Preeclampsia is a life-threatening illness during pregnancy. The main signs of preeclampsia are high blood pressure and proteinuria. Most cases of preeclampsia occur in the third trimester after 32 weeks and affect nulliparous women. Preeclampsia can lead to many serious complications, including the death of both the mother and fetus. In this case report, we reported a case of a 34-year-old Saudi woman, gravid 6 para 4 + 1 abortion, at 22 weeks by ultrasonography (US). Complained of a rare condition of early preeclampsia with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and intrauterine growth restriction (IUGR) due to placental insufficiency in the second trimester of pregnancy This pregnancy was terminated due to maternal risks. In conclusion, we can consider the importance of blood pressure screening in the early stages of pregnancy in the first or second trimester.