received surgical treatment,1 3 cases received conservative treatment and 1 case was dead due to treatment refusal of the family.Neonates with bowel dilatation and meconium leakage all underwent surgery,neonates with meconium peritonitis pseudo-cyst and fetal ascites underwent conservative treatment,and the rate of operation was 100%,100%,22.2% and 35.0%,respectively. Conclusion Prenatal MRI findings of MP are characteristic.Bowel dilatation,meconium leakage,growing meconium peritonitis pseudo-cyst and meconium peritonitis pseudo-cyst connectted with adjacent intestine are highly suggestive of early surgical intervention in neonate.