Acute fatty liver of pregnancy (AFLP) is a dreaded complication seen mostly in the third trimester of pregnancy. It carries significant perinatal and maternal mortality and requires early diagnosis and intervention to prevent maternal and fetal death. If untreated, AFLP can lead to complications, such as, disseminated intravascular coagulation (DIC), renal failure, clotting disorders and coagulopathy, hypoglycemia, fulminant hepatic failure, and eventually multiorgan dysfunction. Even though induction of labor with delivery remains the only real cure for this disease, some other therapies for complicated cases include plasmapheresis with renal replacement, and the use of molecular absorbent recirculating system (MARS). Orthotopic liver transplantation has proved to be effective in cases that progress to multiorgan failure despite aggressive therapy. Here, we present two cases who presented to the hospital with near term pregnancies and features of AFLP. Both the patients rapidly worsened postpartum due to persistent bouts of hypoglycemia and rapidly developing fulminant hepatic failure. Despite all our efforts, both the patients expired a few days after admission.
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