Severe preeclampsia with hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a leading cause of maternal and neonatal morbidity and mortality worldwide. Occurrence at an extremely premature gestational age is most challenging as there are dichotomous imperatives: delivery as definitive therapy for maternal health vs. prolongation of pregnancy to avoid prematurity and associated morbidities. We describe a patient presenting with severe preeclampsia/HELLP syndrome at 26 weeks gestation that was treated with Eculizumab, a targeted inhibitor of complement protein C5, which resulted in marked clinical improvement and complete normalization of lab parameters. Pregnancy was prolonged 17 days, likely resulting in a reduction of neonatal morbidity with its associated short and long-term health care costs. Successful use of Eculizumab in this case suggests that complement inhibition may be an effective treatment strategy for severe preeclampsia/HELLP syndrome.
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