Background: Pre-eclampsia is a significant cause of maternal and fetal morbidity and mortality worldwide. Early identification of women at risk is essential for effective management. This study evaluated ‘biochemical markers and physiological parameters as predictive indices for’ pre-eclampsia. Methods: A cross-sectional study was conducted at Women Medical and Dental College from January 2023 to January 2024, involving 103 pregnant women. Data were collected on demographic characteristics, biochemical markers (PlGF, sFlt-1, sEng, uric acid, homocysteine, and CRP), and physiological parameters (blood pressure, uterine artery Doppler findings, proteinuria, and fetal growth). Emerging biomarkers, such as exosomal miRNA and cell-free fetal DNA (cffDNA), were also analysed. Statistical analysis was performed using SPSS, with a p-value of <0.05 considered significant. Results: Key risk factors identified included advanced maternal age (>35 years), nulliparity, and high BMI (>30 kg/m²). Biochemical markers revealed significantly ‘lower PlGF levels and elevated sFlt-1 and sEng levels’ in women at risk of pre-eclampsia (p<0.05). Physiological parameters, such as hypertension, abnormal uterine artery Doppler findings, and proteinuria, were strongly associated with the condition. Emerging biomarkers, including exosomal miRNA and cffDNA, demonstrated potential for early detection. Psychosocial stress and inadequate nutritional intake further contributed to risk stratification. Conclusion: Integrating biochemical markers, physiological parameters, and demographic factors provides a comprehensive approach to the early identification of pre-eclampsia. This strategy can enable timely interventions to improve ‘maternal and fetal outcomes’.