Hydatid disease is a parasitic infestation of humans caused by Echinococcus granulosus. The incidence in pregnancy in endemic areas is approximately 1 in 20 000. Due to the rarity of this condition in the UK, patients with hydatid disease in pregnancy require multidisciplinary care. With changing immigration patterns, there is a necessity for obstetricians to be more aware of the clinical features, diagnosis and treatment of this previously unusual disease.
We report a case of a patient originating from South Africa, who presented at 7 weeks gestation with abdominal pain and fever. The diagnosis of liver hydatid cyst was confirmed by ultrasound. This lady was jointly managed throughout her pregnancy by obstetric and medical teams in both London and Northern Ireland. At 34 weeks gestation, she underwent a PAIR procedure with adjuvant anti helminthic therapy in London. A live female infant was delivered successfully by caesarean section at 38 weeks gestation. Her postnatal recovery was uncomplicated.
There is no consensus regarding management of these patients in pregnancy, and each case should be individualised. During pregnancy, hydatid cysts may grow bigger due to decreased cell immunity and the humoral effects of placental steroids. There is a risk of cyst rupture due to compression of the enlarging uterus with consequent catastrophic anaphylaxis.
In summary, the treatment of hydatid disease during pregnancy is challenging. The emphasis in this case focused on a multidisciplinary approach, using centres of excellence throughout the U.K, resulting in a successful outcome.
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