Acute fatty metamorphosis of pregnancy is a rare but very serious pregnancy complication with an extremely high fetal (85%) and maternal (75%) mortality rate. The abrupt onset of severe and persistent vomiting near term is followed by jaundice within several days. Symptoms progress rapidly, with coagulopathies, deterioration of mental status and renal failure common. Often the patients appear to have preeclampsia. Treatment rests on meticulous attention to metabolic management. The 61st histologically documented case is presented and the clinical and laboratory features of the disease discussed.