AP in pregnancy

Q: 24 year female at 34 weeks of pregnancy is admitted to ICU with exacerbation of asthma which is getting better. Routine labs showed three times higher than normal value of Serum alkaline phosphatase (AP). All other lab values are in normal range. What should be your next step?

A) STAT ultrasound of the liver
B) Emergent delivery of the baby
C) Check for HELLP syndrome
D) No intervention at this time
E) Check Hepatitis panel


Answer: D

Pregnancy may affect liver function test, particularly serum alkaline phosphatase. Total serum AP goes up to 3-4 times higher than normal, particularly in the third trimester. This is due to placental alkaline phosphatase. The best approach is to look at serum gamma-glutamyl transpeptidase (GGTP) level, which usually gets lower in pregnancy. This may help to confirm placental source of AP. In the absence of no other findings, there is no reason to go behind a million dollar workup.

Ultrasound of liver can be considered but there is no need for STAT order (choice A)

Patient's clinical situation is improving. Until and unless there is no harm anticipated to baby, there is no need to rush for delivery (choice B)

With normal platelet count and other LFTs in normal range, it is unlikely to be HELLP syndrome (choice C).

With no abnormality in AST, ALT, and bilirubin, hepatitis is very unlikely (choice E)


#Ob-gyn
#hepatology


Reference:

Bacq Y, Zarka O, Bréchot JF, et al. Liver function tests in normal pregnancy: a prospective study of 103 pregnant women and 103 matched controls. Hepatology 1996; 23:1030.