فهرست نشریات علمی دسترسی آزاد ایران

Acute Fatty Liver of Pregnancy (AFLP) is a rare but life‑threatening medical and obstetric condition that affects women late in pregnancy. It has a rapid course with multisystem dysfunction and is associated with high maternal and perinatal mortality. The pathophysiology of this condition has been linked to fetal genetic defects in mitochondrial beta‑oxidation of fatty acids, resulting in the accumulation of fatty acid metabolic intermediates that burden maternal hepatic metabolism. The hallmark histopathological finding is hepatic microvesicular fatty infiltration. Early diagnosis, prompt delivery, and supportive liver care are crucial factors in management to prevent acute hepatic failure.  Unfortunately, its early clinical manifestations may resemble those of normal pregnancy, which can delay diagnosis. As the disease progresses, the clinical presentation may be confused with conditions more commonly seen during pregnancy, such as severe preeclampsia, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, or hyperemesis gravidarum. The Swansea criteria have been developed as a noninvasive diagnostic approach, but they may correlate more with patients later in the disease course, potentially resulting in delayed diagnosis. Ultrasound and MRI may demonstrate increased liver echogenicity or fatty infiltration, but these findings are nonspecific and not diagnostic. Similarly, liver biopsy may be impractical and unsafe, particularly in patients with underlying coagulopathy.  In this review, we present an overview focusing on current pathophysiological aspects and the ongoing diagnostic challenges of AFLP.