ACUTE FATTY LIVER OF PREGNANCY: A Cryptic Disease Threatening Mother and Child

Abstract

Acute fatty liver of pregnancy (AFLP) is a rare and potentially devastating disease, revealed by an episode of fulminant hepatic failure in the final weeks of pregnancy, with microvacuolar fatty transformation of liver cell cytoplasm and, in most patients, with a spontaneous recovery postpartum. It generally appears between weeks 30 and 38, although exceptionally it may become apparent immediately after delivery because of the aggravation of previously undetected or wrongly interpreted symptoms in late pregnancy. Synonymous names, such as acute yellow atrophy of the liver in pregnancy and acute obstetric fatty metamorphosis of the liver, have been replaced progressively in the literature by the term acute fatty liver of pregnancy.8, 25, 29, 36, 37, 38, 39, 41, 42, 48 This article reviews clinical experience with 15 patients attended in the author's hospital since 1975 (the first 11 cases were reported previously36) and compares other series and case reports recollected from the literature.