Preeclampsia is a pregnancy specifc disorder commonly defned as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5%  of  pregnancies  and  it  is  still  a major  cause  of  both  foetal  and maternal morbidity and mortality worldwide.  As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. Te only rational treatment is delivery, which benefts the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It  is, however often  associated with maternal morbidity  as  the  risk of progression to severe maternal disease is inversely related with gestational age at onset.  Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by  expectant, non-interventional management. Tis  temporising  treatment option  to  lengthen pregnancy  includes  the use of  antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity. With optimal maternal haemodynamic status and reassuring foetal condition this results on average  in an extension of 2 weeks. Prolongation of these pregnancies  is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefts on  the other. Clinical controversies  regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands – a debate which is even more pronounced  in very preterm pregnancies with questionable  foetal viability. Do maternal risks of prolongation of these very early pregnancies outweigh  the chances of neonatal  survival? Counselling of women with very early onset preeclampsia not only  comprises of knowledge of  the outcome of  those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance.