Dissertation (MMED Obstetrics and Gynaecology)Severe preeclampsia and eclampsia are associated with alterations of serum biomarkers which can be attributed to complications observed in women with severe form of the disease spectrum. The study aims at using several biomarkers to associate them with obstetric outcomes. A quantitative analytical cross section study design was carried out at Dodoma regional referral hospital involving 210 single tone pregnant women at gestation age of ≥20 with severe preeclampsia and eclampsia. Clinical and laboratory details including blood pressure, spot urine for protein and 5mls of blood sample for uric acid, urea, creatinine, ASAT, ALAT, LDH and calcium levels were taken. Mean and standard deviations were used to summarize continuous variables while categorical variables were summarized using proportions. Both univariate and multivariate analysis were done and a p value of less than 0.05 was considered statistically significant. There was elevation in mean value of serum urea (11.0± 11.0), uric acid (6.9± 3.6) and creatinine (2.1± 6.5) in the study participants. Majority 146(69.5%) had hypocalcemia and 110(50.0%) had elevated serum creatinine level. Adverse maternal outcome was noted in 71(33.8%) of the study participants with Pulmonary edema being the commonest complication comprised 25(11.9%). Among the newborn 87(41.4%) were admitted to Neonatal Intensive Care Unit (NICU). In this study urea (AOR 5.9[1.895, 18.151], p=0.0021), creatinine (AOR 2.4[1.018, 5.519], p=0.0454) and calcium (AOR 2.3[1.026, 5.047], p=0.043) were biochemical factors which when deranged independently associated with maternal adverse outcomes while uric acid (AOR 3.2[1.398, 7.521], p=0.0061) was the only serum biomarker which when deranged independently associated with adverse fetal outcomes. Screen of serum biomarkers in pregnant hypertensive women could aid early intervention and reduce maternal and fetal complications.