Abstract: Objective To discuss the anesthesia for emergency caesarean section in patients with acute fatty liver of pregnancy (AFLP). Methods A retrospective analysis on the clinical characteristics and per-operative treatments of patients with AFLP who receiving cesarean section in our hospital from January 1996 to January 2012. Results Primipara accounted for 73.7%. Symptoms include malaise, nausea, vomiting and jaundice. Laboratory results indicated liver function abnormalities, coagulopathy, hypoglycemia and acute renal injury. There occurred two maternal deaths (10.5%), but no fetal deaths. Six cases (31.5%) received epidural anesthesia, nine patients (47.3%) underwent general anesthesia and four patients (28.6%) received combined anesthesia. There were no anesthetic complications. Conclusions AFLP is a rare but life-threatening complication in late pregnancy. Anesthesia selection should be individualized on the basis of coagulation. General anesthesia is the first choice for the patient with severe coagulopathy.