{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:54:22Z","timestamp":1791561262199,"version":"4.3.4"},"reference-count":66,"publisher":"Walter de Gruyter GmbH","issue":"8","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jpm-2025-0290_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the current state and translational readiness of artificial womb technology (AWT), focusing on its technical feasibility, preclinical validation, and ethical, legal, and clinical implications for perinatal medicine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2025-0290_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an integrative narrative review of the scientific literature from January 2000 to May 2025. Searches were performed in PubMed, Scopus, and Web of Science using terms such as \u201cartificial womb\u201d, \u201cextrauterine fetal incubation\u201d, \u201cartificial placenta\u201d, \u201cpreterm birth\u201d, and \u201cbioethics\u201d. A total of 65 peer-reviewed studies were included, spanning domains of bioengineering, preclinical models, clinical frameworks, and normative analysis. Data were synthesized thematically, with supplemental visual mapping and comparative tables to illustrate platform characteristics and ethical considerations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2025-0290_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Advanced AWT systems, including EXTEND and the Perinatal Life Support (PLS) platform, have demonstrated success in sustaining extremely preterm lambs and goat fetuses, preserving physiological development in fluid-based environments. Key innovations include pumpless oxygenators, modular system architecture, and AI-assisted monitoring. Despite progress, unresolved challenges include umbilical cannulation, sterility, endocrine simulation, and long-term neurodevelopmental outcomes. Ethical tensions surround maternal autonomy, fetal personhood, informed consent, and global equity in access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2025-0290_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Artificial wombs represent a paradigm shift in neonatal care, offering the potential to extend viability and reduce preterm morbidity. As AWT approaches clinical translation, interdisciplinary coordination across medicine, ethics, and law will be essential to guide responsible integration. This analysis provides a foundational roadmap for advancing AWT from preclinical innovation to ethical clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jpm-2025-0290","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T03:56:20Z","timestamp":1760327780000},"page":"1344-1360","source":"Crossref","is-referenced-by-count":0,"title":["Artificial wombs in perinatal medicine: a transformative frontier in neonatal care and bioethics"],"prefix":"10.1515","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9062-8501","authenticated-orcid":false,"given":"Wiku","family":"Andonotopo","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fetomaternal Division , Women Health Center, Ekahospital BSD City , Tangerang , Banten , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1710-3909","authenticated-orcid":false,"given":"Muhammad Adrianes","family":"Bachnas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fetomaternal Division , Medical Faculty of Sebelas Maret University, Dr. Moewardi Hospital , Solo , Surakarta , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Dewantiningrum","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fetomaternal Division , Medical Faculty of Diponegoro University, Dr. Kariadi Hospital , Semarang , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mochammad Besari Adi","family":"Pramono","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fetomaternal Division , Medical Faculty of Diponegoro University, Dr. Kariadi Hospital , Semarang , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernawati","family":"Darmawan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine , Airlangga University, Dr. Soetomo General Hospital , Surabaya , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Ilham Aldika","family":"Akbar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine , Airlangga University, Dr. Soetomo General Hospital , Surabaya , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I Nyoman Hariyasa","family":"Sanjaya","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine , Udayana University, Prof. Dr. I.G.N.G Ngoerah General Hospital , Bali , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dudy","family":"Aldiasnyah","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine , Sumatera Utara University, H. Adam Malik General Hospital , Medan , North Sumatera , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cut Meurah","family":"Yeni","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine , Syiah Kuala University, Dr. Zainoel Abidin General Hospital , Aceh , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuswil","family":"Bernolian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine , Sriwijaya University, Dr. Mohammad Hoesin General Hospital , Palembang , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waskita Ekamaheswara Kasumba","family":"Andanaputra","sequence":"additional","affiliation":[{"name":"Undergraduate Program in Medical Science, Faculty of Medicine , Padjajaran University , Bandung , West Java , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri","family":"Sulistyowati","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fetomaternal Division , Medical Faculty of Sebelas Maret University, Dr. Moewardi Hospital , Solo , Surakarta , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milan","family":"Stanojevic","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Rare Diseases , Medical University of Warsaw , Warsaw , Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asim","family":"Kurjak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Medical School University of Zagreb , Zagreb , Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"2026100915172387619_j_jpm-2025-0290_ref_001","doi-asserted-by":"crossref","unstructured":"Partridge, EA, Davey, MG, Hornick, MA, McGovern, PE, Mejaddam, AY, Vrecenak, JD, et al.. 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Artif Organs 2021;45:35\u201343. https:\/\/doi.org\/10.1111\/aor.13771.","DOI":"10.1111\/aor.13771"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_004","doi-asserted-by":"crossref","unstructured":"van der Hout-van der Jagt, MB, Verweij, EJT, Andriessen, P, de Boode, WP, Bos, AF, Delbressine, FLM, et al.. Interprofessional consensus regarding design requirements for liquid-based perinatal life support (PLS) technology. Front Pediatr 2022;9:793531. https:\/\/doi.org\/10.3389\/fped.2021.793531.","DOI":"10.3389\/fped.2021.793531"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_005","doi-asserted-by":"crossref","unstructured":"Stoll, BJ, Hansen, NI, Bell, EF, Walsh, MC, Carlo, WA, Shankaran, S, et al.. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993\u20132012. 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Artificial womb technology and the frontiers of human reproduction: conceptual differences and potential implications. J Med Ethics 2020;46:784\u20138. https:\/\/doi.org\/10.1136\/medethics-2019-105723.","DOI":"10.1136\/medethics-2019-105723"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_009","doi-asserted-by":"crossref","unstructured":"Cohen, IG. Artificial wombs and abortion rights. Hastings Cent Rep 2017;47. inside back cover https:\/\/doi.org\/10.1002\/hast.730.","DOI":"10.1002\/hast.730"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_010","doi-asserted-by":"crossref","unstructured":"Page, MJ, McKenzie, JE, Bossuyt, PM, Boutron, I, Hoffmann, TC, Mulrow, CD, et al.. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https:\/\/doi.org\/10.1136\/bmj.n71.","DOI":"10.1136\/bmj.n71"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_011","doi-asserted-by":"crossref","unstructured":"Glass, HC, Costarino, AT, Stayer, SA, Brett, CM, Cladis, F, Davis, PJ. Outcomes for extremely premature infants. Anesth Analg 2015;120:1337\u201351. https:\/\/doi.org\/10.1213\/ANE.0000000000000705.","DOI":"10.1213\/ANE.0000000000000705"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_012","doi-asserted-by":"crossref","unstructured":"Bryner, B, Gray, B, Perkins, E, Davis, R, Hoffman, H, Barks, J, et al.. An extracorporeal artificial placenta supports extremely premature lambs for 1 week. J Pediatr Surg 2015;50:44\u20139. https:\/\/doi.org\/10.1016\/j.jpedsurg.2014.10.028.","DOI":"10.1016\/j.jpedsurg.2014.10.028"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_013","doi-asserted-by":"crossref","unstructured":"Smajdor, A. The moral imperative for ectogenesis. Camb Q Healthc Ethics 2007;16:336\u201345. https:\/\/doi.org\/10.1017\/S0963180107070319.","DOI":"10.1017\/S0963180107070405"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_014","doi-asserted-by":"crossref","unstructured":"De Bie, FR, Kim, SD, Bose, SK, Nathanson, P, Partridge, EA, Flake, AW, et al.. Ethics considerations regarding artificial womb technology for the fetonate. Am J Bioeth 2023;23:67\u201378. https:\/\/doi.org\/10.1080\/15265161.2022.2048738.","DOI":"10.1080\/15265161.2022.2048738"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_015","doi-asserted-by":"crossref","unstructured":"R\u00e4s\u00e4nen, J. Regulating abortion after ectogestation. J Med Ethics 2023;49:419\u201322. https:\/\/doi.org\/10.1136\/jme-2022-108174.","DOI":"10.1136\/jme-2022-108174"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_016","doi-asserted-by":"crossref","unstructured":"Bulletti, FM, Sciorio, R, Palagiano, A, Bulletti, C. The artificial uterus: on the way to ectogenesis. Zygote 2023;31:457\u201367. https:\/\/doi.org\/10.1017\/S0967199423000175.","DOI":"10.1017\/S0967199423000175"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_017","doi-asserted-by":"crossref","unstructured":"Ferreira, A. The (un)Ethical womb: the promises and perils of artificial gestation. J bioeth Inq 2022;19:381\u201394. https:\/\/doi.org\/10.1007\/s11673-022-10184-w.","DOI":"10.1007\/s11673-022-10184-w"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_018","doi-asserted-by":"crossref","unstructured":"Flake, AW, De Bie, FR, Munson, DA, Feudtner, C. The artificial placenta and EXTEND technologies: one of these things is not like the other. J Perinatol 2023;43:1343\u20138. https:\/\/doi.org\/10.1038\/s41372-023-01716-2.","DOI":"10.1038\/s41372-023-01716-2"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_019","doi-asserted-by":"crossref","unstructured":"De Bie, FR, Binion, CC, Antiel, RM. Artificial womb technology - a more physiologic solution to treating extreme prematurity. Eur J Obstet Gynecol Reprod Biol X 2024;25:100359. https:\/\/doi.org\/10.1016\/j.eurox.2024.100359.","DOI":"10.1016\/j.eurox.2024.100359"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_020","doi-asserted-by":"crossref","unstructured":"Cavolo, A, de Boer, A, De Proost, L, Verweij, EJ, Gastmans, C. Navigating the ethical landscape of the artificial placenta: a systematic review. Prenat Diagn 2025;45:236\u201346. https:\/\/doi.org\/10.1002\/pd.6711.","DOI":"10.1002\/pd.6711"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_021","doi-asserted-by":"crossref","unstructured":"Hukku, S, Wynn, LL, Foster, AM. I don\u2019t really agree with that: Canadians\u2019 perspectives on the 14-day rule in relation to artificial womb technology. Perspect Sex Reprod Health 2025;57:104\u201313. https:\/\/doi.org\/10.1111\/psrh.70005.","DOI":"10.1111\/psrh.70005"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_022","doi-asserted-by":"crossref","unstructured":"Krendel, A, Ryder, M. Role of science fiction in conceptualising the reproductive future: a linguistic and literary perspective. Med Humanit 2025;51:306\u201315.https:\/\/doi.org\/10.1136\/medhum-2024-013207.","DOI":"10.1136\/medhum-2024-013207"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_023","doi-asserted-by":"crossref","unstructured":"Seetharaman, R. The future of parenthood? Examining the promise and complexity of pregnancy robots in reproductive health. J Med Syst 2025;49:4. https:\/\/doi.org\/10.1007\/s10916-025-02147-6.","DOI":"10.1007\/s10916-025-02147-6"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_024","doi-asserted-by":"crossref","unstructured":"Cao, H, Davey, MG, Young, K, Tian, Z, Kosaka, S, Varela, MF, et al.. Experimental impact of increasing circuit resistance in the artificial womb. Prenat Diagn 2025;45:795\u2013804. https:\/\/doi.org\/10.1002\/pd.6802.","DOI":"10.1002\/pd.6802"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_025","doi-asserted-by":"crossref","unstructured":"Nelson, A, Romanis, EC, Adkins, V, Weis, C, Kuberska, K. Death and the artificial placenta. J Law Biosci 2024;11:lsae013. https:\/\/doi.org\/10.1093\/jlb\/lsae013.","DOI":"10.1093\/jlb\/lsae013"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_026","doi-asserted-by":"crossref","unstructured":"Heyer, J, Schubert, F, Seitz, AL, Steinle, Y, Arens, J, Orlikowsky, T, et al.. A volume-adjustable artificial womb for extremely preterm infants. Transpl Int 2024;37:12947. https:\/\/doi.org\/10.3389\/ti.2024.12947.","DOI":"10.3389\/ti.2024.12947"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_027","doi-asserted-by":"crossref","unstructured":"AlJahsh, MAI. Science and Islamic ethics: navigating artificial womb technology through Quranic principles. Heliyon 2024;10:e36793. https:\/\/doi.org\/10.1016\/j.heliyon.2024.e36793.","DOI":"10.1016\/j.heliyon.2024.e36793"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_028","doi-asserted-by":"crossref","unstructured":"Muhsin, SM, Chin, AHB, Padela, AI. An Ethico-Legal analysis of artificial womb technology and extracorporeal gestation based on Islamic legal maxims. N Bioeth 2024;30:34\u201346. https:\/\/doi.org\/10.1080\/20502877.2023.2269638.","DOI":"10.1080\/20502877.2023.2269638"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_029","doi-asserted-by":"crossref","unstructured":"Cavolo, A, Pizzolato, D. Ethical reflections on organizing the first human trial of artificial womb technologies. Prenat Diagn 2024;44:336\u201342. https:\/\/doi.org\/10.1002\/pd.6521.","DOI":"10.1002\/pd.6521"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_030","doi-asserted-by":"crossref","unstructured":"van Haren, JS, Delbressine, FLM, Schoberer, M, Te Pas, AB, van Laar, JOEH, Oei, SG, et al.. Transferring an extremely premature infant to an extra-uterine life support system: a prospective view on the obstetric procedure. Front Pediatr 2024;12:1360111. https:\/\/doi.org\/10.3389\/fped.2024.1360111.","DOI":"10.3389\/fped.2024.1360111"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_031","doi-asserted-by":"crossref","unstructured":"Hunter, P. Exogestation for treating premature births and congenital diseases : artificial womb technology edges towards first trials in humans. EMBO Rep 2024;25:17\u201320. https:\/\/doi.org\/10.1038\/s44319-023-00022-4.","DOI":"10.1038\/s44319-023-00022-4"},{"key":"2026100915172387619_j_jpm-2025-0290_ref_032","doi-asserted-by":"crossref","unstructured":"van Haren, JS, Delbressine, FLM, Monincx, M, Hoveling, T, Meijer, N, Bangaru, C, et al.. From intra- to extra-uterine: early phase design of a transfer to extra-uterine life support through medical simulation. 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