Overview
A 31-year-old woman in her first pregnancy (primigravida), at 36 weeks of gestation, presented to SGVP Holistic Hospital with Acute Fatty Liver of Pregnancy (AFLP), a rare but potentially life-threatening obstetric emergency that most commonly occurs during the third trimester of pregnancy.
AFLP is an uncommon pregnancy-related liver disorder that can rapidly progress to maternal liver dysfunction, acute kidney injury, coagulopathy, multi-organ failure, and fetal loss if not recognized and treated promptly.
Early diagnosis, timely delivery, and coordinated multidisciplinary management are essential for achieving successful maternal and neonatal outcomes.
Patient Presentation
The patient presented with multiple severe complications, including:
- Acute Fatty Liver of Pregnancy (AFLP)
- Severe Acute Kidney Injury (Serum Creatinine approximately 3 mg/dL)
- Markedly deranged liver function tests with elevated liver enzymes
- Hyperuricemia
- Recurrent hypoglycaemia
- Intrauterine Growth Restriction (IUGR)
Considering the rapidly deteriorating maternal condition and fetal compromise, the case required immediate multidisciplinary intervention.
Clinical Challenges
At presentation, the patient was critically ill and at high risk of:
- Progressive liver dysfunction
- Worsening acute kidney injury
- Severe coagulation abnormalities
- Maternal haemorrhage
- Fetal compromise
- Multi-organ failure
Prompt clinical decision-making and close collaboration between multiple specialties were essential to safeguard both mother and baby.
Treatment & Multidisciplinary Management
Following comprehensive evaluation, the multidisciplinary team performed an emergency Lower Segment Cesarean Section (LSCS) to save both mother and baby.
A healthy baby girl weighing 2.3 kg was delivered successfully.
Following delivery, the mother required intensive monitoring and advanced critical care support, including:
- Intensive Care Unit (ICU) management
- Blood component therapy
- Fresh Frozen Plasma (FFP)
- Cryoprecipitate transfusion
- Platelet transfusions
- Continuous monitoring of liver and kidney function
- Correction of coagulation abnormalities
- Comprehensive multidisciplinary critical care
Additional Complications Successfully Managed
The patient’s recovery was further complicated by:
- Immediate postpartum haemorrhage (PPH)
- Late postpartum haemorrhage
Both complications were successfully managed with conservative treatment and close clinical monitoring.
Outcome
Through early diagnosis, prompt emergency delivery, advanced critical care, and coordinated multidisciplinary management:
- A healthy baby girl weighing 2.3 kg was delivered safely.
- Maternal liver and kidney dysfunction were successfully managed with intensive supportive care.
- Immediate and delayed postpartum haemorrhage were effectively controlled using conservative management.
- Blood component therapy and continuous multidisciplinary monitoring supported maternal recovery.
- Both mother and baby recovered successfully following comprehensive treatment.
Why This Case Was Significant
Acute Fatty Liver of Pregnancy (AFLP) is a rare but potentially fatal obstetric emergency, occurring in approximately 1 in 7,000 to 1 in 20,000 pregnancies. It most commonly develops during the third trimester, particularly in first pregnancies (primigravida), and can rapidly progress to maternal liver dysfunction, kidney injury, coagulopathy, multi-organ failure, and fetal loss if not recognized promptly.
This case highlights how:
- Early diagnosis can be lifesaving.
- Timely emergency delivery improves maternal and fetal outcomes.
- Multidisciplinary critical care is essential for managing complex obstetric emergencies.
- Blood component therapy plays a vital role in correcting coagulation abnormalities.
- Coordinated teamwork across specialties can successfully manage even the most challenging high-risk pregnancies.
Multidisciplinary Team Behind the Successful Outcome
This successful outcome was made possible through the coordinated efforts of the multidisciplinary team at SGVP Holistic Hospital, including:
- Department of Obstetrics & Gynaecology
- Department of Anaesthesiology
- Intensive Care Unit (ICU)
- Department of Gastroenterology
- Department of Paediatrics & Neonatology
- Operation Theatre Team
- Medical Officers
- Nursing Team
- Blood Bank Services
Their timely collaboration, clinical expertise, and coordinated decision-making were instrumental in achieving a successful maternal and neonatal outcome.
Key Learning Points
- Acute Fatty Liver of Pregnancy (AFLP) is a rare but life-threatening condition that requires immediate medical attention.
- The condition most commonly occurs during the third trimester and is seen more frequently in first pregnancies.
- Early recognition, timely delivery, and multidisciplinary care are crucial for improving outcomes for both mother and baby.
- Comprehensive critical care, blood component therapy, and coordinated management can successfully treat even severe maternal complications.
Case Summary
| Condition | Acute Fatty Liver of Pregnancy (AFLP) |
| Patient | 31-year-old Primigravida |
| Gestation | 36 Weeks |
| Complications | AKI, Liver Dysfunction, Coagulopathy, Hypoglycaemia, IUGR, PPH |
| Intervention | Emergency LSCS + ICU Care |
| Outcome | Mother and Baby Recovered Successfully |
