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Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a form of severe preeclampsia that threatens the gravida and her fetus. In this report, the diagnostic criteria and maternal and fetal risks of HELLP are defined. Prompt recognition and treatment in tertiary centers is emphasized, because the prognosis can be adversely affected by delayed or less than optimal diagnosis and treatment. Management guidelines are offered for treating this disorder. The potential roles of corticosteroids, plasmapheresis, and expectant management are critically evaluated. Subsequent pregnancy outcome, contraception, and preventative strategies are considered.Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a form of severe preeclampsia which threatens the health and life of both pregnant women and their fetuses. Primary and consulting obstetricians therefore need to know how to recognize and treat the condition. The diagnostic criteria and maternal and fetal risks of HELLP are defined, with stress upon the prompt recognition and treatment of the condition in tertiary centers, because prognosis can be adversely affected by delayed or suboptimal diagnosis and treatment. Management guidelines are offered for treating the disorder, and the potential roles of corticosteroids, plasmapheresis, and expectant management are critically evaluated. Moreover, subsequent pregnancy outcome, contraception, and preventative strategies are considered.