Severe Hepatic Enzyme Elevation and Coagulation Abnormalities in a Pregnant Woman With Recent COVID-19 Infection and Preterm Premature Rupture of Membranes: A Case Report

Severe hepatic dysfunction with coagulopathy in late pregnancy is an obstetric emergency with overlapping clinical features. Acute fatty liver of pregnancy (AFLP), HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), and viral or drug-related liver injury must be considered, as delayed recognition can be fatal. Recent SARS-CoV-2 infection may further obscure the clinical picture, given its potential hepatic effects and overlap with pregnancy-related disorders. Prompt diagnosis and expedited delivery remain the cornerstone of management to prevent maternal and neonatal complications. Here, we describe a 30-year-old primigravida at 34 + 6 weeks' gestation who presented with preterm premature rupture of membranes (PPROM) and, despite a recent mild COVID-19 illness limited to rhinitis, developed rapidly progressive hepatic enzyme elevation, renal impairment, and coagulopathy requiring urgent cesarean delivery. This case highlights the need for heightened vigilance, rapid multidisciplinary evaluation, and timely intervention when hepatic or renal function deteriorates in pregnancy.