Desenvolvimento placentário e pré-eclâmpsia: Revisão integrativa de evidências embriológicas, histopatológicas e clínicas

Preeclampsia is a multisystem, heterogeneous, and multifactorial gestational syndrome in which placental dysfunction plays a central role, particularly in early-onset forms. This study aimed to analyze and synthesize scientific evidence on placental development and its relationship with the pathophysiology of preeclampsia, emphasizing embryological, histopathological, molecular, and clinical mechanisms. A descriptive and analytical integrative review was conducted using the PubMed/MEDLINE, Scopus, Web of Science, SciELO, and BVS/LILACS databases. Original studies, systematic reviews, meta-analyses, consensus statements, and clinical guidelines published in Portuguese, English, or Spanish were included. The findings indicated that abnormalities in decidualization, extravillous trophoblast invasion, and spiral artery remodeling may compromise uteroplacental circulation, leading to reduced or unstable perfusion, hypoxia-reoxygenation, oxidative stress, inflammation, and angiogenic imbalance. The main histopathological findings included maternal vascular malperfusion, placental infarction, acute atherosis, distal villous hypoplasia, and accelerated villous maturation. PlGF, sFlt-1, and the sFlt-1/PlGF ratio showed the most consistent clinical evidence, particularly as complementary tools in the assessment of pregnant women with suspected preeclampsia. It is concluded that the disease results from the interaction between placental and maternal factors, with mechanisms varying across phenotypes, reinforcing the need for integrated assessment, timely diagnosis, risk stratification, and individualized maternal-fetal monitoring.