Background: Eclampsia remains a significant cause of maternal and perinatal morbidity and mortality worldwide, particularly in low-resource settings. Despite advances in obstetric care, it continues to pose a grave challenge in Bangladesh, necessitating local data to guide clinical management and public health interventions. Objective: To evaluate the frequency and nature of maternal and perinatal morbidity and mortality associated with eclampsia. Methods: This prospective cohort study was conducted at Nilphamari Medical College, Nilphamari, from January 2024 to December 2024. A total of 87 eclamptic patients were enrolled using a purposive sampling technique. Data on clinical profiles, maternal complications, and fetal outcomes were collected and analyzed using SPSS version 23.0. Results: The majority of patients were aged 20-30 years (68%) and primigravida (71%). Antepartum eclampsia was the most common type (62%). Major maternal morbidities included acute kidney injury (18%), pulmonary edema (13%), and cerebrovascular accidents (5%). The maternal mortality rate was 4.6%. Perinatal outcomes revealed a high rate of preterm birth (48%), low birth weight (55%), and stillbirth (16%). The perinatal mortality rate was 21%. Admission to the neonatal intensive care unit was required for 58% of the live-born babies. Conclusion: Eclampsia is associated with substantial maternal and perinatal morbidity and mortality in this setting. The findings underscore the urgent need for improved antenatal care, early detection of pre-eclampsia, and prompt, effective management of eclamptic seizures and complications to enhance maternal and fetal outcomes.