Gene polymorphisms of PAI-1 are associated with elevated levels and adverse pregnancy outcomes.<h4>Case</h4>A 36-year-old gravida 6, para 1-1-3-1 with elevated prepregnancy PAI-1 levels, a history of early-onset preeclampsia with severe features superimposed on chronic hypertension, intrauterine growth restriction (IUGR), and recurrent pregnancy loss (RPL), presented with a dichorionic-diamniotic twin gestation. Here, SERPINE1 is linked to abortion.