Two Lives Delivered, One Crisis Emerging: Acute Fatty Liver Unveiled

Abstract

Background: Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening obstetric emergency that typically occurs in the third trimester, though postpartum presentations are increasingly recognized.

Case Presentation: We report the case at University of Hospitals Birmingham (UHB) NHS Trust, a 32-year-old primigravida with a twin pregnancy at 38 weeks gestation who developed acute onset jaundice and malaise within hours of delivery. Laboratory investigations revealed markedly elevated liver enzymes (AST 1020 U/L, ALT 950 U/L), hyperbilirubinemia (7.2 mg/dL), hypoglycemia (48 mg/dL), coagulopathy (INR 2.8), and renal dysfunction, consistent with acute fatty liver of pregnancy. The patient exhibited rapid clinical deterioration requiring transfer to the intensive care unit. Multidisciplinary management, including correction of metabolic abnormalities and supportive care, resulted in gradual clinical and biochemical improvement over the subsequent days.

Conclusion: AFLP can present in the immediate postpartum period and should be suspected in patients with acute hepatic dysfunction, particularly in the context of twin pregnancies. Early diagnosis and prompt multidisciplinary management are essential to prevent life-threatening complications and ensure favorable maternal outcomes.