Intrapartum Fetal Heart Rate Anomalies in Acute Fatty Liver of Pregnancy: A Case Report and Pathophysiological Insights

Abstract – Introduction: Acute fatty liver of pregnancy (AFLP) is a rare but potentially life-threatening obstetric condition characterized by maternal hepatic dysfunction and risk of rapid clinical deterioration. In this setting, fetal hypoxia may develop through multiple mechanisms, including maternal metabolic acidosis, hypovolemia, and placental fatty acid accumulation. These factors may impair oxygen transfer, partly through alterations in the Bohr-Haldane effect, ultimately compromising fetal oxygenation. Case Presentation: We report a case of AFLP complicated by fetal heart rate abnormalities in the context of maternal hepatic failure. The clinical course was characterized by progressive maternal metabolic derangement and signs of fetal compromise. The observed fetal heart rate anomalies were interpreted in light of impaired maternal-fetal oxygen exchange, likely related to a combination of metabolic acidosis and reduced placental perfusion. Conclusion: This report highlights the pathophysiological mechanisms underlying fetal heart rate abnormalities in AFLP, emphasizing the role of maternal metabolic acidosis and placental hypoperfusion in the development of fetal hypoxia. Greater awareness of these mechanisms may facilitate earlier recognition and timely management of fetal compromise in this rare but critical condition.