Hello and welcome to the Zero to Finals podcast. My name is Tom and in this episode I'm going to be talking to you about acute fatty liver of pregnancy.

And you can find written notes on this topic at zero definals.com slash acute fatty liver or in the antinatal care section of the zero definals,

obstetrics and gynecology book. So let's get straight into it. Acute fatty liver of pregnancy is a rare

condition that occurs in the third trimester of pregnancy. There is a rapid accumulation of fat within the liver cells or the hepatocytes

causing acute hepatitis or inflammation of the liver.

There is a high risk of liver failure and mortality

for both the mother and the fetus.

Let's talk about the pathophysiology.

Acute fatty liver of pregnancy results from impaired processing of fatty acids in the placenta.

This is the result of a genetic condition in the fetus that impairs fatty acid metabolism.

The most common cause is long chain three hydroxioceal co-a dehydrogenase deficiency in the fetus,

which is an autosomal recessive condition.

This mode of inheritance means the mother will also have one defective

copy of the gene. This enzyme, long chain three hydroxia seal co-a-dehydrogenase, is important in fatty

acid oxidation, breaking down fatty acids to be used as fuel. The fetus and the placenta are

unable to break down fatty acids. These fatty acids enter the maternal circulation and accumulate

in the liver. The mother's defective copy of the gene may also contribute to the accumulation of

fatty acids. The accumulation of fatty acids.

The accumulation of fatty acids in the mother's liver leads to inflammation and liver failure.

Let's talk about the presentation. The presentation of acute fatty liver of pregnancy is with vague symptoms associated with hepatitis

or inflammation in the liver with general malaise and fatigue nausea and vomiting jaundice

abdominal pain anorexia which is a loss of appetite andites, which is fluid building up in the peritoneal cavity,

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