Th e major life-threatening complications of HELLP syndrome are hepatic hemorrhage, subcapsular hematoma, liver rupture, and multi-organ failure. Liver hemorrhage is managed conservatively where possible with aggressive blood product resuscitation to reverse the coagulopathy and ensure adequate oxygen-carrying capacity. Th e development of a subcapsular hematoma may lead to hepatic rupture, which is potentially life-threatening for the mother and fetus, and 50% maternal and up to 60% fetal mortality rates have been reported. Manage ment of threatened or actual hepatic rupture involves drainage of the hematoma, packing, oversewing of lacera tions, or partial hepatectomy. Consideration should be given to hepatic arterial embolization, either in the high-risk patient or in the period following operative stabilization.