Pregnancy-related acute liver failure with HELLP–AFLP overlap requiring intensive care

Pregnancy-related acute liver failure is an uncommon but life-threatening obstetric emergency that may overlap with HELLP syndrome and disseminated intravascular coagulation. We describe a patient presenting in presenting at 36 weeks of gestation with fever, jaundice, severe anemia, thrombocytopenia, markedly elevated bilirubin, acute kidney injury, and profound coagulopathy. Imaging revealed fetal growth restriction with oligohydramnios and mild ascites. A diagnosis of HELLP syndrome with acute liver failure and multiorgan dysfunction was considered. The patient required intensive critical care management including massive transfusion support, N-acetylcysteine therapy, correction of coagulopathy, and continuous multidisciplinary monitoring. She underwent vacuum-assisted vaginal birth after previous cesarean delivery, complicated by postpartum hemorrhage and transient respiratory compromise. With aggressive ICU-based supportive care, hepatic and renal function gradually improved, and she was discharged in stable condition. This case highlights the importance of early recognition and critical care intervention in pregnancy-associated acute liver failure.