HELLP syndrome consists of the triad hemolysis, elevated liver enzymes and low platelets count. It is usually developed in pregnant women with preeclampsia. Intrahepatic liver hematoma is an extremely rare complication of HELLP syndrome. Pulmonary embolism (PE) is not a typical complication of HELLP syndrome but it may appear in the setting of prothrombotic status associated to pregnancy. We report a case of HELLP syndrome complicated with subcapsular and parenchymal liver hematoma and pulmonary embolism, which represents a therapeutic challenge because it faces the need to anticoagulate with the risk of bleeding.