Acute liver disorders in the third trimester—<scp>AFLP</scp>, <scp>HELLP</scp> and infectious hepatitis—update on pathology, diagnosis and management

Key content The epidemiology and pathophysiology of AFLP, HELLP syndrome and infectious viral hepatitis in late pregnancy. Clinical presentation, diagnosis and management of these conditions. Complications (maternal and fetal) and how these can be managed. The role of a multidisciplinary team in management. Learning objectives To understand the pathophysiology of acute liver disorders in the third trimester, including the role of genetics. To understand the differences between AFLP, HELLP syndrome and other causes of acute liver disorders in late pregnancy and how their management differs. To understand the Swansea criteria for diagnosis of AFLP and how management within a multidisciplinary team can make a difference between survival and mortality. To provide management guidance to reduce the perinatal morbidity and mortality associated with acute liver disorders, including the need for liver transplantation. To understand the different types of acute viral hepatitis in late pregnancy, the differences between them and how they are managed, including the prevention of maternal‐to‐child transmission. Ethical issues Despite the extensive literature on liver disorders, are obstetricians well trained in recognising these in the third trimester, differentiating between the various types and providing adequate care for affected patients? Where is the ideal place to manage the pregnant woman with a liver disorder that may progress to hepatic failure? Should liver transplantation be an option for women with AFLP or HELLP syndrome who do not meet the transplantation criteria?