Acute fatty liver

• Incidence ~ 1:10,000 pregnancies
• Associated with obesity and multiple pregnancy
• More common with male fetuses (3x) and in primigravidae
• Associated with 10-20% maternal mortality and 20-30% perinatal mortality
• Typically presents in the third trimester with malaise, anorexia, nausea and vomiting and epigastric pain and profound hypoglycaemia

• Hypertension and proteinuria may be present and the woman may be jaundiced. 

The woman may develop fulminant hepatic failure with encephalopathy. 

There is also an association with diabetes insipidus
• Ultrasound scan shows fatty infiltration of the liver although it may be normal
• Liver biopsy is the gold standard for diagnosis though rarely needed

• Main differential diagnosis is HELLP syndrome