Hypertensive disorders of pregnancy (HDP) are a public health problem and they complicate about 10 % of all pregnancies worldwide. Eclampsia, one of the hypertensive disorders of pregnancy is the onset of convulsions or coma during pregnancy or post-partum in a patient who has signs and symptoms of preeclampsia [1].

According to the World Health Organization (WHO), incidences of pre-eclampsia and eclampsia were 2.16 % and 0.28 % respectively [2]. The nationwide prevalence of hypertensive disorders of pregnancy was about 6.07 % and preeclampsia/eclampsia accounted for 5.47 % [3]. At Jimma University Medical Center, severe pre-eclampsia and eclampsia was the most common hypertensive disorder of pregnancy accounting for 51.9 % and 23.4 % respectively [4].

Global studies showed that preeclampsia and eclampsia were associated with higher maternal mortality, perinatal mortality and morbidity [5], [6]. It was found that common perinatal complications ascribed to eclampsia were birth asphyxia, low birth weight and prematurity, respiratory distress syndrome and sepsis [7], [8].

Overall, despite efforts to reduce pregnancy-related complications and deaths, perinatal deaths from preeclampsia with severe features and eclampsia are still increasing worldwide. Besides, preeclampsia and eclampsia-related perinatal mortality were associated with the country’s economic index. So from women with preeclampsia, a low perinatal mortality rate was reported from high-wealth index countries whereas a high perinatal mortality rate from low- and middle-income countries ranges from 4.7 % to 41.6 % [9], [10]. Similarly, perinatal mortality in patients with eclampsia in high-income countries has also been reported as 5 to 11 % [11], while in low- and middle-income countries it has been as high as 40 % [12].

In Eastern Africa, eclampsia is associated with a high level of maternal and perinatal mortality of 22.2 % and 35.5 % respectively [13]. The Ethiopian health system's response showed pre-eclampsia complicates 1.2 % of all institutional deliveries [14]. This was also held in two teaching hospitals of Addis Ababa where the perinatal mortality rate of pre-eclampsia/eclampsia was 312.2/1000 in deliveries [15].

The Ethiopian government, in line with WHO, commits to reducing perinatal mortality through multiple high-impact interventions at both the facility and community levels to address bottlenecks such as harmful traditional practices, poor infrastructure, lack of transportation, and inadequate coverage in health facilities which may affect access to safe maternity services [16].

Magnesium sulphate has been included in the National Drug List of Ethiopia since January 2011 in public hospitals to reduce maternal and perinatal morbidity and mortality [17]. Yet the complications continue and there were only a few retrospective studies done to address the problem of perinatal outcomes as a country in general and the Eastern part of Ethiopia in particular. Therefore, this study was conducted to assess the perinatal outcomes and their determinants among women with eclampsia and preeclampsia with severe features admitted to tertiary hospitals in Dire Dawa and Harar Cities, Eastern Ethiopia.