elevated liver enzymes

[momonbedrest]

i am 35 wks pregnant. i have been on bedrest since 26 wks for preterm labor. in the past week my bp has increased. there is no protein in my urine but my ob thinks i likely have preeclampsia. my uric acid is borderline. my ast is 41 and alt 67 (both elevated). however, my hbg, platelet count, pt, and ptt are normal. i have slight headache and nausea but no abdominal pain. am i developing hellp or are the elevated liver enzymes related to the preeclampsia?

thanks

[laura]

Hey there! I've been thinking about your post for a couple of days-

It's really important that we answer questions like yours... but we're not doctors, so we have to be really careful not to give out incorrect information or try to be presumptious and guess what may be going without being a doc and without looking at your records and labs. I did look up some of the information about Hellp in a really good PE book I have, but you can't just go by that, you have to call your doc and have them explain your labs to you, and explain the rationale behind their treatment plan.

Hellp stands for Hemolysis, ELevated liver enzymes,and LP low platelets. It is my understanding that you don't necessarily have to have all parts of the syndrome to be diagnosed, but I'm not sure exactly what that means. Does matching one of the criteria count? I'm not sure. In Chesley's Hypertensive Disorders of Pregnancy (p 219) they list the criteria for diagnosis of HELLP:

Hemolysis:
Abnormal peripheral smear (schistocytes, burr cells)
Lactate dehydrogenase (LDH)> 600 U/L or bilirubin >1.2 mg/dL

Elevated Liver Enzymes:
Asparate amniotransferase (AST) > 70 U/L

Low Platelets
Platelet count < 100,000 uL
(postscript mentioned, these "... represent an average twice the upper limits of normal at Univ. Tenn for LDH and AST")

So, I have two main thoughts on your question 1) you really have to understand the context of all your labs before you can make a guess, and 2) your provider has some explaining to do. Abnormal liver labs aren't so great. Elevated liver enzymes aren't great. If you are developing Hellp you should be inpatient in the hospital. I don't know enough about each labs' signifigance to say which one is the most important- just that we don't want to mess around with our livers, especially in pregnancy. I hope that right now you are well and healthy, and please check in and tell us what happens!

take care, and I hope this helped a little[:)]

Laura-28
DH Jack-30
Allie 5-13-98 (35 weeks-pre-e)
Baby Camille 4-17-03 (36 weeks- htn and oligo)
http://www.babiesonline.com/babies/c/camilleandallie/

[sweetiesuzy]

Laura -

I have to get that book!

Suz

"Go confidently in the direction of your dreams. Live the life you've imagined." - Thoreau

DS 3/25/95
DD Stillbirth 10/26/01
DS 12/30/02

[laura]

Suz- hon, it's awesome. Camille is seven months on Monday, and I'm starting to forget all the things I learned when I was pregnant. I got it on EBAY!!![:D][:D][:D]

Laura-28
DH Jack-30
Allie 5-13-98 (35 weeks-pre-e)
Baby Camille 4-17-03 (36 weeks- htn and oligo)
http://www.babiesonline.com/babies/c/camilleandallie/

[akemt]

And its name is???

Catherine (22)
DH Britton (27)
Emma Margaret (03/02/03) 37 weeks from PIH & oligo

[ileana]

Chesley's Hypertensive Disorders in Pregnancy - Lindheimer, Roberts, Cunningham, 1999
ISBN 0-8385-3970-X

Note that this is a medical textbook... Normal human beings, like me, will find it very hard to read (normal medical info obfuscation)

For the ones that need an easier reading:
"Pre-eclampsia - The facts - Chris Redman, Isabel Walker, 1992

ISBN 0-19-262012-6
ISBN 0-19-262013-4 (paperback)

This quite an old book, and libraries are withdrawing it, so you might get it cheap from a library. Also note that it's more than 10 years old, so not everything (studies) is up to date, but I wished I had this book when I got pregnant.


Ileana 33
Angel stillborn 24w p-e 2/17/03

[laura]

WHERE did you find the Redman book? I've been looking for it for a year now?!

It's lovely to know that I'm NOT Normal![:)] There are some chapters in Chesley's that have me stumped, but overall, it's not so bad. Great reference book. Does that make me a superhero? Mighty Morphin Power Ranger? Every woman?

Woohoo!!!

Laura-28
DH Jack-30
Allie 5-13-98 (35 weeks-pre-e)
Baby Camille 4-17-03 (36 weeks- htn and oligo)
http://www.babiesonline.com/babies/c/camilleandallie/

[ileana]

I preordered Redman's on Amazon. It was used in a library. I had to wait about 5 months, but I eventually got it! [:)] And I liked it a lot!

You are our superhero! [:D] Why read the book when we have Laura interpret it for us?

If you look for specific things, Chesley's is ok, but I tried reading a page at a time at night, and eventually got bored to death, I don't remember the exact chapter... Actually I think it the one that made the connection with cholesterol... That knocked me down!





Ileana 33
Angel stillborn 24w p-e 2/17/03