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

Sep 28, 2026

Severe hepatic dysfunction with coagulopathy in late pregnancy is treated as an obstetric emergency because AFLP, HELLP syndrome, and viral or drug-related liver injury can overlap and delayed recognition may be fatal. Recent SARS-CoV-2 infection can further obscure the differential due to potential hepatic effects that mirror pregnancy-related disorders. Prompt diagnosis and expedited delivery are central for reducing maternal and neonatal complications. A 30-year-old primigravida at 34+6 weeks with PPROM, after mild COVID-19 limited to rhinitis, rapidly developed hepatic enzyme elevation, renal impairment, and coagulopathy requiring urgent cesarean delivery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Premature rupture of membranes and PPROM overview

Differential diagnosis for acute hepatic dysfunction and coagulopathy

AFLP and Swansea criteria

HELLP syndrome and Tennessee classification

Role of SARS-CoV-2 infection

Case Presentation

Review began 10/29/2025 Review ended 12/02/2025 Published 12/04/2025 © Copyright 2025 Stagaki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98462 Open Access Case Report 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 Evgenia Stagaki 1, Anna Damatopoulou 1, Nefeli Prompona 1, Marianna Efstratiadou 1 1. Obstetrics and Gynaecology, Venizeleio General Hospital, Heraklion, GRC Corresponding author: Evgenia Stagaki, [eugeniasta9@gmail.com](eugeniasta9@gmail.com) Abstract 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-yearold 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. Categories: Obstetrics/Gynecology Keywords: acute fatty liver of pregnancy, coagulopathy, covid-19, hellp syndrome, hepatic dysfunction, pregnancy complications, preterm premature rupture of membranes Introduction Premature rupture of membranes (PROM) is defined as rupture of the fetal membranes before the onset of labor. When this occurs before 37 weeks of gestation, it is termed preterm premature rupture of membranes (PPROM) . PROM affects approximately 8 % of term pregnancies, and PPROM complicates 2-3% of deliveries in the United States [1] . PROM may precipitate labor, but if labor does not begin spontaneously, the risk of complications, including chorioamnionitis, placental abruption, prematurity, and related fetal morbidity, rises substantially. Management of PPROM depends on gestational age and fetal status. When no contraindications exist, expectant management is recommended, including administration of broad spectrum antibiotics to prolong latency, a single course of antenatal corticosteroids, and screening/prophylaxis for group B streptococci (GBS) [2] . Although infection is the most common maternal complication of PPROM, the sudden onset of marked hepatic dysfunction and coagulopathy is rare and greatly broadens the differential diagnosis. In pregnancy, the principal causes of fulminant hepatic failure are acute fatty liver of pregnancy (AFLP) and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) [3] . AFLP is an uncommon but life-threatening disorder, affecting roughly one in 7,000-20,000 pregnancies, usually in the third trimester. It is characterized by coagulopathy, electrolyte imbalance, and multi-organ failure. Diagnosis relies on the Swansea criteria, which require ≥6 of the following in the absence of another cause: vomiting, encephalopathy, polydipsia/polyuria, abdominal pain, bilirubin >0 .8 mg/dL (14 µmol/L), hypoglycemia <72 mg/dL (4 mmol/L), leukocytosis >11,000/µL, spartate transaminase (AST) or alanine aminotransferase (ALT) >42 IU/L, am

FAQs

Why is severe hepatic dysfunction with coagulopathy considered an obstetric emergency in late pregnancy?

It can present with overlapping features of AFLP, HELLP syndrome, and other liver injuries, and delayed recognition can be fatal. Rapid evaluation is needed to prevent maternal and neonatal complications.

Which pregnancy-related liver conditions are highlighted as principal causes of fulminant hepatic failure?

Acute fatty liver of pregnancy (AFLP) and HELLP syndrome are identified as the principal causes. Each has specific clinical and diagnostic criteria and requires prompt delivery.

How did COVID-19 affect the clinical picture in the reported case?

The patient had a recent mild COVID-19 illness limited to rhinitis, yet developed rapidly progressive hepatic enzyme elevation, renal impairment, and coagulopathy. The case underscores the need for heightened vigilance when hepatic or renal function deteriorates during pregnancy.

Sep 28, 2026

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