Introduction: Hypertensive disorders of pregnancy are one of the leading causes of maternal and perinatal mortality worldwide. Preeclampsia complicates 2–8% of pregnancies globally. Despite the serious clinical consequences, there is currently no effective preventive measure for preeclampsia hence the focus has shifted to identifying good predictors for diagnosing the severity of preeclampsia. Materials and methods: This was a prospective cohort hospital-based study done in our department. A total of 400 women were found to be eligible for the study after meeting the inclusion criteria. All the patients underwent detailed evaluation and investigation and the risk was calculated using the full preeclampsia integrated estimate of risk (PIERS) calculator. All patients were followed weekly till delivery. The adverse maternal and fetal outcomes were assessed. If the predicted probability of the adverse outcome came out to be >30%, that case was considered as high risk. T-test and Chi-square tests were used for statistical analysis as appropriate. Results: Considering our cut-off value of >30% in our study, out of 384 patients, 82 were categorized into a high-risk group, among them 54 (65.85%) patients had the adverse maternal outcome. (X² = 96.413, p-value = < 0.0001). Among 377 patients, excluding seven women who expired in antenatal period, 75 patients (19.89%) were categorized into high-risk group (>30% predicted probability), among them 59 (78.67%) patients had the adverse fetal outcomes. (X² = 96.413, p-value = < 0.0001). Conclusion: The fullPIERS model successfully stratifies the population into clinically relevant high-risk categories by using a few important clinical and biochemical parameters and does not require extensive laboratory testing. It is economically feasible and quick to use and predict the probability of an adverse outcome. Thus timely referral to the higher centers will help in having a significant impact in reducing maternal morbidity and mortality and perinatal morbidity and mortality associated with preeclampsia in low-resource settings.