Her liver function tests were markedly deranged, ALT 629 unit/L, AST 796 unit/L, Urate 497 umol/L with raised urea and creatinine of 154umol/L. Prior to admission patient had regular antenatal visits, with no history of any medical disorder. On examination her reflexes were normal and had no clonus.

Patient tested positive for Covid-19. She was started on Labetalol 200mg twice daily. Provisional diagnosis of preeclampsia complicated by HELLP syndrome was made. Bedside ultrasound scan of upper abdomen showed signs of fatty liver, normal gallbladder and common bile duct. Her case was discussed amongst a multidisciplinary team of Obstetricians, Medical physicians, Anaesthesiologists and Haematologists in view of significant transaminitis, hyperbilirubinemia, deranged coagulation with acute kidney injury (AKI) and relatively well controlled blood pressure.

Decision to proceed with induction of labour was taken with a diagnosis of Covid-19 with AFLP and AKI. She had a central line inserted and was given 2g Fibrinogen, 10mg Vitamin K and 1g Tranexamic acid to optimize coagulation profile. Her labour progressed well after artificial rupture of membranes and a live male infant was delivered by forceps with pudendal block for abnormal fetal blood sample. Postpartum she was transferred to general hospital for ICU care where she responded well to supportive care.