Acute fatty liver of pregnancy: etiology of fetal distress and fetal wastage.

Acute fatty liver is a rare complication of pregnancy occurring in approximately one in 13,000 deliveries. This disease has been associated with high maternal and fetal mortality rates in the past. Advances in medical care and early recognition and delivery are credited with recent reductions in the maternal and fetal loss seen with this disease. Maternal death is associated with hypoglycemia, hepatic failure, or coagulopathy. The etiology of fetal mortality is not well delineated. Reported is a patient with histologically proved acute fatty liver who developed fetal distress during therapy for coagulopathy. Review of the fetal monitor tracing in conjunction with examination of the placenta have led us to propose that uteroplacental insufficiency may be the cause for fetal distress and fetal wastage in fatty liver of pregnancy.