Background: Eclampsia is associated with substantial maternal morbidity and mortality, while the optimal mode of delivery remains uncertain because available evidence is conflicting. Therefore, the present study was undertaken to compare maternal outcomes according to mode of delivery among women with eclampsia. Methods: This cross-sectional observational study was conducted at the Eclampsia Ward, Department of Gynecology and Obstetrics, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh, from April 20 to October 20, 2015. A total of 100 women with antepartum eclampsia were enrolled through purposive sampling. Data were collected using a semi-structured questionnaire and analyzed using SPSS to compare maternal outcomes according to mode of delivery. Ethical approval, institutional permission, and informed consent were obtained. Results: Among 100 women with eclampsia, 55 (55.0%) had vaginal and 45 (45.0%) caesarean delivery. Demographic and clinical characteristics were largely comparable (p>0.05), except urinary albumin distribution (p=0.034). Maternal morbidity (45.5% vs. 37.8%) and mortality (5.5% vs. 2.2%) were higher after vaginal delivery. ICU referral was significantly higher following vaginal delivery (29.1% vs. 8.9%; p=0.012), while major organ and postpartum complications did not differ significantly (p>0.05). Of four maternal deaths, three followed vaginal delivery and one followed caesarean section. Conclusion: Vaginal delivery was associated with greater maternal morbidity and ICU requirement among women with eclampsia, highlighting the importance of individualized delivery planning based on maternal and fetal condition.