Background: Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a serious obstetric complication with high risk of adverse maternal and perinatal outcomes. The aim of the study was to find the prevalence of HELLP syndrome and to analyze the maternal and perinatal outcomes. Methods: This was a descriptive cross-sectional study conducted in a tertiary care center from April 13, 2016, to April 12, 2020, after obtaining ethical clearance from the Institutional Review Committee. All the women with HELLP syndrome who delivered in the hospital during the study period were enrolled. A convenience sampling technique was used. Data were analyzed using the Statistical Package for the Social Sciences version 24 software. Descriptive analysis was done and frequency and proportion were calculated for binary data. Results: Prevalence of HELLP syndrome was 0.23%. The majority of the cases were in the 25–29 years age-group and the mean maternal age was 28.05 years. Twenty-seven (61.36%) were primigravida. Of 44, 27 (61.36%) delivered through lower segment cesarean section. Nineteen (43.18%) women were admitted to the high dependency unit. There were four (9.1%) maternal deaths. Most (68.18%) of the babies were preterm and 62.5% of the live-born babies were admitted to the neonatal intensive care unit. There were 20 perinatal deaths with a perinatal mortality of 45.45%. Conclusion: Hemolysis, elevated liver enzymes, and low platelet syndrome is a dreadful complication with high morbidity and mortality. Timely termination of pregnancy is warranted to arrest further progress of pathophysiology. Clinical significance: Outcomes in HELLP syndrome can be improved with early diagnosis and timely intervention.