Background: Pulmonary edema in severe preeclampsia is a serious problem because it requires intensive care and has poor maternal and infant outcomes, especially in developing countries. Objective: To understand risk factors, maternal and fetal outcomes in severe preeclampsia patients with acute pulmonary edema. Methods: This study is a descriptive analytic study, using case report data of patients with preeclampsia with acute pulmonary edema at dr. Soetomo General Hospital Surabaya during 2018 to 2019. Result: During 2018 ? 2019 the prevalence of severe preeclampsia cases was 29% of the total deliveries, while acute pulmonary edema occurred in 17.2% of severe preeclampsia cases. More than 50% of cases were found in patients younger than 35 years, with a mean maternal age of 31.7 years. The highest gestational age was more than 34 weeks (45% of cases) and was dominated by multiparas (70.3%). 81% cases of pulmonary edema occur in antepartum, and 48% of them require intensive care with a ventilator. Most cases (61.5%) were delivered by cesarean section. The mean birth weight of infants born was 2265 ? 815 grams with a first minute APGAR score ? was recorded in 72.3% of cases. On the outcome of severe preeclampsia with pulmonary edema, maternal mortality was 8.1% and infant mortality was 5%. Conclusion: The prevalence of acute pulmonary edema in patients with severe preeclampsia is 17.2%, occurs mostly in antepartum phase with gestational age more than 34 weeks and most cases requires intensive care with a ventilator.