Purpose of investigation: The objective of this study was to predict preeclampsia using extreme-low first-trimester pregnancy-associated- plasma-protein-A-(PAPP-A), extreme-low free-beta-human-chorionic-gonadotropin-(free-βhCG)-levels, and extreme-high pulsatility- index (PI) of uterine arteries, as single and combined predictors for preeclampsia development in resource-limited-settings. Materials and Methods: First-trimester screening for PAPP A, free-βhCG, and PI was performed between 11-13⁺⁶ gestation-weeks in nulliparous, normotensive women with singleton pregnancy with extremely-low PAPP-A (PAPP-A ≤ 0.52 MoM), extremely-low free- βhCG (free-βhCG ≤ 0.56 MoM) and extremely-high PI (≥ 2.52). Results: Of 85 pregnant women, 14 (16.5%) developed preeclampsia. PAPP-A ≤ 0.52 MoM and PI ≥ 2.52, as a single categorical variables, found to be with high OR for preeclampsia-development (OR = 7.07, 95% CI = 0.873-57.204, p = 0.067; OR = 5.098, 95% CI = 0.625-41.575, p = 0.128, respectively). The ROC-curve identified PAPP-A and PI as continuous variables to be significant predictors of preeclampsia (AUC = 0.864, 95% CI = 0.750-0.978, p = 0.000; AUC = 0.762, 95% CI = 0.598-0.925, p = 0.002, respectively). A prediction model for preeclampsia including PAPP-A ≤ 0.52 MoM + PI ≥ 2.52 was found to be significantly associated with preeclampsia (p = 0.027). Conclusion: The present study suggests that the firsttrimester extreme low-PAPP-A and increased Doppler-PI levels have significant predictive capability for preeclampsia.