**Core Concept**
Fatty liver of pregnancy, also known as acute fatty liver of pregnancy (AFLP), is a rare but potentially life-threatening condition characterized by the accumulation of fat in liver cells. It typically occurs in the third trimester of pregnancy, leading to liver dysfunction and coagulopathy.

**Why the Correct Answer is Right**
Fatty liver of pregnancy is indeed characterized by **microvesicular fatty change**, which is a distinct histopathological feature. This condition is caused by a deficiency in the beta-oxidation of fatty acids, leading to the accumulation of fat droplets within the hepatocytes. The exact mechanism is not fully understood, but it is believed to be related to a defect in the long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) enzyme, which is involved in the beta-oxidation process.

**Why Each Wrong Option is Incorrect**
**Option A:** While AFLP can occur in the third trimester, it is not exclusive to this period, and symptoms can appear earlier or later in pregnancy.
**Option C:** Lysosomal injury is not the primary cause of fatty liver of pregnancy. The condition is related to a defect in fatty acid metabolism, not lysosomal dysfunction.
**Option D:** Alcohol is not a main cause of fatty liver of pregnancy. The condition is associated with a genetic defect in the LCHAD enzyme, not alcohol consumption.

**Clinical Pearl / High-Yield Fact**
Fatty liver of pregnancy is a medical emergency that requires prompt recognition and treatment. The condition is often associated with a poor prognosis, especially if left untreated.

**Correct Answer:** B. Microvesicular fatty change