MODERN ASPECTS OF PLACENTAL DYSFUNCTION: A LITERATURE REVIEW

Анотація

Placental dysfunction (PD) is one of the most common and serious complications of pregnancy, characterized by impaired placental function and inadequate delivery of oxygen and nutrients to the fetus. This condition occupies a leading position among the causes of perinatal morbidity and mortality, as it is associated with fetal growth restriction, chronic hypoxia, fetal distress, preterm birth, and a high risk of neonatal complications. The incidence of placental dysfunction significantly increases in the presence of preeclampsia, arterial hypertension, anemia, endocrine disorders, infectious diseases, and maternal extragenital pathology.

The development of PD is primarily based on impaired placentation, inadequate trophoblast invasion, alterations in uteroplacental blood flow, endothelial dysfunction, and oxidative stress. As a result, placental ischemia develops, leading to impaired transport of oxygen and nutrients as well as disruption of the endocrine function of the placenta. Decompensated forms of PD are particularly dangerous, as they may result in intrauterine fetal death and severe disturbances in postnatal adaptation.

Current approaches to the diagnosis of PD are based on a comprehensive assessment of the mother-placenta-fetus unit. The most informative diagnostic methods include ultrasound fetometry, Doppler assessment of uteroplacental and fetal blood flow, cardiotocography, and the evaluation of biochemical markers of placental dysfunction. Early detection of hemodynamic abnormalities enables prediction of pregnancy complications and facilitates the selection of optimal management strategies.

Modern management of pregnant women with PD includes careful fetal surveillance, correction of associated maternal disorders, prevention of thrombotic and hemodynamic disturbances, and an individualized approach to determining the timing of delivery. Early diagnosis and appropriate treatment contribute to reducing severe perinatal outcomes and improving both maternal and neonatal prognosis.

References:

1.    Kyllo, H. M., Wang, D., Lorca, R. A., Julian, C. G., Moore, L. G., Wilkening, R. B., Rozance, P. J., Brown, L. D., & Wesolowski, S. R. (2023). Adaptive responses in uteroplacental metabolism and fetoplacental nutrient shuttling and sensing during placental insufficiency. American journal of physiology. Endocrinology and metabolism, 324(6), E556–E568. https://doi.org/10.1152/ajpendo.00046.2023   

2.    Toledano, J. M., Puche-Juarez, M., Galvez-Navas, J. M., Moreno-Fernandez, J., Diaz-Castro, J., & Ochoa, J. J. (2024). Pregnancy Disorders: A Potential Role for Mitochondrial Altered Homeostasis. Antioxidants (Basel, Switzerland), 13(8), 979. https://doi.org/10.3390/antiox13080979

3.    Ino, H., Negishi, Y., Horii, Y., Koike, E., Flavell, R. A., Suzuki, S., & Morita, R. (2026). IL-18 produced by pregnant uterus promotes essential inflammatory responses and fetoplacental growth. Cell reports, 45(1), 116865. https://doi.org/10.1016/j.celrep.2025.116865

4.    van Kammen, C. M., van Woudenberg, S. J., Schiffelers, R., Terstappen, F., & Lely, A. T. (2023). Nanomedicines: An approach to treat placental insufficiency and the current challenges. Journal of controlled release: official journal of the Controlled Release Society, 360, 57–68. https://doi.org/10.1016/j.jconrel.2023.06.003

5.    Ichinose, M., Iriyama, T., & Hirota, Y. (2026). Placental Insufficiency and Neonatal Vulnerability: Organ-Specific Mechanisms Shaping Early-Life Health. The journal of obstetrics and gynaecology research, 52(2), e70202. https://doi.org/10.1111/jog.70202

6.    Kleuskens, D. G., Van Veen, C. M. C., Groenendaal, F., Ganzevoort, W., Gordijn, S. J., Van Rijn, B. B., Lely, A. T., Schuit, E., & Kooiman, J. (2023). Prediction of fetal and neonatal outcomes after preterm manifestations of placental insufficiency: systematic review of prediction models. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 62(5), 644–652. https://doi.org/10.1002/uog.26245

7.    Rizzo, G., Mappa, I., Bitsadze, V., Słodki, M., Khizroeva, J., Makatsariya, A., & D'Antonio, F. (2020). Role of Doppler ultrasound at time of diagnosis of late-onset fetal growth restriction in predicting adverse perinatal outcome: prospective cohort study. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 55(6), 793–798. https://doi.org/10.1002/uog.20406

8.    Ashwal, E., Ferreira, F., Mei-Dan, E., Aviram, A., Sherman, C., Zaltz, A., Kingdom, J., & Melamed, N. (2022). The accuracy of Fetoplacental Doppler in distinguishing between growth restricted and constitutionally small fetuses. Placenta, 120, 40–48. https://doi.org/10.1016/j.placenta.2022.02.007

9.    Phaloprakarn, C., Jenkumwong, P., Suthasmalee, S., Chavanisakun, C., & Tangjitgamol, S. (2025). Umbilical venous blood flow and its association with placental pathology in pregnancies complicated by gestational diabetes mellitus. Acta obstetricia et gynecologica Scandinavica, 104(12), 2244–2253. https://doi.org/10.1111/aogs.70073

10.Chandraharan, E., Pereira, S., Ghi, T., Gracia Perez-Bonfils, A., Fieni, S., Jia, Y. J., Griffiths, K., Sukumaran, S., Ingram, C., Reeves, K., Bolten, M., Loser, K., Carreras, E., Suy, A., Garcia-Ruiz, I., Galli, L., & Zaima, A. (2024). International expert consensus statement on physiological interpretation of cardiotocograph (CTG): First revision (2024). European journal of obstetrics, gynecology, and reproductive biology, 302, 346–355. https://doi.org/10.1016/j.ejogrb.2024.09.034

11.Innocenti, F., Scaramuzzo, R. T., Lunardi, F., Tosto, S., Pascarella, F., Calvani, M., Pini, A., & Filippi, L. (2025). Placental and Fetal Metabolic Reprogramming in Pregnancies with Intrauterine Growth Restriction. Reproductive sciences (Thousand Oaks, Calif.), 32(2), 502–513. https://doi.org/10.1007/s43032-024-01764-9

12.Kostka, L., Ježová, M., Mikulenková, Z., Jouzová, A., & Hruban, L. (2025). Placental insufficiency and late-onset growth restriction in fetuses appropriate for gestational age. Placentární insuficience a pozdní růstová restrikce ve skupině plodů s adekvátní velikostí pro dané gestační stáří. Ceska gynekologie, 90(5), 398–406. https://doi.org/10.48095/cccg2025398

13.Davenport, B. N., Wilson, R. L., & Jones, H. N. (2022). Interventions for placental insufficiency and fetal growth restriction. Placenta, 125, 4–9. https://doi.org/10.1016/j.placenta.2022.03.127

14.Majumder, S., Moriarty, K. L., Lee, Y., & Crombleholme, T. M. (2024). Placental Gene Therapy for Fetal Growth Restriction and Preeclampsia: Preclinical Studies and Prospects for Clinical Application. Journal of clinical medicine, 13(18), 5647. https://doi.org/10.3390/jcm13185647

15.Cruz-Lemini, M., Vázquez, J. C., Ullmo, J., & Llurba, E. (2022). Low-molecular-weight heparin for prevention of preeclampsia and other placenta-mediated complications: a systematic review and meta-analysis. American journal of obstetrics and gynecology, 226(2S), S1126–S1144.e17. https://doi.org/10.1016/j.ajog.2020.11.006

16.Allard, M., Grosch, S., Jouret, F., Masson, V., Surinder, T., & Masset, C. (2024). Prévention de la prééclampsie et de ses complications [Prevention of preeclampsia and its complications]. Revue medicale de Liege, 79(5-6), 448–454.