Dissertation (MMed Obstetrics and Gynecology)Background: severe pre-eclampsia, eclampsia is responsible for a significant proportion of maternal and neonatal morbidity and mortality worldwide. In Mnazi mmoja Hospital, clinical experience has shown that severe pre eclampsia, eclampsia are common, the overall fetal maternal outcomes and various forms of clinical presentations of severe pre eclampsia, eclampsia is still largely unknown. Objective: To determine clinical presentation and fetal maternal outcome of severe pre eclampsia, eclampsia at Mnazi mmoja Hospital Zanzibar. Methodology and materials: This was a prospective cross sectional study conducted in obstetrics and gynecology department at Mnazi mmoja Hospital in Zanzibar from January to June 2019. Structured questionnaire were used to collect data on social demographic characteristics, obstetric history, diagnosis confirmed by laboratory finding like urine for protein,liver functional test, Renal function test and full blood count. Data were analyzed using SPSS version 25. Descriptive statistics were generated and associations of categorical variable were examined in bivariate analysis. Results: A total of 76 pregnant women were recruited during the study, of which SPE was 57(75%) and Eclampsia was 19 (25%) , among of all recruited participant gravida 2 to gravida 5 were more likely to present to present with eclampsia than other groups, on the other hand most of the clinical presentation were headache 75( 98.68%), epigastric pain 63( 82.89), and blurred vision 35( 45%). Moreover, there was a significant association between the clinical presentation and fetal maternal outcome. Conclusion: severe pre eclampsia was highest than eclampsia which means its most manageable type of pregnancy induced hypertension, if the intervention could be taken as soon as possible compare to eclampsia, early diagnosis and proper management to prevent poor fetal maternal outcome.