During the last decade major progress has been achieved in identifying new predictive biomarkers as well as setting up screening strategies for preeclampsia. A number of biochemical markers in combination with biophysical markers coupled to patients' demography and clinical history were identified and have been used in a number of studies. The combination of independent markers with various demographic and multivariate algorithms should have led to stratification of the risk to develop preeclampsia. However, today studies are still ongoing mostly focusing on a single marker and its performance for the early subtype of preeclampsia, which makes up only about 20% of all preeclampsia cases. While it is hard to forecast how medicine will progress, it has been the hope that a combination of risk stratification with large international randomised studies validating various prediction methods would enable new studies to identify preventive methods as well. This would have led to a significant revolution in the way pregnancy is managed to prevent preeclampsia. However, looking back on all the studies on markers such as soluble endoglin, placental protein 13 (PP13), placental growth factor (PlGF), vascular endothelial growth factor (VEGF) and soluble VEGF receptor-1 (sVEGF-R1 or sFlt-1) today pregnant women destined to develop preeclampsia are still suffering from the lack of any commonly accepted preventive therapy. Putative reasons for this failure of predictive biomarkers will be discussed in this talk.