Our objective was to determine whether there is a difference in middle cerebral artery blood flow velocity in patients with the syndrome of hemolysis, elevated liver enzymes and low platelet counts (HELLP syndrome) compared to a matched controlled group of patients with pre-eclampsia and without HELLP syndrome. Six pre-eclamptic patients with HELLP syndrome and 12 pre-eclamptic women without HELLP syndrome had maternal middle cerebral artery blood flow velocity assessed antepartum and at 24 and 48 h postpartum. We compared the effect of the development of HELLP syndrome on middle cerebral artery blood flow velocity changes using non-parametric tests. Patients with HELLP syndrome showed no significant differences in diastolic, systolic, mean middle cerebral artery blood flow velocity or pulsatility index in either the antepartum or 24-h and 48-h postpartum phases when compared to non-HELLP pre-eclamptic patients. Our data suggest that there is no difference in the blood flow velocity waveform of the maternal middle cerebral artery between patients with pre-eclampsia and those with HELLP syndrome.