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Background: Preeclampsia is a hypertensive disorder of pregnancy and an important cause of maternal and perinatal morbidity. The soluble fms-like tyrosine kinase-1 to placental growth factor ratio reflects placental angiogenic imbalance and may support diagnosis and short-term risk stratification. Case Presentation: A 29-year-old primigravida developed new-onset hypertension at 34 weeks and 1 day without significant proteinuria, with preserved renal function and hyperuricaemia. The ratio was markedly elevated at 318.4, prompting admission, antenatal corticosteroids, and close maternal-fetal surveillance. At 34 weeks and 3 days, labour was induced because of persistent hypertension and rising transaminases, culminating in caesarean section for arrest of dilatation and non-reassuring fetal status. Maternal and neonatal outcomes were favourable. Discussion: The biomarker supported risk stratification and escalation of care in an equivocal presentation. Conclusion: Placental growth factor-based testing may complement clinical assessment in suspected preeclampsia without proteinuria.