• Home
  • Blogs
  • Acute Fatty Liver Of Pregnancy Vs Hellp
image

AFLP vs. HELLP Syndrome: Key Differences, Risks and Treatment

Acute Fatty Liver of Pregnancy (AFLP) and Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) syndrome are rare but life-threatening liver disorders that can occur during pregnancy. While both conditions share similarities, they have distinct causes, complications, and management approaches.

Understanding their differences is essential for appropriate early diagnosis and intervention to prevent maternal and fetal complications.

AFLP and HELLP syndrome can present with overlapping symptoms, such as nausea, vomiting, abdominal pain, and jaundice. However, they differ significantly in their underlying mechanisms and diagnostic criteria.

Differences Between AFLP and HELLP Syndrome

AFLP

  • Primarily caused by mitochondrial dysfunction in fatty acid metabolism, leading to small fat deposits within liver cells.
  • Typically appears in the third trimester.
  • Symptoms include jaundice, hypoglycemia, and encephalopathy.
  • Lab tests commonly show an increased level of liver enzymes, low glucose levels and prolonged clotting times.
  • It can rapidly progress to liver failure, kidney problems, and coagulopathy if not promptly treated.

HELLP Syndrome

  • Believed to be linked to abnormal placental function.
  • Occurs most often when pregnancy has reached 20 weeks or later, usually with preeclampsia.
  • Leads to hepatocellular damage with periportal necrosis.
  • Characterized by hypertension, hemolysis, and thrombocytopenia.
  • Patients commonly have high blood pressure, increased liver enzymes, and a low platelet count.
  • Increases the risk of clotting issues, organ damage, and stroke.

How HELLP Syndrome Affects the Liver

HELLP syndrome directly impacts liver function by causing widespread endothelial dysfunction, leading to increased liver enzyme levels and hepatocellular necrosis.

The damage to liver cells can result in subcapsular hematomas and, in severe cases, liver rupture.

Additionally, the reduced platelet count and clotting abnormalities increase the risk of internal bleeding, which can be life-threatening if not treated immediately.

Complications of Fatty Liver in Pregnancy

AFLP can result in multi-organ failure when not recognized early. Some of the most severe complications include:

  • Liver Failure: Fat accumulation in the liver impairs its function, leading to hepatic encephalopathy and coagulation disorders.
  • Renal Dysfunction: AFLP is associated with acute kidney injury due to severe blood flow impairment.
  • Disseminated Intravascular Coagulation (DIC): Clotting abnormalities result in excessive bleeding, complicating delivery.
  • Fetal Risks: Preterm birth, intrauterine growth restriction, and stillbirth are common due to placental insufficiency.

Risk Factors for AFLP and HELLP

Although these conditions are rare, some factors may elevate the risk.

For AFLP, risk factors include genetic defects in fatty acid oxidation (e.g., LCHAD deficiency), multiple pregnancies, previous history of AFLP, and male fetal sex.

HELLP syndrome is most commonly associated with preeclampsia, chronic hypertension, maternal age over 35, and a history of HELLP in previous pregnancies.

Diagnosing Liver Disorders in Pregnant Women

Early detection is crucial to prevent severe complications. Diagnosis involves:

  • Clinical Assessment: Evaluating symptoms such as ongoing nausea, pain in the upper right abdomen, and jaundice.
  • Laboratory Tests: Liver function tests (LFTs), complete blood count (CBC), coagulation profile, and renal function tests.
  • Imaging: Ultrasound or MRI may help identify liver abnormalities, though lab results and clinical presentation primarily determine diagnosis.

Treatment Options for Pregnancy Liver Conditions

Both AFLP and HELLP require immediate medical care.

For AFLP, immediate delivery is the primary treatment. Supportive care includes IV fluids, glucose supplementation, and monitoring for organ failure.

In HELLP syndrome, delivery is also the definitive treatment, often requiring steroid therapy to promote fetal lung development if premature delivery is necessary. Blood transfusions and magnesium sulfate may be needed to manage complications.

Frequently Asked Questions

<

Which condition is more life-threatening, AFLP or HELLP?

Both conditions are severe, but AFLP has a higher risk of multi-organ failure and maternal or fetal death if not promptly treated. HELLP syndrome also poses severe risks, including liver rupture and stroke.

Do both AFLP and HELLP require immediate delivery?

Delivery is the only way to stop disease progression in both conditions. Early intervention is crucial to prevent severe maternal and fetal complications.

Can AFLP and HELLP occur in the same pregnancy?

Yes, though rare, some women may develop both conditions simultaneously, leading to severe maternal and fetal complications.

Which condition is more likely to recur in future pregnancies?

HELLP syndrome has a higher recurrence rate, especially in women with a history of preeclampsia. AFLP is less likely to recur unless there is an underlying genetic mutation in fatty acid metabolism.

What is the role of genetics in AFLP and HELLP?

AFLP is strongly linked to genetic defects in fatty acid oxidation (e.g., LCHAD deficiency). HELLP is associated with preeclampsia risk factors but does not have a clear genetic cause.

How do AFLP and HELLP affect the baby?

AFLP increases the risk of fetal distress, preterm birth, and stillbirth due to maternal liver failure. HELLP can cause fetal growth restriction, placental abruption, and preterm delivery.