Biliary lithiasis in patients with severe preeclampsia has not been well studied. To describe the frequency and clinical course of biliary lithiasis in patients with severe preeclampsia. Cross-sectional study on 141 women with severe preeclampsia who had an abdominal ultrasound performed during the pre-partum period or in the immediate puerperium. Patients were treated in the Intensive Care Unit of the Hospital de Ginecologia y Obstetricia núm. 3, Centro Medico Nacional La Raza, IMSS (Mexico), in the period of November 26, 2006 to June 26, 2009. Findings from gallbladder lithiasis (sand, solitary stone, multiple stones or wall calcification) and choledocho conduit were reported. Significant maternal data (clinical and laboratory) and perinatal results of patients without stones (group A) were compared to patients (group B) with stones. Measures of central tendency and dispersion, and T-test were used. Frequency of gallbladder lithiasis was 15% (21 cases). Solitary stone were found in 12 cases, multiple stones in seven cases and gallbladder calcification in two cases. There were no cases of choledocholithiasis. Epigastric pain was present in 13 cases (9.2%: group A, 10 cases [7.1%] vs. group B, 3 cases [2.1%], p = 0.06). There were no complications in patients with lithiasis and none required invasive procedures. Clinical evolution and perinatal results were similar in both groups. Duration of stay in the intensive care unit was similar (group A, 2.2 +/- 0.18 days vs. group B, 2.1 +/- 0.13 days, p = 0.86). The frequency of biliary lithiasis in patients with severe preeclampsia was 15%. There were no adverse effects on the maternal clinical course or on the perinatal results.