HELLP syndrome (H – hemolysis, EL – elevated liver enzymes, LP – low platelet) is a severe complication of pregnancy, with potentially lethal outcomes for both the mother and neonate. The etiology and pathogenesis are still being investigated, but the root cause is considered to be abnormal placentation. Due to the disruption of the placental circulation, the stressed placenta emits various products which results in an enhanced inflammatory response, as well as endothelial and platelet activation, causing ischemia in the liver. The gestational age at onset is typically between 27 and 37 weeks, and women usually present with pain in the upper abdomen (epigastric or in the right upper quadrant), nausea, vomiting, malaise and headache with or without neurological involvement. The diagnosis of HELLP is based on both the clinical presentation and laboratory abnormalities that the name of the acronym is comprised of. HELLP syndrome can then be categorized into three classes according to platelet count. Delivery is the basis of treatment. Before 24 and after 34 weeks of gestation the mother should be delivered immediately, while the delivery between 24 and 34 weeks' gestation can be briefly delayed in order to administer corticosteroids for fetal lung maturity. The treatment also includes administering magnesium sulphate for seizure prophylaxis and fetal neuroprotection, antihypertensive therapy for blood pressure control and platelet transfusion in case of very low platelet count. The HELLP syndrome is associated with poor maternal and perinatal outcomes, including increased rates of serious morbidity and mortality. The risk of recurrence is high, as are the risks for developing other gestational hypertensive disorders, intrauterine growth retardation, placental abruption and preterm delivery.