Acute Fatty Liver Of Pregnancy

Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening liver disorder of pregnancy that typically presents in the third trimester.  It is characterized by microvesicular fatty infiltration of maternal hepatocytes, which leads to massive hepatocyte injury.  Acute liver failure (eg, jaundice, encephalopathy, coagulopathy, hypoglycemia) can develop, followed by multiorgan failure and possible death.

The cause of AFLP is not fully understood but may be related to defective fatty acid metabolism.

During the third trimester, free fatty acids normally increase to support fetoplacental growth and development.  However, in the setting of defective maternal-fetal fatty acid metabolism, intermediate products of fatty acid metabolism can cross the placenta and accumulate in the maternal circulation and hepatocytes.  The massive fatty infiltration of maternal hepatocytes can lead to fulminant liver failure (eg, jaundice, thrombocytopenia, coagulopathy, profound hypoglycemia, hepatic encephalopathy).  If untreated, patients develop multiorgan failure (particularly renal failure due to hepatorenal syndrome) and experience rapid decompensation, leading to maternal and fetal death.