Abstract: Objective The prognosis of patients with acute fatty liver of pregnancy (AFLP) have dramatically improved, and the main purpose of this study was to summarize the clinical feature shift of the entity in the past two decades. Method The clinical data of patients with AFLP in Beijing You'an Hospital were retrospectively analyzed, and 25 patients in group A were encountered in this hospital between January 2002 and December 2011, and other 28 patients in group B were from January 2012 to January 2022. The clinical manifestations, complications and mortalities in the two groups were compared, and the causes of death were analyzed. Results There was no significant difference respect to serum bilirubin levels in the two groups [(239.8±104.2)μmol/l vs. (161.9±107.7 )μmol/l, P=0.052], while the incidence of abnormal liver function tests in group A was 12.0%, significantly lower than 42.9%(P=0.006) in group B, the cesarean section in group A was 76.0%, much lower than 100.0%(P=0.020) in group B, the incidences of disseminated intravascular coagulation (DIC, 40.0% vs. 3.6%, P=0.001) and the hemorrhagic shock (24.0% vs. 3.6%, P=0.028) were significantly different; the maternal fatality in group B was 3.6%, much lower than 24.0% in group A. Conclusion The leading causes of maternal death in patients with AFLP ten years ago were DIC and massive hemorrhage, while the liver failure is common in recent ten years although the mortality falls dramatically, and the early diagnosis and management is still important.

Key words: Acute fatty liver of pregnancy, Postpartum hemorrhag, Disseminated intravascular coagulation, Liver failure, Mortality