The aim of this study was to evaluate the immunohistochemistry and ultrastructural of syncytiotrophoblast and Hoffbauer cells in placental villi of HELLP syndrome patients. Placental samples with twenty control (normotensive) and twenty HELLP syndrome were fixed in 10% neutral formalin solution for paraffin-embedding wax protocol. Placental samples were fixed in 2.5% buffered glutaraldehyde and then, in 1% osmium tetra oxide for routine electron microscopic procedure. When the HELLP group fetal placental sections were examined, intracytoplasmic edema in syncytiotrophoblast, degenerative vacuoles and degenerative findings on cell surface membranes were observed. Moreover, villous edema was remarkable. The number of CD68 positive Hoffbauer cells per villus control group sections was 0.23 ± 0.02 and the number of CD68 positive cells per villus in HELLP group placenta sections was 0.83 ± 0.12 . The increase in the number of Hoffbauer cells per villus in the HELLP group was statistically significant (p