Background: HELLP Syndrome is the severe form of preeclampsia characterised by hemolysis(H), elevated liver enzymes (EL) and low platlets count, frequently leads to adverse maternal and perinatal outcome. This study aimed to determine the incidence, complications of HELLP syndrome and evalution of Maternal and Fetal outcome at a rural tertiary care center. Methods: A prospective observational study was conducted at Department of obstetrics and gynaecology, RIMS, Adilabad during a period of one year. The analysis of data was done on all the patients diagnosed with HELLP syndrome and categorized by mississippi classification for better analysis of complications and outcome in HELLP syndrome. Results: Total 5820 women were delivered in our institute during the study period of which 572 women with Pre-eclampsia and 48 patients diagnosed with HELLP syndrome. Incidence of HELLP syndrome is 0.8 % of total deliveries and 8.3%of Pre-eclampsia patients. Most of them were primigravida 52%. Majority were in 32-36 weeks of gestational age Out of total 48 patients of HELLP syndrome,40 patients delivered vaginally and 8 patients delivered by LSCS Complications includes Ascites (27%), Postpartum hemorrhage (25%), Placental abruption (23%), Acute renal failure (16%), Pulmonary edema (10.4%), Disseminated intravascular coagulation (6.2%), Multi Organ Dysfunction (4.1%). Patients who received Blood products were 54.1% Preterm deliveries (58.3%), NICU admission (27%). Intra uterine Fetal demise (14.5%) There was no maternal mortality. Perinatal mortality rate was 43.7%. Conclusions: Vaginal delivery is allowed as better stabilization and better maternal outcome. There is increased fetal morbidity and mortality as patients came in advanced disease. Early detection and management of its complications with timely intervention to arrest further progress to reduce maternal and neonatal morbidity and mortality.