Background. Presence of maternal symptoms like severe headache, nausea and vomiting, visual disturbances and epigastric pain have been associated with complications in women with pre eclampsia. Objective. To determine the accuracy of maternal symptoms in predicting complications in women with pre-eclampsia by systematic review. Data sources. We searched Medline (1951-2010), Embase (1980-2010), the Cochrane Library (2009) and the MEDION database. Methods of study selection. Studies which evaluated the accuracy of symptoms in women with pre-eclampsia for predicting complications were selected in a two-stage process. Information was extracted by two independent reviewers. We summarised accuracy with a bivariate model estimating sensitivity, specificity and area under the curve. Results. Six primary articles with 2573 women were included. The Area Under the Curve for predicting complications for headache, epigastric pain and visual disturbances were 0.58 (95%CI 0.24-0.86), 0.70 (95% CI 0.30-0.93) and 0.74 (95% CI 0.33-0.94). The sensitivity and specificity of the symptoms in predicting adverse maternal outcomes were as follows: headache 0.54 (95% CI 0.27- 0.79) and 0.59 (95% CI 0.38-0.76); epigastric pain 0.34 (95% CI 0.22-0.5) and 0.83 (95% CI 0.76- 0.89); visual disturbances 0.27 (95% CI 0.07- 0.65)) and 0.81 (95% CI 0.71, 0.88); nausea and vomiting 0.24 (95% CI 0.21, 0.27) and 0.87 (95% CI 0.85, 0.89) respectively. Conclusion. Presence of symptoms is more useful in predicting complications in pre-eclampsia compared to their absence in excluding adverse events.