Acute fatty liver of pregnancy fatal complication post-cesarean delivery in low-resource settings, case report, September, 2025

Introduction: Acute fatty liver of pregnancy (AFLP) is a rare but serious obstetric emergency that can lead to liver failure and severe complications for both mother and fetus. In this case, AFLP was diagnosed after a cesarean delivery and resulted in a fatal maternal outcome. The incidence of AFLP is estimated at 1 in 7000 to 20 000 pregnancies. Presentation of Case: A 28-year-old woman underwent an emergency cesarean delivery due to grade III meconium. She had not received antenatal care and presented with jaundice. Following spinal anesthesia, a flaccid neonate was delivered but recovered after resuscitation. Postoperatively, the mother developed anemia, jaundice, and abdominal distension. An exploratory laparotomy revealed internal bleeding. She was diagnosed with AFLP, anemia, and disseminated intravascular coagulation. Despite intensive care and multiple surgical interventions, she developed multi-organ failure and died on the sixth postoperative day. The newborn recovered and was discharged in good health. Discussion: This case highlights the importance of early recognition of AFLP in pregnant women presenting with jaundice. Although rare, AFLP is life-threatening, and prompt delivery is essential. Diagnosis often relies on the Swansea criteria. In this case, delayed diagnosis, lack of antenatal care, and delayed investigations contributed to poor outcomes. Patients with AFLP typically require blood transfusions and intensive care in the ICU. Early intervention significantly improves survival, particularly in resource-limited settings where antenatal follow-up is often inadequate. Conclusion: AFLP requires early recognition and rapid intervention. In emergency situations, clinicians should consider AFLP even when laboratory results are not immediately available. Timely delivery and aggressive management of complications are crucial to safeguard both maternal and neonatal outcomes.