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Thrombotic microangiopathy (TMA) is an important component in obstetric practice. Despite this, patients with suspected TMA should be under the supervision of not only an obstetrician-gynecologist, but also related specialists such as a hematologist, nephrologist, cardiologist, therapist, etc. The main types of TMA found in pregnant women are thrombotic thrombocytopenic purpura (TTP), catastrophic antiphospholipid syndrome (KAFS), atypical hemolytic-uremic syndrome (aHUS), preeclampsia (PE) and HELLP syndrome. The most common TMA, according to world literature, is HELLP syndrome, which, in turn, in 10-20% of cases is a complication of severe preeclampsia. In this article, we reviewed the clinical observation of the development of HELLP syndrome in a 32-year-old woman with a severe form of preeclampsia. The features of the differential diagnosis in the framework of thrombotic microangiopathy with predominant kidney damage were demonstrated. We have analyzed the issues of the origin of HELLP syndrome and the methods of treatment. This article discusses modern approaches to the diagnosis of a group of thrombotic microangiopathies found in obstetric practice. An interdisciplinary approach involving specialists such as a hematologist, a nephrologist, a clinical pharmacologist, a cardiologist, a therapist and a hemotransfusiologist is extremely important for the differential diagnosis of HELLP syndrome in a patient with severe preeclampsia, which allows you to get a positive result from timely and well-chosen therapy. The end result is a reduction in both maternal and perinatal mortality.