Acute Fatty Liver of Pregnancy

A woman near term who develops persistent vomiting, abdominal or right-upper-quadrant pain, jaundice, hypoglycaemia, and a rising INR may be developing acute fatty liver of pregnancy (AFLP), even if her 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. AFLP is both an obstetric and acute-liver-failure emergency. Stabilisation begins immediately, but definitive treatment requires delivery of the fetus and placenta. Delivery removes the pregnancy-related source of hepatotoxic fatty-acid metabolites; it does not eliminate the need for intensive monitoring, because some patients worsen after birth.