"It's been a great birthday week again," Ko told the Golf Channel after sinking her winning putt from four feet at the Lake Merced course in San Francisco.
"This week I hit the ball really well and it definitely makes this course a lot easier."
Pressel, however, will be ruing the birthday gifts she offered Ko by squandering two chances for victory.
The American missed a 15-foot birdie putt at the final regulation hole, the par-five 18th, and also missed from inside 10 feet at the first extra hole.
Eight years ago, Pressel became the youngest player to win a major at the age of 18 but she has only triumphed once since and remains without a victory since 2008.
Ko showed why she is worthy of her world number one ranking when she sank a clutch eight-foot birdie at the 18th to force extra holes, after earlier sinking a 40-footer at the 15th that took a sharp right-hand turn and dropped in on the final roll.
The New Zealander carded a two-under 70 and Pressel shot a 72 with the pair finishing on eight-under 280, one ahead of the long-time leader Brooke Henderson, the Canadian teenager dropping back with a final round of 74.
(Reporting by Andrew Both in Cary, North Carolina; Editing by John O'Brien)
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