Acute Fatty Liver of Pregnancy

In 1940 Sheehan¹called attention to six patients who developed jaundice in the third trimester of pregnancy and died within three days after delivery. The course in these cases was similar to that of fulminant hepatitis, but histologic examination of the liver revealed no hepatocellular necrosis, little or no inflammatory reaction, and many small intracytoplasmic lipid-laden vacuoles arranged about a centrally placed, normal nucleus. He considered these findings to be a distinct histologic entity which he termed "obstetric acute yellow atrophy." Others subsequently referred to it as "acute fatty metamorphosis of the liver associated with pregnancy"²and "acute fatty liver of pregnancy."³ To date at least 39 patients with this syndrome have been described.¹⁻¹⁶Eight others are known to have been studied but not reported.²,³,⁵,¹⁷The cases presented by Barry and O'Dwyer,¹⁸Dill (case VI),¹⁹and Cullinan (case A)¹¹also may be