Acute Fatty Liver of Pregnancy

A patient in late pregnancy who develops persistent vomiting, profound fatigue, abdominal or right upper quadrant pain, jaundice, hypoglycaemia and a rising INR may be developing acute fatty liver of pregnancy (AFLP), even if AST and ALT are only moderately elevated. The experienced nurse notices the mismatch: the liver is failing, but the transaminases do not look dramatic. Falling glucose, impaired clotting, altered mentation and reduced urine output carry more urgency than the enzyme numbers alone. Normal blood pressure does not exclude AFLP. That matters because the learned reflex for a sick third-trimester patient with upper abdominal pain is to look for preeclampsia, and a normal reading can falsely reassure the team. AFLP is both an obstetric emergency and an acute liver failure emergency. Stabilization begins immediately, and delivery is the definitive obstetric intervention. Delivery removes the pregnancy-related trigger, but it does not immediately reverse organ dysfunction, so intensive monitoring continues after birth.