Background: The common perinatal complications associated with eclampsia are intrauterine death, intrapartum death, neonatal death, neonatal seizures, and prematurity. Aim: To study the factors affecting perinatal outcome in eclampsia of the south Indian population. Materials and Methods: 50 eclampsia patients (>32 weeks of gestational age) utilized, and the patients with medical complications like anaemia, diabetes mellitus, hypertension, vascular or renal disease, multiple gestations, and polyhydramnios excluded from the study. The patient history followed by physical examination and systemic examination recorded. Results: In 50 cases of eclampsia, 12 perinatal deaths occurred, of which five neonatal deaths (41.6%) and the most common cause for the death are prematurity (60%) in the present study. The majority of perinatal deaths observed in the middle socio-economic group population. The perinatal deaths were significantly higher in unbooked cases. Perinatal mortality increases with parity and found statistically significant. Perinatal mortality was significantly higher in < 36 weeks of gestational ages. Perinatal mortality was considerably higher in patients with the blood pressure of more than 160/100 mm of Hg. Perinatal mortality increases with the number of convulsions and found statistically significant. The perinatal mortality was very high in convulsion delivery interval in more than 24 hours, with an incidence of 30%. Perinatal mortality increases with the duration of labour. The perinatal mortality was more in vaginal delivery (34.4%) in the present study. Conclusion: The better health care facilities, improving socioeconomic status, adequate antenatal supervision will improve perinatal outcome in eclampsia.