Background: Preeclampsia (PE) especially severe or early PE, is a leading cause of morbidity and mortality among the mothers and infants. To determine the maternal risk factors and fetomaternal outcome of severe preeclampsia. Objective: To find out the Risk factors of Gestational Hypertension-Preeclampsia in Pregnant Women Patients aged within 20-35 Years with Fetomaternal Outcome & Its Perioperative Management. Methods: It was a case control study, done in a Department of Anaesthesiology and ICU, Shaheed ziaur Rahman Medical College & Hospital, Bogra, Bangladesh during a period of six months from January to Jun-2018. Among 131 patients with severe preeclampsia and normal pregnant women admitted. Sampling technique were consecutive sampling methods. Singleton pregnancy between 28 to 40 weeks of gestation with severe preeclampsia was selected as study patients. Written informed consent was obtained. A questionnaire was completed for each patient including patient's age, gestational age, and parity, History of hypertension in family, weight and Body Mass Index (BMI) and PIH time level. Results: This study was out of 131 pregnant women with PIH 51 (38.93%), severe PIH 45 (34.35%), Eclampsia 24(18.32%) and Ch. Hypertension 11(8.39%) were age variation. Among the 81 cases and 50 controls regarding different risk factors age 20-35 Yrs. BMI, history of precelampsia, were found significant (p<0.05) between two groups. Among the case group, patients developed eclampsia 2(4.0%) abruptio placenta 3(6.0%) HELLP syndrome 2(4.0%) ascites 4(8.0%) and oliguria1 (2.0%). Among the 81 cases and 50 controls regarding different risk factors age 20-35 Yrs. BMI, history of precelampsia, were found significant (p<0.05) between two groups. Among the case group, patients developed eclampsia 2(4.0%) abruptio placenta 3(6.0%) HELLP syndrome 2(4.0%) ascites 4(8%) and oliguria1 (2.0). 64 (48.5%) pregnant women with PIH were having gestation time less than 28 weeks, 52(39.6%) of pregnant women with PIH were gestation time between 28-37 weeks, 11 (8.3%) of pregnant women with PIH were gestation time between 37-40 weeks, 4 (3.0%) of women with PIH were P1L1. Most 56.0% of the neonates had APGAR score 4-6 at 1 minute in case group and 12(24.0%) in control group. Showing different risk factors where regarding age 35> years, 15 patients found in case group and 4 patients in control group. Significant (p<0.05) difference was found between two groups. Patients had 4.93 times more likely to developed preeclampsia. Take baby in home safely in 35(70.0%) in cases group and 50(100.0%) in control group. Early neonatal death was found in 5(10.0%) in case group and not found in control group. Still birth was 10(20.0%) case group and not found control group. Statistically significant (p<0.05) difference was between two groups. There was found to be that still eclampsia and severe PIH contribute significantly to foetal and maternal morbidity and mortality. Conclusion: Preeclampsia is a leading cause of both fetal and maternal morbidity and mortality in the developing countries. Maternal and fetal outcome are worse in severe preeclampsia.