Background: Preeclampsia and eclampsia, hypertensive disorders of pregnancy, are major contributors to maternal and neonatal morbidity and mortality in Bangladesh. Liver dysfunction, manifested as elevated liver enzymes, is a frequent complication in these conditions and can exacerbate adverse outcomes. Understanding the association between liver function abnormalities and maternal or neonatal complications is essential for improving clinical management. Objective: This study aimed to evaluate the alterations in liver function among Bangladeshi women with preeclampsia and eclampsia and their association with maternal and neonatal outcomes. Methods: This retrospective cohort study enrolled women diagnosed with hypertensive disorders of pregnancy who delivered in Institute of Applied Health Science (IAHS), Foy's, Lake, Chittagong, Bangladesh, from January 2024 to December 2024. A total of 60 eligible participants were selected based on predefined inclusion and exclusion criteria and were evenly divided into two groups: Group 1 comprised women with elevated liver function tests (above-threshold LFTs), while Group 2 included women with normal or below-threshold liver function tests (below-threshold LFTs). Maternal data were collected from medical records, including demographic information, obstetric history, and liver function test results. The cohort was stratified into two groups based on LFT results (above-threshold vs. below-threshold). Descriptive statistics and univariable analyses were used to identify differences between the groups, and multivariable logistic regression was employed to assess the association between elevated LFTs and adverse maternal and neonatal outcomes, adjusting for confounders such as maternal age, BMI, and gestational age at delivery. Statistical significance was set at p < 0.05. Results: Among mothers, blood transfusions were significantly more frequent in the elevated LFT group (16%) compared to the normal LFT group (5%, p = 0.011). Composite adverse maternal outcomes were higher in the elevated LFT group (20% vs. 15%, p = 0.38), though not statistically significant. Adverse neonatal outcomes were notably elevated, including NICU admission (68% vs. 52%, p = 0.041) and respiratory distress syndrome (41% vs. 25%, p = 0.029). The composite adverse neonatal outcome was significantly higher in the elevated LFT group (70% vs. 53%, p = 0.035). General anesthesia is associated with higher rates of adverse maternal and neonatal outcomes compared to regional anesthesia, with significant differences in maternal blood transfusion, neonatal ICU admissions, and respiratory distress syndrome. Regional anesthesia demonstrates a safer profile, particularly for reducing neonatal complications. Conclusion: Elevated LFTs in preeclampsia and eclampsia are associated with increased maternal and neonatal complications, including higher rates of blood transfusion, NICU admission, and respiratory distress syndrome. Routine liver function monitoring is critical for identifying high-risk patients and implementing timely interventions, especially in resource-limited settings.