Introduction: Pregnancy induced hypertension is the most common medical problem encountered during pregnancy, complicating 5 to 10 percent of pregnancies and together they form one member of the deadly triad, along with hemorrhage and infection that contribute greatly to maternal morbidity and mortality rates. Objective: The main objective for this study is to determine maternal and perinatal management outcome for preeclampsia with severity feature and associated factors among pregnant women admitted to Debre Markos comprehensive Specialized hospital, , From January 1 2019 to December 30 2020 G.C. Method: A Institutional based cross sectional chart review was conducted among 194 mothers from January 1 2019 to December 30 2020G.C based on the data registered in medical record books in the obstetric department in Debre Markos comprehensive Specialized Hospital, Debre Markos town, North west Ethiopia mothers who were admitted to obstetrics and gynecology department with diagnosis of preeclampsia with severity features during the study period were included in the study. Data was collected manually using check lists and enter in to EPI Info Versions seven statistical software and was transfer to SPSS windows version 25 for analysis. Result; - From 194 numbers of cases of preeclampsia with severity feature were studied, unfavorable maternal outcome was present in 33.5% of cases while 53.1% of cases had unfavorable perinatal outcome. Gestational age of delivery, Severity of blood pressure, blurring of vision and residence were associated with unfavorable maternal outcome and the unfavorable perinatal outcomes were early gestational age at diagnosis, residence, gravidity and Severity of blood pressure were associated with unfavorable perinatal outcome. Conclusion and recommendation: The top unfavorable maternal outcomes were HELLP syndrome; renal complication and unfavorable perinatal outcome were low birth weight and preterm birth. To prevent long & short term complication from preeclampsia with severity feature and to decrease maternal and perinatal mortality from the disease multi sectorial response is required which involves the government body, community and nongovernmental organizations. Key Words:-preeclampsia, management and outcome