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Objective To determine the predictive value of plasma soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) ratio for detection of preeclampsia in elderly gravida at 16–18 weeks of gestation and to identify whether abnormalities of this ratio are associated with any other pregnancy complications or not. Methods Blood samples of 300 cases were collected. Plasma sFlt-1 and PlGF levels were measured using an automated immunoassay. Results  Sensitivity and specificity for plasma sFlt-1/PlGF ratio above 9.8 for preeclampsia prediction were 85.7% and 61.2%, respectively. The sensitivity and specificity to predict early onset preeclampsia were 100% and 61.1%, respectively. Women with abnormal plasma sFlt-1/PlGF ratio were not associated with any other pregnancy complications. Conclusion  sFlt-1/PlGF ratio at 16–18 weeks of gestation in elderly gravida has a high sensitivity for predicting preeclampsia, especially early onset preeclampsia.