| Summary: | Background: The normal serum concentration of alkaline phosphatase (ALP) in adults over the age of 18 ranges from 37 to 116 U/L, while in pregnant women levels of up to twice that upper limit can still be normal. There have been very few reports of extreme elevations in ALP, and here we present the case of a 29-year-old pregnant woman with an incidentally found 30-fold increase. Case: The patient, G6P2–1–2-4, received routine prenatal care, though presented to obstetric triage at 36 weeks and 1 day of gestation for diagnosis and management of viral rhinosinusitis and was found to have an ALP level of 2817 U/L. She was expectantly managed and levels were monitored during the peripartum period. Conclusion: The literature proposes that elevation of the placental isotype of ALP could be a marker for placental insufficiency, preterm delivery, or infants born large for gestational age. We report a case with delivery of a normal infant and no placental pathology at term.
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