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It may rapidly progress to hepatic failure and death. Acute fatty liver may be uncommon (1 in 13,328 deliveries), but is important, having a maternal mortality of 18% and fetal mortality of fat white girls 23%. The etiology is unknown, but the microvesicular fat that accumulates in hepatocytes probably represents disordered intermediary fat metabolism, perhaps related to mitochondrial injury. Acute fatty liver of pregnancy almost invariably presents in the third fat white girls trimester, with a peak frequency around 36-37 fat white girls weeks gestation. Occasionally, it will become apparent only after delivery. There is an association with nulliparity, twin gestations, male fetus and pre-eclampsia or eclampsia. Presentation can vary from nonspecific symptoms to fulminant hepatic failure. Nausea and vomiting with or without abdominal pain are common.
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