Acute fatty liver disease of pregnancy (AFLP) occurs in about 1 per 10,000 pregnancies characterized by hepatic microvesicular steatosis and manifests in the third trimester. Without early diagnosis and treatment (fetal delivery), the patient may develop acute liver failure and hepatic encephalopathy. It is more common in primiparas, in twin pregnancies, and in patients who have preeclampsia. AFLP is a mitochondrial disorder [11] related to inherited mutations that cause a defi ciency of the long-chain 3-hydroxyacyl coenzyme A dehydrogenase (LCHAD), a fatty acid beta-oxidation enzyme. When a heterozygous mother has a fetus that is homozygous for these mutations, the fetus is unable to metabolize longchain fatty acids; these acids accumulate in the fetus and spill over into the materna l circulation [12] . Th is mutant gene and defi cient coenzyme product leads to accumulation of long-chain fatty acid metabolites that are hepatotoxic [13] .