Preeclampsia is a multisystem disorder affecting 5.8% of primigravidas. It is a progressive disease with a very variable mode of presentation and rate of progression. Of all the features of the syndrome, hypertension and pregnancy-induced proteinuria are the classic clinical manifestations. This disease causes severe complications of the mother and the fetus. Neither are factors available for prediction, nor are there strategies for prevention and therapy of this disease. The accumulated evidence strongly suggests that failure or incomplete trophoblastic invasion (end of first, beginning of second trimester) of the spiral arteries, resulting in narrowed spiral arteries and subsequent endothelial damage, is responsible for the occurrence of this disease (third trimester). The reason for trophoblastic failure is not known. After clinical symptoms have occurred, only symptomatic therapeutic options are available. In this paper, we discuss potential ways to find specific and sensitive predictive parameters according to the current knowledge of the pathophysiology of this pregnancy-induced severe disorder.