[Abstract] Objective: To analyze the predictive value of placental growth factor (PLGF), soluble fms-like tyrosine kinase-1 (sFlt-1) combined with uterine artery pulsatility index (PI) for preeclampsia in pregnant women with medium to high risk factors. Methods: 536 pregnant women with medium to high risk factors for preeclampsia and regular prenatal check ups who were registered for early pregnancy in our outpatient department from June 2023 to June 2024 were selected as the research subjects, and the PLGF, sFlt-1 and PI of pregnant women were detected and other clinical data were recorded. According to the occurrence of preeclampsia during pregnancy, the pregnant women with medium to high risk factors were divided into preeclampsia group and normal group. The PLGF, sFlt-1, PI and other clinical data between the two groups were compared, and the influencing factors of preeclampsia in pregnant women with medium to high risk factors were analyzed using the stepwise multivariate Cox proportional hazards regression model, and the predictive value of PLGF, sFlt-1 combined with PI for preeclampsia in pregnant women with medium to high risk factors were analyzed using the receiver operating characteristic (ROC) curves. Results: 82 cases developed preeclampsia among 536 pregnant women with medium to high-risk factors, and the incidence rate was 15.30%. The first-trimester PLGFof the preeclampsia group was lower than that in the normal group (P<0.05), while the second-trimester sFlt-1/PLGF, third-trimester sFlt-1/PLGF, first-trimester PI and second-trimester PI were all higher than those in the normal group (P<0.05). The third-trimester sFlt-1/PLGF in two groups were higher than those the second-trimester sFlt-1/PLGF (P<0.05), while the second-trimester PI were lower than those the first-trimester PI (P<0.05). The Cox regression analysis showed that first-trimester PLGF was a protective factor for preeclampsia in pregnant women with medium to high risk factors (P<0.05), while the second-trimester sFlt-1/PLGF, third-trimester sFlt-1/PLGF, first-trimester PI, second-trimester PI, pre pregnancy BMI and high risk factor were risk factors for preeclampsia in pregnant women with medium to high risk factors (P<0.05). The sensitivity, specificity and area under curve (AUC) of the combined prediction of first-trimester PLGF, second-trimester sFlt-1/PLGF, third-trimester sFlt-1/PLGF, first-trimester PI and second-trimester PI for preeclampsia in pregnant women with medium to high risk factors were 95.12%, 81.50% and 0.913 respectively, and the sensitivity and AUC were higher than single indicator predictions, while specificity was similar to single indicator predictions. Conclusion: The first-trimester PLGF, second-trimester sFlt-1/PLGF, third-trimester sFlt-1/PLGF, first-trimester PI and second-trimester PI are all influencing factors factors for preeclampsia in pregnant women with medium to high risk factors, and they have predictive value for preeclampsia, and the combined prediction of the above indicators can further enhance the predictive value.