AFLP vs Preeclampsia with Severe/HELLP

Oct 24, 2025

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Here is a real-world clinical case with a tricky differential: Our team recently readmitted a patient 6 days postpartum/post C-section (which was done for ICP and fetal macrosomia at close to 4500 grams, with A2GDM). She had elevated blood pressures, a frontal headache, some midepigastric pain/RUQ discomfort. Pretty clear picture right: sounds like preeclampsia (PreE) with severe features based on BP elevation and symptoms. So, we started her on mag-sulfate per protocol. Well, her transaminases were in the 400-600s, which was significantly higher than they were at delivery. They then peaked the next day at 900! OK, it still meets criteria for PreE with severe features. But could this also be postpartum Acute fatty Liver of Pregnancy (AFLP)? The clinical picture of these 2 conditions may overlap but there are distinct differences here. AFLP is potentially fatal, so we have to get that diagnosis correct. How can we distinguish AFLP from PreE with severe features or HELLP? Listen in for details.

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