Objectives: To evaluate the diagnostic and prognostic value of histophenotyping of the extracellular matrix of the cervical stroma at cervical intraepithelial neoplasia (CIN). Methods: Retrospective analysis of 160 biopsies and surgical preparations of the cervix in women of reproductive age included cases of CIN 1–3 and the group with confirmed persistence or lesion progression (CIN P) at repeated biopsy. The control group (n = 40) consisted of morphologically intact cervical tissue. Histophenotypes were evaluated by staining with hematoxylin, eosin, and Masson trichrome, and classified as follows: normal (dense parallel bundles of type I collagen), intermediate (disorganized and fragmented type I collagen fibers), and myxoid (amorphous weakly fibrillar matrix). The clinical, viral, and inflammatory characteristics between histophenotypes were statistically compared. Results: The distribution of histophenotypes of the extracellular matrix of the cervix varied significantly depending on the CIN degree (p < 0.001). In the control group, the normal pattern was detected in 97.5% of cases; its frequency decreased from CIN 1 (27.5%) to CIN 2 (12.5%) and was absent at CIN 3. The frequency of the myxoid pattern increased significantly in severe and persistent forms: 55% at CIN 3 and 62.5% at CIN P. Human papillomavirus 16/18 was most frequently detected in groups with intermediate (69.1%) and myxoid (27.2%) patterns. Inflammatory changes were more often accompanied by disorganized extracellular matrix; however, intermediate and myxoid types also occurred in the absence of inflammation. Conclusions: The myxoid histophenotype of the extracellular matrix is significantly associated with the high degree of dysplasia and CIN persistence. It can reflect the morphological equivalent of tumor-associated stroma remodeling. Histophenotyping of the extracellular matrix of the cervix appears to be a promising method of risk stratification and may complement existing diagnostic algorithms for CIN.

Relevance: The placenta plays a crucial role in ensuring normal pregnancy progression by facilitating metabolic exchange, hormonal regulation, and fetal immune protection. Abnormalities in its development and structure are associated with severe perinatal complications, including intrauterine growth restriction (IUGR), congenital malformations (CM), and hypoxic-ischemic encephalopathy (HIE).The study aimed to systematize current knowledge on the stages of placental morphogenesis, modern classifications of placental pathology, and their clinical implications in complicated pregnancies.Materials and Methods: This review analyzed 41 peer-reviewed publications selected from PubMed, Scopus, and eLibrary (2015–2024) using keywords: “placental morphogenesis,” “Amsterdam classification,” “IUGR,” “HIE,” and “villitis.” Inclusion criteria: (1) studies with histopathological data; (2) clear clinical-pathological correlations; (3) adherence to modern classifications (Amsterdam 2021). Exclusion criteria: case reports and pre-2015 literature. PRISMA-guided screening of 78 initially identified records yielded 41 relevant sources.Results: The review outlined six key stages of physiological placental morphogenesis and identified four major pathological patterns: maternal and fetal vascular malperfusion, acute chorioamnionitis, and chronic villitis. Their morphological characteristics, pathogenesis, and clinical correlations with perinatal complications (e.g., IUGR, CM, HIE) have been critically reviewed.Conclusion: Modern classifications of placental pathology and advances in understanding morphogenesis are critical for early diagnosis and prevention of pregnancy complications. Timely identification of histological abnormalities can improve perinatal outcomes and reduce neonatal morbidity and mortality. Further research is needed to refine clinical monitoring protocols and therapeutic strategies.

Актуальность: В статье рассмотрены современные представления о морфофункциональной незрелости плода, встречающейся как у недоношенных, так и у доношенных новорождённых. Проведён сравнительный анализ клинических особенностей, определены основные этиологические факторы, патогенетические механизмы и современные подходы к диагностике и лечению. Особое внимание уделено мультидисциплинарным стратегиям ведения новорождённых с признаками незрелости. Подчёркнута необходимость раннего выявления патологических состояний и комплексной профилактики в системе мать-плацента-плод. Цель исследования – определить особенности формирования и клинического течения морфофункциональной незрелости плода с позиций взаимодействия системы «мать–плацента–плод» для обоснования междисциплинарных подходов к её диагностике и ведению у доношенных и недоношенных новорождённых. Материалы и методы: Проведён литературный обзор по базам e-Library, Google Scholar и PubMed с использованием ключевых слов исследования. Результаты: Выявлены сходные морфологические изменения (дизэмбриогенетические структуры, признаки фетоплацентарной недостаточности, сосудистые аномалии) в плацентах доношенных и недоношенных детей с признаками незрелости. Установлены статистически значимые различия в содержании ряда микроэлементов. На основании анализа литературы обобщены мультидисциплинарные подходы к ведению новорождённых с морфофункциональной незрелостью плода, включающие раннюю неонатальную диагностику, участие акушера-гинеколога, неонатолога и патологоанатома, а также персонализированные стратегии постнатального наблюдения и коррекции метаболических нарушений. Заключение: Полученные данные подтверждают необходимость расширения концепции «морфофункциональной незрелости плода для гестационного возраста» с учётом факторов, выходящих за рамки гестационного возраста, а также внедрения междисциплинарного подхода (акушер-гинеколог, неонатолог, патологоанатом) к диагностике и ведению таких новорождённых. Плацента может служить информативным маркером внутриутробного неблагополучия.

Objectives: to evaluate the diagnostic and prognostic value of histophenotyping of the extracellular matrix of the cervical stroma at cervical intraepithelial neoplasia (CIN). Methods: Retrospective analysis of 160 biopsies and surgical preparations of the cervix in women of reproductive age included cases of CIN 1 – 3 and the group with confirmed persistence or lesion progression (CIN P) at repeated biopsy. The control group (n=40) consisted of morphologically intact cervical tissue. Histophenotypes were evaluated by staining with hematoxylin, eosin and Masson trichrome, and classified as follows: normal (dense parallel bundles of type I collagen), intermediate (disorganized and fragmented type I collagen fibers), and myxoid (amorphous weakly fibrillar matrix). The clinical, viral, and inflammatory characteristics between histophenotypes were statistically compared. Results: The distribution of histophenotypes of the extracellular matrix of the cervix varied significantly depending on the CIN degree (p< 0.001). In the control group, the normal pattern was detected in 97.5% of cases, its frequency decreased from CIN 1 (27.5%) to CIN 2 (12.5%) and was absent at CIN 3. The frequency of the myxoid pattern increased significantly in severe and persistent forms: 55% at CIN 3 and 62.5% at CIN P. Human papillomavirus 16/18 was most frequently detected in groups with intermediate (69.1%) and myxoid (27.2%) patterns. Inflammatory changes were more often accompanied by disorganized extracellular matrix, however, intermediate and myxoid types also occurred in the absence of inflammation. Conclusions: The myxoid histophenotype of the extracellular matrix is significantly associated with the dysplasia high degree of and CIN persistence. It can reflect the morphological equivalent of tumor-associated stroma remodeling and be detected even in the absence of viral persistence or inflammation. Histophenotyping of the extracellular matrix of the cervix appears to be the promising method of risk stratification and may complement existing diagnostic algorithms for CIN.