Introduction: Pre-eclampsia is a pregnancy-specific disorder characterized by hypertension and proteinuria occurring after 20 weeks of gestation, impacting various organ systems like the placenta, kidneys, liver, and cardiovascular system. Early-onset pre-eclampsia, occurring before 34 weeks, poses significant challenges due to its unpredictable progression and heightened maternal and fetal risks. It is linked to higher rates of maternal complications, including multi-organ dysfunction, and obstetric issues like premature birth and fetal growth restriction. Women with a history of early-onset pre-eclampsia face increased risks of cardiovascular disease and metabolic disorders post-pregnancy. The study, conducted at Pravara Rural Hospital, Maharashtra, aims to explore the complexities of early-onset pre-eclampsia and improve maternal and fetal health outcomes. The study aims to investigate maternal and fetal outcomes in early-onset severe pre-eclampsia. Materials And Methods: A prospective cross-sectional study was conducted at Pravara Rural Hospital, Loni, with 208 participants. Data were analyzed using appropriate statistical tests. Inclusion criteria included patients with gestational age between 24 and 34 weeks, diastolic BP ≥90 mmHg, proteinuria ≥+1, and certain symptoms like persistent headache or blurred vision. Exclusion criteria included patients with co-morbidities or outside the specified gestational age range. Results: The study revealed high maternal complications, including anemia, abnormal coagulation, and organ dysfunction. Treatment involved magnesium sulfate and antihypertensive drugs. Maternal mortality was 4.32%, with significant fetal mortality (18.88% intrauterine death, 13.33% neonatal death). Conclusion: Vigilant monitoring and individualized care are critical for improving outcomes in early-onset pre-eclampsia.