Risk factors for pre-eclampsia represent a bewildering array of causative antecedents that reflect the complexity of the maternal syndrome. The HELLP syndrome is most commonly regarded as related to severe pre-eclampsia. Assessment of cerebral function via continuous communication with the awake patient is essential and provides important hemodynamic information. Transcranial Doppler measurements have given interesting insight in cerebral hemodynamics in pre-eclampsia. The choice of anti-hypertensive agent should be guided by local experience and continuous monitoring of blood pressure and flow, both for the mother and the baby. Intravascular volume depletion has been considered the norm in women with pre-eclampsia. Prevention of pre-eclampsia-related cerebral complications is one of the major indications for observation and treatment in ICU. Prevention and management of eclamptic seizures is based upon giving magnesium sulfate. Patients with HELLP syndrome have an increased risk of venous thromboembolism and bleeding during pregnancy.