HELLP stands for hemolysis, elevated liver enzymes, and low platelets, and is associated with preeclampsia. The intense vasospasm in the microvessels essentially crushes the red blood cells and platelet cells and causes hepatocellular necrosis and edema. Complications are progressive and sudden and must be anticipated. The clinical course includes disseminated intravascular coagulation, liver infarction, rupture or hemorrhage, renal compromise or failure, abruptio placentae, eclampsia, pulmonary edema, acute respiratory distress syndrome, fetal compromise, shock, and cardiac arrest. Early interventions include identification and stabilization, fetal assessment, transport to a tertiary center, rapid platelet and red blood cell transfusion, emergent childbirth, steroid therapy, liver transplantation, and tremendous psychological support.