22years old female at 37weeks gestation was admitted with abdominal pain, vomiting icterus and pedal edema. Clinical examination was unremarkable with normal blood pressures and no bleeding manifestations externally.Investigations showed bilirubin of 9mg/dl, SGOT200U/L, SGPT215U/L, fibrinogen 51mg/dl, ammonia-46mcg/dl, HC03-7millimoles/ l,platelets of 1,80,000 and no clot formation in Prothrombin time.LSCS was done under GAwith controlled ventilation after 4units of FFP transfusion and multiple blood products- FFP, cryoprecipitates, packed cells transfused.Postoperatively patient developed Acute kidney injury, for which Hemodialysisinstituted and continued for 10days.Patient dischargedfollowing recovery of renal and liver functions after 45 days. Thesecond case presented with similar clinical profile, with Bilirubin of 19mg/dlhad persistent severe lactic acidosis, required higher inotropicsupport, progressiveworsening of liver andrenal functiontests not amenable to corrective measures leading to mortality. The third patient presented without coagulopathy in spiteof elevated bilirubin and liver enzymes. Prophylactic vitamin K therapygiven andlscs done under spinal anesthesia. Patient had uneventful postoperative course withnormal LFT.

Patients with AFLP have significant perioperative mortality and morbidity secondary to renal dysfunction, coagulopathy and massive transfusion related complications. Early recognition, urgent delivery of fetus and multidisciplinary approach with supportive care improved clinical outcome inour patients.