HELLP syndrome is a constellation of fi ndings that include hemolysis with a microangiopathic hemolytic anemia (hemolysis), elevated liver function tests, and thrombo cytopenia (low platelets). HELLP syndrome complicates up to 3 per 1,000 pregnancies, may present as a severe manifestation of PET, and occurs in up to 20% of patients. Th e majority of patients are diagnosed before 37 weeks of gestation. Th ere is a clear overlap between PET and HELLP syndrome, and it is unclear whether the latter is a primary or secondary disease process. Th e syndrome is believed to be due to generalized endothelial and microvascular injury from activation of the complement and coagulation cascades, increased vascular tone, and platelet aggregation. Th is results in areas of hemorrhage and necrosis within the liver and may evolve to large hematomas, capsular tears, and intraperitoneal bleeding. Laboratory criteria for this syndrome include microangiopathic hemolysis with schistocytes present on the peripheral blood smear, platelet count of fewer than 50,000/mm 3 , serum total bilirubin of more than 20 μmol/L (1.2 mg/100 mL), serum lactate dehydrogenase of more than 600 U/L, and serum aspartate transaminase of more than 70 U/L.