Acute fatty liver of pregnancy is a rare, potentially life-threatening condition with maternal and fetal mortality rates each approaching about 20%. Incidence is 1 in 1000-35 000 deliveries. Etiology is related to defects in fatty acid metabolism. Risk factors include carrying a male fetus, history of preeclampsia, and having multiples.

Patients can present in numerous ways but will usually be in the third trimester or in the immediate postpartum period and have nausea, vomiting, headache, and abdominal pain. The patient likely will be jaundiced. Other symptoms can include fever, decreased urine output or anuria, hypoglycemia, and tachycardia. Cases often rapidly progress to multisystem organ failure including renal failure, gastrointestinal tract bleeding, disseminated intravascular coagulation (DIC), encephalopathy, and pancreatitis.

Fetal mortality is related to metabolic acidosis as a byproduct of maternal metabolic acidosis.  

This can recur in subsequent pregnancies.