EC Clinical and Medical Case Reports

Introduction: Acute fatty liver of pregnancy (AFLP) is a rare but serious condition that can pose a risk to both the mother and baby. It usually occurs in the third trimester and shows vague symptoms that can quickly lead to problems with multiple organs. Quick identification and a team approach to care are crucial for better outcomes for both the mother and fetus, especially in areas with limited resources.

Case Summary: A 26-year-old woman, who has had three pregnancies and two births, came to the hospital in her third trimester. She was experiencing vomiting, abdominal pain, jaundice, and confusion. She met more than ten Swansea criteria, which confirmed she had AFLP along with disseminated intravascular coagulation (DIC), acute liver failure, and acute kidney injury. Doctors performed an emergency cesarean section. One twin needed resuscitation but did not survive because of a poor APGAR score. The second twin stayed clinically stable. The mother received intensive supportive care, including transfusions and treatment for her confusion. She showed gradual clinical improvement.

Conclusion: This case highlights the vital role of early diagnosis and teamwork in treating AFLP, especially when there are complications like DIC and organ failure. Access to high-dependency and intensive care services was crucial for achieving positive outcomes for both mothers and newborns. The experience at St. Peter Specialized Hospital shows the challenges and the possibility for successful treatment in places with limited resources.

 Keywords: Acute Fatty Liver of Pregnancy; Disseminated Intravascular Coagulation; High Dependency Unit; Multidisciplinary Management; St. Peter Specialized Hospital

1. Liu J., et al. “Acute fatty liver disease of pregnancy: updates in pathogenesis, diagnosis, and management”. American Journal of Gastroenterology 6 (2017): 838-846.
2. Nelson David B., et al. “Acute fatty liver of pregnancy”. Clinical Obstetrics and Gynecology1 (2020): 152-164.
3. Ramanathan R., et al. “Mitochondrial dysfunction plays central role in nonalcoholic fatty liver disease”. International Journal of Molecular Sciences13 (2022): 7280.
4. Terrault NA and Williamson C. “Pregnancy-associated liver diseases”. Gastroenterology1 (2022): 97-117.e1.
5. Donck M., et al. “Acute fatty liver of pregnancy - A short review”. Australian and New Zealand Journal of Obstetrics and Gynaecology 2 (2021): 183-187.
6. Stroes ES., et al. “Acute pancreatitis, and familial chylomicronemia syndrome”. New England Journal of Medicine19 (2024): 1781-1792.
7. Nguyen PN and Ho QN. “Acute fatty liver disease in full-term pregnancy”. Journal of Medical Case Reports 1 (2025): 326.
8. Byrne JJ., et al. “Comparing acute fatty liver of pregnancy from HELLP syndrome”. Journal of Maternal-Fetal and Neonatal Medicine 7 (2022): 1352-1362.
9. Martin JN Jr and Tucker JM. “Missing or making the timely diagnosis of acute fatty liver of pregnancy (AFLP): lessons learned”. Journal of Maternal-Fetal and Neonatal Medicine18 (2022): 3595-3601.
10. Zhang L., et al. “Coagulopathy in acute fatty liver of pregnancy: Clinical course and management”. Thrombosis and Haemostasis 2 (2024): 210-218.
11. Suzuki K., et al. “Coagulation abnormalities in acute fatty liver of pregnancy: Distinguishing from primary DIC”. Journal of Thrombosis and Haemostasis1 (2025): 52-61.
12. Anand R., et al. “Disseminated intravascular coagulation in obstetric emergencies: Differentiating etiologies and outcomes”. Thrombosis Research 192 (2020): 135-142.
13. Vaduva C., et al. “Pregnancy-related acute pancreatitis and its overlap with acute fatty liver of pregnancy”. Clinical Case Reports4 (2024): e8956.
14. Kothari P., et al. “Acute pancreatitis in pregnancy: Rare differential and complication of acute fatty liver of pregnancy”. World Journal of Clinical Cases2 (2024): 245-252.
15. Westbrook R and Williamson C. “Pancreatic and hepatic complications of pregnancy”. Best Practice and Research Clinical Gastroenterology 1 (2016): 103-116.
16. Nelson HD., et al. “Effectiveness and harms of contraceptive counseling and provision interventions for women: a systematic review and meta-analysis”. Annals of Internal Medicine 7 (2022): 980-993.
17. Kumar A., et al. “Therapeutic plasma exchange in acute fatty liver of pregnancy: a case report and literature review”. Pan African Medical Journal 40 (2021): 220.
18. Wu Zhenping., et al. “Treating acute fatty liver of pregnancy with artificial liver support therapy: Systematic review”. Medicine38 (2018): e12473.
19. Hadi Y and Kupec J. “Fatty liver in pregnancy”. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing (2025).
20. Lee R., et al. “Acute fatty liver of pregnancy with transient resolution preceding postpartum liver failure requiring liver transplant”. Case Reports in Perinatal Medicine 1 (2024): 20240028.
21. Rath W., et al. “HELLP syndrome or acute fatty liver of pregnancy: a differential diagnostic challenge”. Geburtshilfe und Frauenheilkunde 5 (2020): 499-507.
22. Li L., et al. “The assessment in patients with acute fatty liver of pregnancy treated with plasma exchange: a cohort study of 298 patients”. BMC Pregnancy and Childbirth1 (2023): 171.
23. Tesfaye G., et al. “Maternal outcomes of acute fatty liver of pregnancy in tertiary hospitals in Ethiopia: a retrospective review”. Ethiopian Journal of Health Sciences4 (2022): 421-428.
24. Okafor UV., et al. “Acute fatty liver of pregnancy: diagnostic and management challenges in a Nigerian tertiary hospital”. African Journal of Reproductive Health3 (2021): 112-118.