A Case Report of Acute Fatty Liver of Pregnancy

Abstract Objective: Report on a rare pregnancy complication. Background: Acute fatty liver of pregnancy (AFLP) is one of the most common causes of acute liver failure during pregnancy, although its incidence is low. The primary pathological change is diffuse microvesicular steatosis of hepatocytes. The manifestations of AFLP are nonspecific, and its diagnosis typically relies on clinical symptoms, laboratory findings, and the Swansea criteria as an auxiliary diagnostic tool. Early diagnosis and timely termination of pregnancy are crucial measures to improve outcomes. Case Description: A 23-year-old woman, at 38+5 weeks of gestation, G1P0, presented with a 10-day history of abdominal distension, nausea, vomiting, and constipation, with only the ability to consume small amounts of liquid food. The patient reported a long-term preference for carbonated beverages and an aversion to drinking plain water. Upon admission, physical examination revealed severe jaundice of the skin and sclera. Laboratory tests indicated elevated liver enzymes, increased total bilirubin, abnormal kidney function, and coagulopathy. Abdominal ultrasound revealed abnormalities. The patient’s Swansea score was 6, leading to a diagnosis of AFLP, and an emergency cesarean section was performed. The patient’s liver enzymes improved within a day post-surgery, but persistent coagulopathy postoperatively led to the development of an abdominal subcutaneous hematoma. After treatment with clotting factor supplementation, coagulation function gradually improved within four days. Conclusion: Early detection and timely termination of pregnancy can improve outcomes in cases of AFLP. Post-cesarean section, vigilance is required for persistent coagulopathy, which may lead to the development of abdominal subcutaneous hematomas.