The Intern At Work: Internal Medicine De-Liver: It's Crucial
Mar 8, 2026
A focused clinical dive into acute fatty liver in pregnancy, exploring fetal–maternal fatty acid oxidation defects and why it presents in the third trimester. Quick guidance on assessing maternal and fetal stability and the key lab and imaging clues that raise concern. Practical discussion of risk stratification, urgent delivery timing, postpartum complications, newborn screening, and emerging diagnostic and therapeutic ideas.
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AFLP Is A Third Trimester Microvesicular Steatosis
- Acute fatty liver of pregnancy (AFLP) is a rare, pregnancy-specific microvesicular steatosis causing liver failure that typically occurs in the third trimester.
- It arises from impaired fatty acid beta-oxidation leading to toxic metabolites that cause multi-organ fatty infiltration and rapid deterioration.
Fetal LCHAD Deficiency Drives Maternal AFLP Risk
- Fetal and placental defects in long-chain fatty acid beta-oxidation (eg LCHAD deficiency) can dump toxic metabolites into maternal circulation and precipitate AFLP.
- Up to ~20% of AFLP cases are linked to fetal LCHAD deficiency; other risk factors include nulliparity, male fetus, low maternal BMI, multifetal pregnancy, and hypertensive disorders.
Stabilize Both Patients And Call A Multidisciplinary Team
- Stabilize both mother and fetus first and involve multidisciplinary care including MFM, obstetric internal medicine, anesthesia, ICU, and NICU.
- Early detection and active management have reduced maternal mortality to roughly 2–12% and fetal mortality to 10–15% in recent series.