Acute Fatty Liver in Pregnancy: Literature Review

Acute fatty liver of pregnancy (AFLP) is a rare but potentially life-threatening obstetric emergency that typically arises in the third trimester. Although uncommon, its rapid onset, multisystem involvement, and historically high mortality make it an essential condition for clinicians to recognize and manage promptly. Its pathogenesis has been linked to defects in fatty acid metabolism and an abnormality in mitochondrial beta oxidation is a recognised cause of AFLP in a subset of cases. The clinical significance of AFLP lies in its dramatic course and overlap with other hepatic disorders of pregnancy such as haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, preeclampsia, and viral hepatitis. Misdiagnosis or delayed recognition can result in rapid maternal and fetal deterioration. Early suspicion, timely diagnosis, and expedited delivery have transformed outcomes over the past few decades in reducing maternal and perinatal mortality. AFLP is associated with multi-organ dysfunction. Hepatic complications include jaundice, coagulopathy, hypoglycaemia, and fulminant liver failure. Systemic complications frequently reported are acute kidney injury, disseminated intravascular coagulation, pancreatitis, sepsis, and encephalopathy. Obstetric complications include postpartum haemorrhage and preterm delivery, while fetal complications range from intrauterine growth restriction and hypoglycaemia to intrauterine death. Intensive care admission is often required, and in rare cases liver transplantation may be necessary when hepatic failure does not reverse after delivery. Despite its severity, prognosis has improved dramatically with heightened clinical awareness and advances in perinatal and critical care. Maternal survival rates now improve especially in tertiary centres with timely diagnosis and intervention. Fetal prognosis is closely tied to early delivery, usually by induction or caesarean section depending on maternal and fetal stability. Fetal prognosis remains more guarded, with outcomes influenced by gestational age at diagnosis, intrauterine compromise, and neonatal complications of prematurity. AFLP represents a rare but critical complication of pregnancy, demanding rapid recognition and multidisciplinary management. Its importance is underscored not only by its acute threat to maternal and fetal survival but also by its link to underlying metabolic disorders with intergenerational implications. Literature over the recent few years demonstrates significant progress in survival outcomes, yet ongoing challenges include improving diagnostic accuracy, clarifying genetic risk, and standardizing management strategies across diverse healthcare settings. Continued research into early biomarkers, targeted therapies, and global epidemiological patterns will be vital for further improving prognosis and reducing preventable maternal and perinatal morbidity and mortality.