Wiku Andonotopo, Muhammad Adrianes Bachnas, Julian Dewantiningrum, Mochammad Besari Adi Pramono, Ernawati Darmawan, Muhammad Ilham Aldika Akbar, I. Nyoman Hariyasa Sanjaya, Dudy Aldiasnyah, Cut Meurah Yeni, Nuswil Bernolian, Waskita Ekamaheswara Kasumba Andanaputra, Sri Sulistyowati, Milan Stanojevic, Asim Kurjak
Objectives: 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. Methods: 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 “artificial womb,” “extrauterine fetal incubation,” “artificial placenta,” “preterm birth,” and “bioethics.” 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. Results: 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. Conclusions: 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. © 2025 the author(s), published by De Gruyter, Berlin/Boston.
Department of Obstetrics and Gynecology, Fetomaternal Division, Women Health Center, Ekahospital BSD City, Banten, Tangerang, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Medical Faculty of Sebelas Maret University, Dr. Moewardi Hospital, Solo, Surakarta, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Medical Faculty of Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia; Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine, Airlangga University, Dr. Soetomo General Hospital, Surabaya, Indonesia; 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; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Sumatera Utara University, H. Adam Malik General Hospital, North Sumatera, Medan, Indonesia; Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine, Syiah Kuala University, Dr. Zainoel Abidin General Hospital, Aceh, Indonesia; Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine, Sriwijaya University, Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia; Undergraduate Program in Medical Science, Faculty of Medicine, Padjajaran University, West Java, Bandung, Indonesia; Department of Neonatology and Rare Diseases, Medical University of Warsaw, Warsaw, Poland; Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
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