This document compares and contrasts acute fatty liver of pregnancy (AFLP) and HELLP syndrome. AFLP is a rare but potentially lethal condition that occurs during pregnancy, usually in the third trimester. It is associated with defects in fetal fatty acid metabolism. HELLP syndrome is a severe form of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets. Both can involve liver dysfunction and cause risks to both mother and fetus. While clinical features may overlap, the key to diagnosis is compatible laboratory findings and differentiation between the two conditions. Urgent delivery is usually required once maternal stabilization has occurred.