Delayed Emergence From Anesthesia as the First Manifestation of Acute Fatty Liver of Pregnancy: A Case Report

Acute fatty liver of pregnancy (AFLP) is a rare obstetric emergency that may present with nonspecific symptoms and rapidly progress to multiorgan failure. We report a 37‐year‐old woman at 37 weeks’ gestation who underwent urgent cesarean delivery under general anesthesia for nonreassuring fetal status. Despite appropriate anesthetic management and neuromuscular reversal, she exhibited delayed emergence with persistent unresponsiveness. Initial anesthetic and neurologic evaluations were unrevealing. Subsequent investigations demonstrated lactic acidosis, hepatic dysfunction, hyperammonemia, hyperuricemia, coagulopathy, renal dysfunction, and hepatic steatosis on imaging, fulfilling Swansea criteria for AFLP. The patient received multidisciplinary intensive care, including ventilatory, hemodynamic, and metabolic support, with complete maternal recovery; the neonate remained well. This case highlights delayed emergence due to AFLP‐related encephalopathy and underscores the importance of considering pregnancy‐specific acute liver failure in parturients with unexplained postoperative unconsciousness after common anesthetic causes have been excluded.