Preeclampsia (PE) is a complex complication of pregnancy, which is a major cause of maternal and neonatal mortality. Its pathogenesis is closely associated with placental defects, although the specific mechanisms remain unknown, and specific targeted therapeutic interventions are currently unavailable. This article reviews recent domestic and international literature on PE and reveals the differences in placental mesenchymal stem cells (PMSCs) between PE and normal pregnancy groups. PMSCs play a crucial role in intercellular communication, regulating the normal functions of cells and organs, including maintaining a healthy pregnancy. The pathogenesis of PE is intricately linked to PMSCs, and abnormalities in these cells are associated with oxidative stress, inflammation, vascular endothelial damage and placental anomalies. Recent research on exosomes offers the potential for treatment strategies for PE. This article provides a comprehensive overview of the role of PMSCs and their exosomes in the pathogenesis of PE, while also delving into their potential utility in the prognosis and management of this distinctive pregnancy-related ailment presenting invaluable perspectives for forthcoming investigations within this domain of scholarly inquiry.