Maternal Mortality Rate (MMR) remains a major global and national health issue, with pregnancy-related hypertension such as preeclampsia being one of the leading causes. This study aimed to analyze the risk factors associated with severe preeclampsia (PEB) among pregnant women at the Siti Fatimah Regional Special Hospital for Mothers and Children (RSKD Ibu dan Anak) in 2023. An observational analytic study design with a case-control approach was employed. The sample was selected using purposive sampling, comprising 50 cases and 50 controls (totaling 100 samples). Secondary data obtained from medical records were analyzed using the chi-square test to examine the associations between PEB and the variables of age, parity, interpregnancy interval, history of preeclampsia, obesity, and multiple pregnancy. The results showed significant associations between PEB and high-risk age (<20 or >35 years) (p-value = 0.023; OR = 2.846; 95% CI: 1.228–6.597), high-risk parity status (primipara/grandemultipara) (p-value = 0.027; OR = 2.705; 95% CI: 1.197–6.113), and a history of preeclampsia (p-value = 0.006; OR = 2.190; 95% CI: 1.753–2.738). Conversely, no significant associations were found regarding interpregnancy interval (p-value = 1.000), obesity (p-value = 0.072), or multiple pregnancy (p-value = 0.495). The study concludes that high-risk age, primipara/grandemultipara parity status, and a history of preeclampsia are significant risk factors for severe preeclampsia. Healthcare professionals are advised to enhance early detection and prevention education for pregnant women presenting with these risk factors.