Artificial Uterus, A New Weapon in Prevention Severe Fetal Morbidity: A Systematic Review

Abstract

Background: Severe fetal morbidity, particularly in cases of extreme prematurity and intrauterine growth restriction, remains a critical global health challenge. While advances in neonatal care have improved outcomes, current interventions often fall short for neonates born at the limits of viability. Objective: To systematically review recent advancements in artificial uterus (AU) technology and evaluate its potential in improving survival and reducing morbidity among extremely premature infants. Methods: A structured narrative and literature review was conducted, synthesizing preclinical and clinical studies on AU systems published between 2005 and 2025. Sources included animal model research, early-phase human trials, and multidisciplinary evaluations encompassing technological, biomedical, and ethical perspectives. Relevant databases (PubMed, Scopus, Web of Science) were searched using keywords such as "artificial womb," "ectogenesis," "neonatal care," and "prematurity." Results: Recent studies demonstrate that AU systems, which replicate key intrauterine functions such as oxygenation, nutrient exchange, and waste elimination, significantly improve survival and developmental outcomes in animal models. Reported benefits include reduced incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, and necrotizing enterocolitis. Early-phase human feasibility studies show encouraging safety profiles. Emerging approaches incorporating microbiome integration and regenerative uterine materials offer additional promise. Conclusions: While artificial uterus technology remains in preclinical and early clinical stages, it represents a transformative step in neonatal care. Challenges related to ethics, maternal- fetal bonding, and long-term outcomes persist, requiring robust regulatory and interdisciplinary frameworks. If successfully translated into clinical practice, AUs could extend gestation ex utero, redefine thresholds of viability, and usher in a new era in perinatal medicine.