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Review
. 2025 May 8:1753495X251338746.
doi: 10.1177/1753495X251338746. Online ahead of print.

Acute fatty liver in pregnancy presenting in the second trimester: A systematic literature review

Laurence Bourque  1 , Michèle Mahone  1   2
Affiliations
Review

Acute fatty liver in pregnancy presenting in the second trimester: A systematic literature review

Laurence Bourque et al. Obstet Med. .

Abstract

Objective: We present clinical features and outcomes of second-trimester acute fatty liver of pregnancy (AFLP), a serious but rare condition.

Results: Fourteen pregnant women with AFLP or compatible biopsy were identified in the literature. Diagnosis occurred between 20 and 27 + 6 weeks of gestational age. In total, 50% were primigravid. Thirteen cases met the Swansea criteria while the other case had a compatible liver biopsy. In total, 10 out of 11 cases had microvesicular steatosis on their liver biopsy. Common maternal complications included acute renal failure, hypoglycaemia, liver failure, encephalopathy, intensive care unit admission and need for blood transfusions. Seven deliveries were on the day of diagnosis, five within four weeks, and two within three months. One maternal death, seven fetal deaths and three neonatal deaths occurred.

Conclusion: AFLP diagnosed in the second trimester is a rare condition. Neonatal mortality and maternal morbidity are high. Most cases had nonspecific symptoms and clinical findings, but a majority had compatible biopsies.

Keywords: Acute fatty liver of pregnancy.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA 2020 flow diagram for systematic review.
See this image and copyright information in PMC

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