Characteristic clinical manifestation

Acute self-limiting, and a serum aspartate transaminase elevation of aminotransferases or jaundice or both.[17]

After a typical acute onset, patient become deeply jaundiced and went into hepatic encephalopathy within 4 wk of onset of disease without any past history of chronic liver disease.[18]

Ranging from asymptomatic elevations in aminotransferases to fulminant hepatic failure with jaundice, profound coagulopathy, hepatic coma, and hypoglycemia.[19] Preeclampsia is present in 50% of cases.[20]

Usually with signs of pre-eclampsia and thrombocytopenia[21],
65% patients present with abdominal pain.

Ranging from modest pruritus to intractable itching associated
with jaundice.[22]

Liver biopsy

Moderate necrosis

Severe necrosis

Minor necrosis[23], involves a microvesicular fatty infiltrative disorder, hepatic vacuolization and pallor in the central zone

Periportal hemorrhage and fibrin deposition

Bland cholestasis


Moderate to severe



Mostly not

Mild to moderate

Serum aminotransferases and coagulation abnormalities

At least fivefold increase of serum aminotransferases

Serum aminotransferases significantly increase at the onset, then decrease as the necrosis of hepatocytes proceed, reduced coagulation abnormalities

The aminotransferases are
usually elevated but <1000 U, with longer prothrombin time and low fibrinogen.

Ranging from 70 U to 6,000 U, with 250 U in average.[21]

normal GGTP, elevated aminotransferases
(<1000 U)[24], increased serum bile acid level

Viral serologies



Not related

Not related

Not related

AVH: Acute viral hepatitis
AFLP: Acute fatty liver of pregnancy
HELLP: Hemolysis, Elevated Liver enzymes and Low Platelet count syndrome.
ICP: Intrahepatic Cholestasis of Pregnancy
GGTP: g-glutamyl transpeptidase
Table 2: Differential diagnosis of fulminant hepatitis in late pregnancy (FVHLP).