Fetuses with growth restriction and zero and negative umbilical artery blood flow values are a group at high risk for perinatal pathology and death. The investigations have established that these blood flow values in the umbilical cord correlate with its abnormally increased vascular resistance. The lack of autonomic innervation is the uniqueness of the placental vascular system; in this case, its vasomotor tone is regulated by the mediators secreted by local endothelial cells. Fetal growth restriction shows the significantly imbalanced synthesis of these vasoactive agents with a predominance of vasoconstrictors. Morphological examination of placentas in fetal growth restriction demonstrates impaired angiogenesis with the abnormal branching and thinning of villous vessels. Endothelial cells are key regulators of placental angiogenesis and vascular tone. Further investigation of the role of the placental endothelium can identify the possibility of finding new approaches to preventing and treating severe fetal growth restriction with abnormal umbilical artery diastolic blood flow.