BACKGROUND: A study of fetomaternal outcome in patients with severe pre– eclampsia and eclampsia with HELLP syndrome Purpose: To determine the trend of occurrence of HELLP syndrome, risk factors, its complications and its effect on maternal and perinatal outcome of HELLP syndrome in pregnant women at Madurai Medical College Hospital, Madurai. METHODS: Patients with severe hypertension in pregnancy who were admitted between Sep 2016 to Sep 2018 at Madurai Medical College Hospital, Madurai were taken up for the study. Out of 750 cases of severe preeclampsia/ eclampsia, there were 182 cases of HELLP syndrome. These were compared with case without HELLP syndrome for their mode of presentation along with maternal and perinatal morbidity and mortality. RESULT: The overall incidence of HELLP syndrome was 24.2% in the antepartum factors; multi (55.8%), preeclampsia (90%), symptoms (81.4%), Haemolysis (86%), Preterm Delivery (84%) were statistically significant. Abnormal perinatal outcome was statistically significant. Conclusion: Women with severe hypertension in pregnancy manifesting with HELLP syndrome show a significantly greater frequency of developing Complications like Abruption, ARF and DIC. Therefore, their care necessitates intensive monitoring to preclude development of these complications. Successful management requires recognition, a timely intervention and to render optimal patient treatment.