Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 19-35: Acute Fatty Liver of Pregnancy + Key Features Download Section PDF Listen +++ ++ Acute liver failure in the third trimester of pregnancy Mortality of 7–23% with early delivery Likely cause is the result of poor placental mitochondrial function Many cases may be due to fetal long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency Fatty engorgement of hepatocytes seen on CT of liver and on biopsy Incidence of 1:14,000 deliveries + Clinical Findings Download Section PDF Listen +++ ++ Gradual onset of flu-like symptoms Progression to jaundice, encephalopathy, disseminated intravascular coagulation, and death Signs of liver failure are present on examination All etiologies of acute liver failure should be considered, but transaminase levels are lower (500–1000 units/mL) in acute fatty liver of pregnancy + Diagnosis Download Section PDF Listen +++ ++ Marked elevation of alkaline phosphatase Only moderate alanine aminotransferase and aspartate aminotransferase elevations Hypocholesterolemia and hypofibrinogenemia are typical Coagulopathy is also frequently seen with depressed procoagulant protein production Kidney function should be assessed for hepatorenal syndrome White blood cell count is elevated; platelet count is depressed Hypoglycemia may be extreme + Treatment Download Section PDF Listen +++ ++ Intensive supportive care with ICU-level observation is essential and typically includes administration of blood products and glucose as well as correction of acidemia Diagnosis mandates immediate delivery, preferably vaginally Rare cases of liver transplantation have been reported Resolution of encephalopathy occurs over days and laboratory derangements occurs over days with supportive care Recurrence rates are unclear