Acute Fatty Liver of Pregnancy Presenting With Isolated Nausea and Vomiting in the Third Trimester: A Case Report.

Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening obstetric emergency occurring in the third trimester. Its non-specific presentation frequently overlaps with other pregnancy-related conditions, leading to diagnostic delay and increased maternal and fetal morbidity and mortality. We report the case of a 27-year-old primigravida at 38 + six weeks of gestation presenting with isolated nausea and vomiting, without abdominal pain, hypertension, proteinuria, or obstetric complaints. Clinical examination revealed mild jaundice and stable hemodynamics. Initial laboratory investigations demonstrated leukocytosis, hepatic cytolysis, hyperbilirubinemia, coagulation abnormalities, and hypoglycemia. Repeat testing within 10 hours showed rapid biological deterioration with worsening leukocytosis, acute kidney injury, and progressive coagulopathy. In the absence of thrombocytopenia and hypertension, and with fulfillment of eight Swansea criteria, AFLP was strongly suspected. Emergency cesarean section was performed for maternal indication, with prophylactic perioperative coagulation support. A female neonate weighing 2,440 g was admitted briefly to the neonatal intensive care unit for transient respiratory distress. Postpartum maternal recovery was rapid, with normalization of all biological parameters, and both patients were discharged in good condition. AFLP remains a diagnostic challenge due to its non-specific presentation. Early recognition using the Swansea criteria, prompt delivery, and multidisciplinary supportive care are essential to optimize outcomes. Neonatal metabolic screening for fatty acid oxidation disorders should be systematically considered.