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INTRODUCTION: Hypertensive pregnancy disorders, including preeclampsia, pose significant risks. The fullPIERS model predicts maternal complications, assisting clinicians in managing outcomes, triage, treatment, and newborn risk based on gestational age. AIM: To evaluate the fullPIERS calculator in predicting adverse maternal outcomes in preeclampsia. Objectives: Primary: Assess maternal outcomes in hospitalized preeclamptic patients and their correlation with the fullPIERS calculator. Secondary: Establish exclusion criteria cut-off values and evaluate fetal outcomes. MATERIALS AND METHODS: A cohort study was conducted at DDU, Delhi, from May 2022 to June 2023, with a sample size of 120 patients. Inclusion criteria: Hospitalized preeclamptic patients not in labor. Exclusion criteria: PIH with severe complications or coexisting medical conditions (e.g., thyroid, heart, SLE, epilepsy, renal, liver, pulmonary diseases, anemia, fever, diabetes). Predictor variables within 24 hours of admission were measured to calculate predicted probabilities of adverse events, with a risk prediction score determined using the fullPIERS calculator. RESULTS: Among 120 patients, the mean age was 23.4 ? 4.19 years. Common maternal complaints included headache (30.8%) and epigastric pain (25%). HELLP syndrome (14.2%) was the most frequent maternal complication, followed by postpartum hemorrhage (13.3%) and eclampsia (9.2%). Neonatal outcomes included NICU admission (38.3%) and preterm birth (36.7%). A significant correlation was found between fullPIERS scores and adverse outcomes, with optimal cut-off values for maternal and neonatal outcomes determined through ROC analysis (AUC = 0.91 and 0.68). CONCLUSION: Chest pain/dyspnea and SpO2 <94.9% were linked to adverse maternal outcomes. FullPIERS strongly predicts adverse maternal outcomes with a cut-off of 6.9. FullPIERS was associated with neonatal outcomes, though with moderate discrimination. Recommendations: Integrate fullPIERS into clinical practice. Assess its efficacy in peripheral healthcare facilities. Conduct larger multicenter studies to validate findings.