INTRODUCTION AND IMPORTANCE: Acute fatty liver of pregnancy (AFLP) is a rare and potentially life-threatening condition that typically manifests in the third trimester. Its nonspecific presentation often overlaps with other hepatic disorders of pregnancy, complicating timely diagnosis. Prompt recognition and intervention are vital to reduce maternal and fetal morbidity and mortality.

CASE PRESENTATION: A case of 29-year-old primigravida at 36 weeks' gestation who presented with progressive malaise, jaundice, confusion, and signs of hepatic and renal dysfunction is reported. Laboratory evaluation revealed severe coagulopathy, hypoglycemia, elevated liver enzymes, and acute kidney injury. The Swansea criteria supported the diagnosis of AFLP. An emergency cesarean section was performed, followed by intensive care unit admission for multidisciplinary supportive care. The patient demonstrated a favorable clinical recovery and was discharged in stable condition on postoperative day 14.

CLINICAL DISCUSSION: AFLP is closely associated with defects in mitochondrial fatty acid oxidation, particularly involving the LCHAD enzyme. Early signs such as jaundice, encephalopathy, and metabolic disturbances should prompt suspicion. In this case, the fulfillment of eight Swansea criteria and timely cesarean delivery were critical to patient survival. Aggressive management of coagulopathy and hypoglycemia in the ICU setting facilitated a successful outcome. This report underscores the need for heightened clinical vigilance and the utility of Swansea criteria in AFLP diagnosis.

CONCLUSION: This case highlights the importance of early recognition and intervention in AFLP, especially when complicated by severe coagulopathy. Prompt delivery and intensive supportive care remain the cornerstone of management.