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We noted that in two recent reports in Gut, none of 62 patients diagnosed by the Swansea criteria to have acute fatty liver of pregnancy (AFLP) underwent liver biopsy.1 2 We retrospectively assessed the accuracy of the Swansea criteria to predict hepatic microvesicular steatosis in 34 patients with suspected pregnancy-related liver disease who underwent liver biopsy at our centre between 1998 and 2006. These patients tested negative for other causes of acute liver dysfunction such as hepatitis viruses (hepatitis B virus surface antigen (HBsAg), hepatitis C virus (HCV) antibody, immunoglobulin (Ig) M hepatitis A virus (HAV) antibody, IgM hepatitis E virus (HEV) antibody), malarial parasite and sepsis (blood culture). No patient gave a history of ingestion of a potentially hepatotoxic drug. We excluded 10 patients (details in figure 1).