Acute fatty liver of pregnancy. Survival with early cesarean section

We have cared for two women with acute fatty liver of pregnancy in the past two years. Both patients survived as did three of babies. This compares with published mortality rates of up to 85% with this condition. Both patients presented with symptoms and signs of impending liver failure during the third trimester of pregnancy. Both patients were jaundiced, had elevated aminotransferases, leukocytosis, hepatic encephalopathy, and disseminated intravascular coagulation. The diagnosis was confirmed by liver biopsy in both. We attribute the unusually good outcome of these women and their children to early recognition of their disorder and prompt delivery once the diagnosis was considered.