This chapter discusses the pathophysiology, key implications, diagnostic signs and management of severe preeclampsia and eclampsia in an obstetric setting. Preeclampsia may affect multiple organ systems. Blood pressure greater than or equal to160/110 mmHg, severe headache with visual disturbance, epigastric pain, clonus and papilloedema are some of the diagnostic signs of severe preeclampsia. Patients should be managed in a high-dependency obstetric care setting with one-to-one experienced midwifery care. Hourly measurement and documentation of maternal observations like (blood pressure, pulse, respiratory rate, oxygen saturation, temperature, urine output, and neurological status) should be done. Magnesium sulphate should be commenced at diagnosis of severe preeclampsia/eclampsia; continuing until 24 hours following delivery/last seizure/commencement of magnesium sulphate therapy, whichever is the later. Antihypersensitives should be administered, and fluid management should be considered. Postpartum haemorrhage should be anticipated and managed efficiently. Regular 'skills drills' should be conducted on management of severe preeclampsia/eclampsia.