Placental extracellular vesicles (EVs) play an essential role in pregnancy by protecting and transporting diverse biomolecules that aid in fetomaternal communication. However, in preeclampsia, they have also been implicated in contributing to disease progression. Despite their potential clinical value, most current technologies cannot provide a rapid and effective means of differentiating between healthy and diseased placental EVs. To address this, we developed a fabrication process called laser-induced nanostructuring of SERS-active thin films (LINST), which produces nanoplasmonic substrates that provide exceptional Raman signal enhancement and allow the biochemical fingerprinting of EVs. After validating LINST performance with chemical standards, we used placental EVs from tissue explant cultures and demonstrated that preeclamptic and normotensive placental EVs have classifiably distinct Raman spectra following the application of both conventional and advanced machine learning algorithms. Given the abundance of placental EVs in maternal circulation, these findings will encourage immediate exploration of surface-enhanced Raman spectroscopy (SERS) as a promising method for preeclampsia liquid biopsies, while our novel fabrication process can provide a versatile and scalable substrate for many other SERS applications.