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Acute Fatty Liver of Pregnancy: Report of a Surviving Patient Studied with Serial Liver Biopsies

R. J. DUMA, M.D.; EDMUND A. DOWLING, M.D.; H. C. ALEXANDER, M.D.; DYRC SIBRANS, M.D.; and HUGH DEMPSEY, M.D., F.R.C.P.(C), F.A.C.P.
Ann Intern Med. 1965;63(5):851-858. doi:10.7326/0003-4819-63-5-851
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Fatty metamorphosis of the liver associated with acute liver failure, fatal to both mother and child, was first recognized in 1934 (1). Several years later Sheehan (2) described the clinical features of this unusual syndrome and distinguished its characteristic liver histology from that of infectious hepatitis and acute yellow atrophy in pregnancy. Clinically the disorder is manifested between the thirty-sixth and fortieth week of pregnancy by the sudden onset of epigastric pain and vomiting. In rapid progression the mother suffers intense jaundice, headache, precipitous labor, and delivery of a stillborn fetus, followed by hematemesis, deepening coma, and death, usually before

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