Education  |   March 2019
Acute Fatty Liver of Pregnancy: Pathophysiology, Anesthetic Implications, and Obstetrical Management
Author Notes
  • From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.E.N., L.R.L., H.V.C.); the Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine (K.J.G.), the Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), and the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (B.T.B.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.
  • This article is featured in “This Month in Anesthesiology,” page 5A.
    This article is featured in “This Month in Anesthesiology,” page 5A.×
  • Submitted for publication January 3, 2018. Accepted for publication November 13, 2018.
    Submitted for publication January 3, 2018. Accepted for publication November 13, 2018.×
  • Address correspondence to Dr. Naoum: 55 Fruit Street, GRB 444, Boston, Massachusetts 02114. eminaoum@gmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Gastrointestinal and Hepatic Systems / Obstetric Anesthesia / Clinical Focus Review
Education   |   March 2019
Acute Fatty Liver of Pregnancy: Pathophysiology, Anesthetic Implications, and Obstetrical Management
Anesthesiology 3 2019, Vol.130, 446-461. doi:10.1097/ALN.0000000000002597
Anesthesiology 3 2019, Vol.130, 446-461. doi:10.1097/ALN.0000000000002597
Acute fatty liver of pregnancy is a potentially morbid obstetric complication characterized by acute hepatic failure secondary to fatty infiltration of the liver. The resultant effects include coagulopathy, electrolyte abnormalities, and multisystem organ dysfunction. Management of this condition requires an anesthesiologist’s understanding of both its pathophysiology and its obstetric impact for appropriate recognition and management.
Acute fatty liver of pregnancy was once considered to be extremely rare; however, with increased awareness and improved prenatal care and testing, the diagnosis is made earlier, and milder cases are recognized. The prevalence is now estimated to be 1 to 3 cases per 10,000 deliveries.1–4  Estimates of the mortality rate for acute fatty liver of pregnancy range widely. Data from publications in the 1980s suggested mortality rates in excess of 70%,5  but more recent estimates are dramatically lower—around 2%.1,6,7  The recognition of milder presentations, early intervention and delivery, and aggressive management of complications have likely contributed to a decreased mortality rate.