Preeclampsia is a multisystem progressive disease unique to pregnancy and one of the leading causes of maternal and fetal morbidity and mortality. As the core initiating organ in the pathogenesis of preeclampsia, the placenta undergoes pathological changes throughout the entire course of the disease. These changes not only serve as the pathological basis for the occurrence and progression of preeclampsia but also are closely associated with clinical diagnosis and treatment decision-making, disease severity evaluation, and prognostic judgment. Based on the Amsterdam Placental Consensus and the latest research advances, this manuscript systematically elaborates the gross and microscopic pathological features of the placenta in preeclampsia, and further analyzes the correlations between placental pathological alterations and clinical symptoms, disease severity, as well as maternal and fetal prognosis, to provide pathological evidence for the early warning, precise diagnosis, individualized treatment and prognostic assessment of preeclampsia.