Acute Fatty Liver of Pregnancy: An Obstetric Emergency

Acute fatty liver of pregnancy (AFLP) is a rare but serious hepatic disorder associated with significant maternal morbidity and mortality. While hepatic encephalopathy and multiorgan failure are recognized complications, the occurrence of transfusion-related acute lung injury (TRALI) and abdominal compartment syndrome (ACS) in the context of AFLP is rarely reported. We present a case of AFLP complicated by fulminant hepatic failure, hepatic encephalopathy, TRALI, ACS, and multiorgan dysfunction. A young primigravida at 36 weeks of gestation presented to the emergency department with nausea, vomiting, and jaundice. An immediate lower uterine segment caesarean delivery was performed, resulting in the birth of a live male infant. Postoperatively, the patient exhibited progressive deterioration in neurological status, worsening hepatic function, and acute kidney injury, necessitating admission to the surgical intensive care unit. Infectious and metabolic causes of hepatic failure were excluded, and viral hepatitis serologies were negative. She received intensive resuscitation with blood products, intravenous dextrose, and N-acetylcysteine. Abdominal haemorrhage, TRALI, and ACS complicated her clinical course. She progressed to fulminant hepatic failure with associated hypoglycaemia, hypoproteinaemia, hepatic encephalopathy, and ultimately brain herniation. AFLP remains a potentially life-threatening obstetrical emergency. Our patient had two risk factors for AFLP as a primigravida and carrying a male foetus. She had multiple organ failures in addition to TRALI and ACS, leading to a fatal outcome.