Acute fatty liver of pregnancy is a rare disease of pregnancy that occurs with greater preponderance during the third trimester. Its etiology is unknown, but there is evidence of a micro vesicular fat deposit in the hepatocyte. It has a maternal-fetal mortality up to 20% because the only treatment is to end gestation. We present a case of a 28-year-old pregnant woman, with 36 weeks of pregnancy, who had abdominal pain associated with general malaise, nausea and vomiting. Laboratory tests showed liver profile alteration, renal failure and coagulopathy. Abdominal ultrasound showed fatty liver infiltration. Support management and correction of hemodynamic disorders were provided. The final management was emergency caesarean section to avoid fetal death as a dreaded complication. The patient was discharged with improvement of clinical symptoms and laboratory alterations.

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