Elevated liver enzymes and high blood pressure can occur during pregnancy in a condition called the HELLP syndrome, although the overwhelming majority of pregnant women do not develop this medical disorder. While the treatment is to deliver as soon as possible, the physician may also need to lower the blood pressure and stop or prevent the onset of seizures.
The HELLP Syndrome
Preeclampsia describes the medical disorder in which a pregnant woman has protein in her urine, swelling and high blood pressure. It may affect a young woman who has never been pregnant before; however, it can also affect women who have had several pregnancies and are age 35 and older. This condition develops in approximately 5 to 7 percent of all pregnancies, according to David Miller, M.D. in "Current Diagnosis & Treatment: Obstetrics & Gynecology." The HELLP syndrome can develop in preeclampsia and eclampsia, which is the term for preeclampsia occurring with seizures.
Elevated Liver Enzymes and High Blood Pressure
The term HELLP syndrome stands for hemolysis, elevated liver enzymes and low platelets. Most women also have high blood pressure. Hemolysis means the red blood cells are being destroyed and the destruction can be so severe that 54 to 86 percent of the women with HELLP become anemic, according to "Williams Hematology." The lab may also detect that the liver enzymes have increased 100 times their normal values, or even higher. How low the platelets drop can be associated with the problems that the mother and baby will have during delivery and right afterward, how fast they recover and the likelihood of it occurring again.
Liver Enzymes
The liver enzymes are aspartate aminotransferase and alanine aminotransferase. Usually referred to as AST and ALT, these proteins are found inside cells. AST is found inside the cells of the liver, as well as the heart, skeletal muscle and kidneys. ALT is mainly in the liver cells. A small amount of AST and ALT is also in the bloodstream; the normal range is 0 to 35 U/L. More of these enzymes will escape to the bloodstream when damage occurs to cell membranes. Thus, damage to the liver can cause an increase in liver enzymes.
High Blood Pressure
Even though the mother's blood pressure may be before pregnancy, with preeclampsia, eclampsia and the HELLP syndrome, it can rise to 140/90 mm Hg or higher, remaining at least this high at two different readings, from 6 hours to 7 days apart. High blood pressure can affect the brain, eyes, heart and kidneys. A pregnant woman with the HELLP syndrome can feel confused, have severe headaches, nausea, vomiting, various vision problems and not have to urinate as often as normal. A stroke can occur, but this is rare. Blood pressure medication may be needed.
References
- "Current Diagnosis & Treatment: Gastro, Hepatology, & Endoscopy"; Norton Greenberger, M.D.; 2009
- "Current Diagnosis & Treatment: Obstetrics & Gynecology"; Alan DeCherney, M.D. et al.; 2007
- MayoClinic.com; Preeclampsia; April 2011
- "Pocket Guide to Diagnostic Tests"; Diana Nicoll, M.D., Ph.D., Stephen McPhee, M.D. et al.; 2007
- "Tintinalli's Emergency Medicine: A Comprehensive Study Guide"; Judith Tintinalli, M.D. et al.; 2004
- "Williams Hematology"; Marshall Lichtman, M.D., Thomas Kipps, M.D. et al.; 2010
