Objective — to assess the role of magnetic resonance imaging in investigating the characteristics of central nervous system (CNS) changes in a fetus with hemolytic disease due to Rh incompatibility in the treatment with intrauterine blood transfusion. Subject and methods. The investigation enrolled 45 pregnant women with Rh incompatibility and their 45 newborn infants. A study group included 30 pregnant women (mean gestational age, 32.1 weeks) with hemolytic disease of the fetus, who had undergone intrauterine intravascular blood transfusion, and their 30 newborns with hemolytic disease. In this group, magnetic resonance imaging was performed to comparatively study the fetal CNS according to a specialized protocol prior to intrauterine fetal blood transfusion and delivery. A comparison group consisted of 15 pregnant women (mean gestational age, 38.6 weeks) with no signs of hemolytic disease and their newborns matched with those in the study group for gestational age, who had been examined using magnetic resonance imaging for other reasons (comorbidities during pregnancy). Results. Comparing the obtained changes in the fetal central nervous system in the study group with those in the comparison group before the first intrauterine blood transfusion revealed significantly more focal changes in the brain substance of fetuses with hemolytic disease. When applying the specialized magnetic resonance imaging protocol based on the modified diffusion-weighted image (DWI) pulse sequence, the frequency of focal changes made it possible to assess the dynamics of the process and to rule out false positive results due to the inclusion of DWI. No focal changes in the brain substance were detected in the comparison group matched with the study group for gestational age. Conclusion. The application of DWI pulse sequence makes it possible to rule out false positive results, to identify new foci of cerebral circulation disorders, and to optimize prognosis in severe forms of hemolytic disease of the fetus and newborn.