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Pregnancy Prolongation After Eculizumab Use in Early-Onset Preeclampsia

Lu, Angela B. MBBS; Lazarus, Benjamin MBBS, MPH; Rolnik, Daniel L. MD, PhD; Palmer, Kirsten R. MBBS, PhD

doi: 10.1097/AOG.0000000000003570
Contents: Hypertension: Case Report
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BACKGROUND: Untreated microangiopathic hemolytic anemia in pregnancy is associated with adverse maternal and perinatal outcomes. Accurate diagnosis is challenging owing to nonspecific clinical features and pathologic findings. Timely initiation of appropriate management is essential to optimize maternal and perinatal outcomes.

CASE: A 26-year-old primiparous woman presented at 20 weeks of gestation with new-onset microangiopathic hemolytic anemia on a background of poorly controlled type 1 diabetes. She received eculizumab for presumed atypical hemolytic uremic syndrome. At 24 weeks of gestation, she developed superimposed early-onset preeclampsia; she delivered at 27 weeks of gestation after continuing eculizumab.

CONCLUSION: Eculizumab may prolong pregnancy in early-onset preeclampsia. Additional research is needed to assess short-term and long-term maternal and newborn outcomes.

Eculizumab may contribute to pregnancy prolongation in early-onset preeclampsia owing to its role in complement inhibition.

Departments of Obstetrics & Gynecology and Nephrology, Monash Health, Victoria, Australia.

Corresponding author: Angela B. Lu, MBBS, Department of Obstetrics & Gynecology, Monash Health, Clayton, Victoria, Australia; email: angela_b_lu@hotmail.com.

Financial Disclosure Kirsten R. Palmer disclosed receiving money paid to her from Monash Health and Monash University. Money was paid to her institution from Equity Trustees, and Glaxo Smith Kline provided a grant to her institution, Monash University. The other authors did not report any potential conflicts of interest.

The authors thank Melinda Tee for comments on the manuscript, Ian Simpson for renal biopsy images and assessment, and Saskia Rowson for the sFlt-1 and PlGF analysis.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B599.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.