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A retrospective case-control study was conducted to investigate the risk factors for pre-eclampsia – including the protective effect of placenta previa – at Medani Maternity Hospital, Sudan. Medical files of the patients during the period 2003–2010 were reviewed for age, parity, education level, prenatal care, placenta previa, and hemoglobin level.Women with pre-eclampsia were the cases, and women with normal pregnancy were the controls. There were 54,339 singleton deliveries and 1765 women with pre-eclampsia in the hospi-tal, giving the incidence of pre-eclampsia of 3.2%.The risk factors for pre-eclampsia were; women with age>35 years (OR=1.4, 95 % CI: 1.1–1.8), primiparity (OR=3.3, 95 % CI: 2.7–4.0), para>5 (OR=3.1, 95 % CI: 2.4–4.0), and anemia (OR=3.3, 95 % CI: 2.8–3.9). The risk of pre-eclampsia was inversely increased with education level and prenatal care attendance. The prevalence of placenta previa was 0 (0%) and 55 (3.3%), P <0.001 in pre-eclamptic and control women, respectively. Placenta previa was a significant protec-tive factor of pre-eclampsia (OR=0.3, 95 % CI: 0.1–0.7). Although, the socio-demographic risk factors for pre-eclampsia observed among women at Medani hospital were similar to those found in other settings; placenta previa was associated with decreased incidence of pre-eclampsia