Th e patient usually presents with vague symptoms, vomiting, or abdominal pain and may develop preeclampsia. Often there are no specifi c clinical signs, except tenderness in the right upper quadrant. Serum aminotransferase and bilirubin levels are signifi cantly elevated, and in later stages there is a coagulopathy evidenced by low fi brinogen and a prolonged prothrombin time. Compared with HELLP, thrombocytopenia and hypertension are unusual. Urate levels may be extremely high and there may be signifi cant hypoglycemia. Conclusive diagnosis requires liver biopsy, although owing to coagulopathy thi s is rarely possible or practical. Th e diff erential diagnosis includes HELLP syndrome, pre-eclampsia, and acute hepatitis due to alcohol or a virus [14] . Th e treatment of choice is urgent delivery of the fetus. Th is stops the overload of the mother's fatty acid oxidation system from fetal production and leakage into the maternal circulation [13] .