Background: Pre-eclampsia is a pregnancy complication that affects approximately 5% of pregnancies worldwide. It is characterized by the onset of high blood pressure and protein in the urine after 20 weeks of pregnancy or the new onset of hypertension and significant end-organ dysfunction with or without proteinuria after 20 weeks of gestation in a previously normotensive patient. Severe pre-eclampsia before term is associated with higher risks for both the mother and the fetus. 
Aim of the Work: To evaluate the maternal and perinatal outcomes of cases with severe preeclampsia before 34 weeks and to evaluate the benefits and risks of a policy of early delivery by induction of labor or by caesarean section, and policy of delaying delivery (expectant management) for women with severe pre-eclampsia between 26 and 34 weeks gestation.
Patients and Methods: This study is a prospective Observational study. This study start from 6 to 12 months after protocol approval of the ethical committee. This study conducted at Ain Shams University Maternity Hospital. Study Population: The study will be conducted on records of pregnant women attending Ain Shams University Maternity Hospital. 
Results: The study assessed severe preeclampsia cases before 34 weeks, with a cohort of 90 participants (mean age: 29.58 years). Most were aged 18-30 years (81.1%), with diverse gravidity and parity. Prior cesarean sections and abortions were common. Symptoms included headache (57.8%) and vomiting (40.0%). Maternal outcomes showed complication-free courses in 71.1%, but 32.2% required ICU admission. Neonatal challenges included respiratory distress syndrome (75.6%) and NICU admission (56.7%). Cesarean section rate was 97.8%, this underscores the multifaceted nature of severe preeclampsia before 34 weeks, affecting both maternal and perinatal outcomes. 
Conclusion: This study comprehensively investigated severe preeclampsia cases before 34 weeks of gestation, revealing demographic characteristics, clinical features, and outcomes. Maternal complications, including ICU admission, were observed in a substantial proportion, emphasizing the critical nature of severe preeclampsia. Neonatal outcomes were marked by challenges such as respiratory distress syndrome and low birth weight, with notable neonatal mortality. Gestational age, blood pressure parameters, and interventions like steroid use and immediate delivery played significant roles in influencing outcomes.