Preeclampsia with severe features (SPE) remote from term remains a major cause of maternal morbidity and mortality worldwide. With increasing diagnosis of SPE remote from term and improved methods for monitoring maternal and fetal well-being, several challenges have been made regarding management of preeclampsia. We reviewed the scientific literature of the diagnosis and outcome of SPE before 28 weeks. On the basis of this review, we will present our recommendations on management of SPE before 28 weeks’ gestation. In summary, expectant management of SPE at <28 weeks is appropriate in selected cases. Careful in-hospital maternal and fetal surveillance are recommended.