Purpose:To determine the relationship between pregnancy-associated plasma protein-A (PAPP-A) levels and uterine Doppler ultrasonography for the prediction of severe preeclampsia (PE) and HELLP syndrome at the last trimester. Methods: Two groups were constructed; severe preeclampsia group consisted of 38 women; HELLP Syndrome group consisted of 12 women. Both groups were matched strictly for gestational age at last trimester. Maternal blood sample for PAPP-A was collected and uterine Doppler ultrasonography was performed as soon as any woman under the study was diagnosed as severe preeclampsia or HELLP syndrome at last trimester and compared. Results: Mean ages of participants, Parity, gestational weeks and fetal weights were similar. Mean PAPP-A levels were significantly higher in severe preeclampsia and HELLP groups. There was a statistically significant difference regarding Resistive Index (RI) (P<0.001) and Pulsatility Index (PI) (P=0.005) between cases presenting with severe preeclampsia and HELLP groups. Conclusion: PAPP-A levels could provide prediction for severe preeclampsia and HELLP syndrome at last trimester. Increased uterine artery resistance in the third trimester of pregnancy could be used to predict maternal complications including severe preeclampsia and HELLP syndrome.