Acute fatty liver of pregnancy (AFLP) is a rare and potentially life-threatening condition characterized by maternal hepatic failure and evolving fetal hypoxia resulting from different mechanisms that include impaired Bohr-Haldane effect, maternal hypovolemia, and placental fatty acid accumulation resulting in impaired oxygenation of the fetal hemoglobin. This manuscript highlights the pathophysiological basis of fetal heart rate anomalies observed in AFLP and contributes to the limited literature emphasizing the role of maternal metabolic acidosis and placental hypoperfusion in determining fetal hypoxia.
Dall'Asta et al. (2026) studied this question.