Epigastric pain is a common pregnancy symptom. True clinical symptoms are less evident and more challenging during pregnancy. The incidence of HELLP (hemolysis–elevated liver enzymes–low platelet count) is rare but life threatening. Liver rupture is rare and associated with a maternal mortality rate of 16.4% and a perinatal mortality rate of 31.3%. Early diagnosis and treatment have a profound effect on patients’ prognosis. Obstetric nurses should have a heightened awareness of HELLP syndrome in patients presenting with epigastric pain. Expedited interventions geared toward rapid diagnosis and treatment should be implemented to help decrease maternal and neonatal morbidity and mortality. A gravida 2 para 0 term patient presented to triage complaining of severe epigastric pain and uterine contraction for the previous 3 hours. Her cervix was closed; the fetal heart rate was tachycardic at 170 beats per minute (Category II). Intravenous therapy was begun, and a preeclampsia laboratory panel was obtained. The lab results were suggestive of HELLP syndrome. An abdominal ultrasound was performed; findings included a large subcapsular liver hematoma with right upper quadrant and perisplenic fluid. The obstetrician consulted with the trauma surgeon, and the decision was made to do an emergency cesarean and exploratory laparotomy. The patient gave birth to a viable newborn. The trauma surgeon proceeded with a laparotomy and found a large, right-lobe, subcapsular hematoma; disruption of Glisson’s capsule; and active hemorrhage from the liver. The liver was sutured; Class 3 hemorrhagic shock and disseminated intravascular coagulation were noted. The patient required multiple blood transfusions and interventions to resolve blood loss. She required two subsequent trips to the operating room and was intubated for 5 days. She recovered and was discharged home after 12 days in the hospital. Epigastric pain occurring in pregnant and postpartum patients requires diligent assessment. Epigastric pain is the most common symptom of HELLP syndrome, and it can precede abnormal bloodwork changes by several hours. Because of the life-threatening potential of HELLP syndrome, epigastric pain should always be considered a serious symptom.