Acute fatty liver of pregnancy is more frequently associated with first pregnancies, twin gestations, and male fetuses. It generally occurs late in the third trimester or in the immediate post-partum period. Histologic features include microvesicular steatosis and ballooning hepatocyte degeneration. This high power view shows involvement of pericentral hepatocytes. The image also shows bile canalicular plugs as well as hypertrophied Kupffer cells with lipofuscin pigment.