Introduction: Acute fatty liver of pregnancy (AFLP), a rare but recognized obstetric and medical emergency, is a catastrophic illness for both the mother and unborn offspring. It develops rapidly in the last trimester of pregnancy and contributes to significant maternal and perinatal mortality. Its demands early diagnosis, immediate delivery of fetus, systematic approach for anticipating complications and dealing with them.

Aim and Objective: To enlighten the varied presentations of this rare entity which help in early diagnosis, prompt delivery and highlighting the importance of supportive care to reduce maternal morbidity and mortality.

Materials and Methods: The authors report an observational case series of patients who developed AFLP and were managed in critical care in a period of 3 months.

Results: A total of three cases of AFLP were diagnosed in a period of 3 months. Nausea, vomiting and anorexia were the most common symptoms. Jaundice was seen in all. Anticipation of the complications like postpartum haemorrhage, DIC, hepatorenal syndrome and sepsis and providing prophylactic treatment in that view can reduce the morbidity and in-hospital days for the patient.

Conclusions: AFLP has significant perioperative mortality and morbidity secondary to renal dysfunction, coagulopathy and massive transfusion related complications. Clinical outcome can be improved by early diagnosis, urgent delivery of fetus and supportive care from multidisciplinary team.