This study aims to gather and synthesize the extant knowledge on pivoting in the startup development process through a systematic literature review. The analysis highlights that the number of papers on this topic is limited (35) but it is steadily increasing, suggesting that this topic is relatively recent and that it is attracting rapidly growing interest among academics. The analysis also highlights that, despite the limited body of literature, the thematic areas (and sub-areas) explored therein are quite numerous, indicating that many important aspects of pivoting in the startup development process have already been studied and that the literature on this topic is, at present, quite fragmented. The analysis finally highlights that all the thematic areas identified—particularly those labeled “triggers and responses,” “factors influencing pivot,” and “consequences”—have considerable potential for future development as research topics. On the one hand, this study provides researchers with an updated research landscape and several valuable future research directions with respect to pivot decisions in the startup development process. On the other hand, it provides several useful references for entrepreneurs who should or could make pivot decisions in the startup development process.