Acute fatty liver of pregnancy (AFLP) is a rare, potentially fatal obstetric emergency. Due to its nonspecific signs and symptoms, there is often a delay in diagnosis and management which is associated with morbid complications and high mortality. We report a case of a 30-year-old female gravida 3 para 2 at 32 weeks gestation who presented with nausea and vomiting for two weeks, pruritis for three days, and upper abdomen pain for a day. A clinical diagnosis of HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome/obstetric cholestasis/AFLP was made. Despite prompt management, her postpartum period was complicated by acute hepatic encephalopathy, hepatorenal shutdown, pancreatitis, coagulopathy, postpartum hemorrhage, and large abdominal wall hematoma. A high index of suspicion, prompt delivery, advanced critical support, and multidisciplinary team involvement led to successful fetomaternal outcomes in the patient.