Background: The placenta connects the mother and fetus. It manages the exchange of oxygen and nutrients and the elimination of waste. Pregnancy-related hypertensive disorders like gestational hypertension, eclampsia, and preeclampsia are known to affect the development and the placental function, resulting in suboptimal fetal outcomes. Studying the placental morphology and histology reveals the degree of damage these conditions have inflicted. In this comparison study, we analyze the gross and microscopic features of placentas with hypertensive disorders and compare them to uncomplicated normotensive pregnancies to explore the different features attributable to maternal hypertension. Methods: This cross-sectional study was conducted at Khyber Medical University, Peshawar, from January 2023 to January 2024. One hundred four placentas were collected in total, out of which 52 were normotensive and 52 were hypertensive pregnancies. For each placenta, the gross parameters of the placenta, which were noted, include: weight, diameter, thickness, shape, infarction, calcification, and placental parameters. For tissue samples, histological evaluation was done using hematoxylin and eosin staining. SPSS version 25 was used to perform the statistical analyses. Results: Placentas from hypertensive pregnancies showed significantly reduced weight, diameter, and thickness compared to the normal group. The hypertensive group had more frequent gross abnormalities such as infarcts, irregular shape, and increased calcification. Histological examination revealed increased syncytial knots, fibrinoid necrosis, basement membrane thickening, and vascular atherosis in hypertensive cases, all with statistically significant differences (p < 0.05). Conclusion: Hypertensive disorders during pregnancy are associated with distinct morphological and histological alterations in the placenta, indicating chronic ischemic changes and vascular dysfunction. These findings highlight the importance of placental assessment in understanding disease severity and its impact on maternal and fetal health.