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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Acute fatty liver and HELLP syndrome

Obstetrics and gynaecology · UK scope · Sources checked 7 Sept 2026 · Clinical review pending

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Late pregnancy liver failure or microangiopathy

Vomiting or upper abdominal pain with hypoglycaemia, jaundice, coagulopathy, haemolysis or falling platelets may represent acute fatty liver or HELLP and can deteriorate rapidly.

Action: Call senior obstetrics, anaesthesia and critical care immediately; assess airway, circulation and glucose, obtain urgent blood and coagulation studies, initiate maternal stabilisation and organise birth without delaying for diagnostic certainty or completion of fetal steroids.

Synopsis

Differentiate overlapping late-pregnancy liver emergencies, recognise organ failure early and coordinate maternal stabilisation, urgent birth and continued postpartum critical care.

  • HELLP combines haemolysis, elevated liver enzymes and low platelets, usually within the pre-eclampsia spectrum.
  • Acute fatty liver often produces hepatic synthetic and metabolic failure, including hypoglycaemia and coagulopathy.
  • Clinical overlap is common; normotension does not safely exclude HELLP or other serious pregnancy liver disease.
  • Obtain platelet trend, blood film and haemolysis tests together with glucose, renal function, liver tests and coagulation.
  • Stabilise the mother and plan urgent birth through a multidisciplinary team; liver biopsy is rarely needed before action.
  • Continue close postpartum surveillance because laboratory and clinical deterioration can occur after delivery.

Key red flags

Right upper quadrant pain with shock or a falling haemoglobin requires immediate assessment for hepatic haematoma or rupture.

Hypoglycaemia, encephalopathy, renal impairment or prolonged clotting in late pregnancy requires urgent consideration of acute liver failure.

Severe hypertension, visual disturbance, headache or seizure with liver abnormalities requires immediate pre-eclampsia and eclampsia management.

Investigation priorities

01
Urgent full blood count and haemolysis studiesFirst step

Identify thrombocytopenia, anaemia and evidence of microangiopathic red-cell destruction.

Management branches

Immediate responseTreat maternal deterioration as an emergency

A late-pregnancy or recently postpartum patient has hepatic abnormalities with systemic illness.

  1. Escalate to consultant obstetrics, anaesthesia, critical care and haematology, adding hepatology early when synthetic or metabolic failure is present.
  2. Establish intravenous access, frequent observations, bedside glucose checks and strict fluid balance while sending urgent bloods and preparing compatible blood.
  3. Correct hypoglycaemia and circulatory disturbance, treat severe hypertension and use magnesium for eclampsia or qualifying severe pre-eclampsia.

Key medicines

Magnesium sulfate for eclampsiaGive 4 g intravenously over 5–15 minutes, then 1 g/hour for 24 hours; after eclampsia continue for 24 hours after the last seizure, with further seizures managed using an additional 2–4 g intravenously over 5–15 minutes.Monitor respiration, reflexes and urine output; renal impairment increases toxicity risk and requires dose review and ready access to calcium gluconate.
Glucose for hypoglycaemiaWhen oral treatment is unsafe, give intravenous glucose through the hospital hypoglycaemia pathway, for example 150–200 mL of 10% glucose over 10–15 minutes, then recheck and provide continuing replacement if needed.Repeat bedside glucose frequently, protect the airway in reduced consciousness and titrate ongoing infusion to measured need and fluid tolerance.
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Sources and review status4 sources · checked 7 Sept 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.

  • NICE NG133 severe pre-eclampsia and HELLP management
  • EASL clinical practice guidelines liver diseases in pregnancy
  • NICE NG25 antenatal corticosteroids and preterm birth
  • JBDS hospital hypoglycaemia guideline

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom