OBJECTIVE: The purpose of this study was to determine maternal and neonatal outcomes of women who were delivered because of severe preeclampsia before 25 weeks of gestation. STUDY DESIGN: We used a computerized database to identify 3800 women with preeclampsia among 35, 937 deliveries from 1991 to 1997. Of these, 39 women (1%) with severe preeclampsia were delivered before 25 weeks of gestation. We abstracted outcomes in these women and their newborns. RESULTS: All 39 women had severe preeclampsia as defined by clinical and/or laboratory criteria. Thirty-three of the 39 women had severe-range hypertension. Twenty-one women (54%) experienced morbidity that included abruptio placentae (n = 5), HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome (n = 9), renal insufficiency (n = 5), and eclampsia (n = 3). No women required dialysis or intensive care unit admission, and none of the women died. All maternal morbidities reversed after delivery. Twenty-two infants (55%) were live-born. Only 4 infants (10%) survived, all with severe handicaps. CONCLUSION: In women with severe preeclampsia before 25 weeks of gestation, delivery is associated with minimal short-term maternal morbidities, although neonatal morbidity and death are appreciable.