Fatal outcome in acute fatty liver of pregnancy and review of literature

Reena Rani, Asmita M. Rathore, Sangeeta Bhasin


Acute fatty liver of pregnancy (AFLP) is an uncommon life-threatening disorder of pregnancy seen commonly in third trimester. When not diagnosed at right time it can lead to hepatic failure, encephalopathy, coagulopathy, maternal and fetal mortality. The clinical symptoms and signs are nonspecific, and it needs to be identified early in order to prevent poor outcome. The gold standard for diagnosis of AFLP is liver biopsy, which is difficult in an acute setting and in abnormal coagulation profile hence the diagnosis is usually based on clinical criteria   Early termination of pregnancy and good intensive care support are the mainstay of management. The authors here presented a case report where even early delivery and good critical care failed to prevent maternal mortality. Review of literature regarding etiopathogenesis, management and recurrences of AFLP are also discussed.


Acute fatty liver, Coagulopathy, Encephalopathy, Pregnancy

Full Text:



Gregory TL. Hughes S. Coleman MA. De Silva A. Acute fatty liver of pregnancy; three cases and discussion of analgesia and anesthesia. Int J Obstet Anesthes. 2007;16(2):1759.

Riely CA. Acute fatty liver of pregnancy. Semin Liver Dis. 1987;7:47-54.

Knox TA, Olans LB. Liver disease in pregnancy. N Engl J Med. 1996;335(8):569-76.

Sheehan HL. The pathology of acute yellow atrophy and delayed chloroform poisoning. J Obstet Gynaecol Br Emp 1940;47(1):49-62.

Duma RJ, Dowling EA, Alexander HC, Sibrans D, Dempsey H. Acute fatty liver of pregnancy. Report of a surviving patient studied with serial liver biopsies. Ann Intern Med. 1965;63(5):851-8.

Burroughs AK, Seong NH, Dojcinov DM, Scheuer PJ, Sherlock SV. Idiopathic acute fatty liver of pregnancy in 12 patients. Q J Med. 1982;51(4):481–97.

Vigil-De Gracia P, Lavergne JA. Acute fatty liver of pregnancy. Int J Gynaecol Obstet. 2001;72:193-5.

Ko H, Yoshida EM. Acute fatty liver of pregnancy. Can J Gastroenterol. 2006;20(1):25-30.

Varner M, Rinderknecht NK. Acute fatty metamorphosis of pregnancy. A maternal mortality and literature review. J Reprod Med 1980;24(4):177-80.

Kaplan MM. Acute fatty liver of pregnancy. N Engl J Med 1985;313:367-70.

Schorr-Lesnick B, Lebovics E, Dworkin B, Rosenthal WS. Liver diseases unique to pregnancy. Am J Gastroenterol 1991;86(6):659-70.

Ch’Ng CL, Morgan M, Hainsworth I, Kingham JG. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut. 2002;51(6):876-80.

Pilego Periz AR, Zavala Soto JO, Rodriguez Ballesteros R. Fatty liver of pregnancy. A report of two cases and medical literature review. Gynecol Obstet Mex 2006;74(3):164-9.

Fesenmeier MF, Coppage KH, Lambers DS, Barton JR, Sibai BM. Acute fatty liver of pregnancy in 3 tertiary care centers. Am J Obstet Gynecol 2005;192(5):1416-9.

MacLean MA, Cameron AD, Cumming GP, Murphy K, Mills P, Hilan KJ. Recurrence of acute fatty liver of pregnancy. Br J Obstet Gynaecol 1994;101(5):453-4.