PLACENTAL LESIONS RELATED TO MATERNAL VASCULAR MALPERFUSION: A HISTOPATHOLOGICAL REVIEW

Background : The placenta is a dynamic organ essential for fetal and maternal health. Among its pathologies, maternal vascular malperfusion (MVM) represents a major cause of adverse pregnancy outcomes, including preeclampsia, intrauterine growth restriction (IUGR), stillbirth, and preterm birth. Despite its recognized clinical importance, MVM remains insufficiently characterized in terms of pathophysiology, morphology, and clinical translation. Objective : This review synthesizes current knowledge on MVM, integrating histopathological patterns, pathophysiological mechanisms, and clinical correlations. It proposes a lesion-based interpretive framework to guide diagnosis and perinatal management, particularly in resource-limited settings. Key Findings: MVM lesions are closely linked to adverse outcomes, such as intrauterine growth restriction, preeclampsia, stillbirth, and neonatal complications. Each lesion is associated with specific maternal and neonatal indicators, placental features, and suggested postpartum actions. Histopathological protocols and clinical correlations are summarized to guide diagnosis and management. Methods: This narrative review combined a literature analysis with examination of representative placental cases. Databases searched included PubMed, ScienceDirect, and Google Scholar, covering publications from 1995 to 2025, with emphasis on studies applying the Amsterdam Consensus classification of MVM lesions. Search terms included combinations of “maternal vascular malperfusion,” “placental infarction,” “uteroplacental insufficiency,” “villous hypoplasia,” “preeclampsia,” and “IUGR.”. Representative placentas from the Department of Pathology, Ibn Sina University Hospital Center (Rabat, Morocco) were examined using standardized histopathological protocols, formalin fixation, paraffin embedding, microtomy, and hematoxylin–eosin (H&E) staining, in accordance with international guidelines for placental pathology. Conclusion: Early recognition and targeted management of MVM lesions can improve perinatal outcomes. This review provides a structured framework for clinicians to identify, monitor, and intervene in MVM-related complications, supporting preventive strategies and personalized follow-up.