Abdominopelvic hydatid disease during pregnancy: a systematic review of the literature.

Objective: To review the available literature on abdominopelvic cystic echinococcosis (CE) during pregnancy, focusing on clinical presentation, diagnostic approaches, management strategies, and maternal and foetal outcomes. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Studies reporting abdominopelvic hydatid disease in pregnant women were included without restrictions on study design or geography. Results: Fifty-one studies (45 case reports and 6 case series) including 79 patients were analysed. The mean maternal age was 28 years (range 15-42). Most patients with reported clinical-presentation data were symptomatic (56/67, 83.6%), commonly presenting with right upper quadrant or nonspecific abdominal pain. Ultrasound was the primary diagnostic modality (50/52, 96.1%), while MRI was used in selected cases. The liver was the most frequently involved site (50/72, 69.4%), followed by pelvic and adnexal locations. Surgical intervention was performed in 38.5% of cases, conservative management in 30.8%, and cyst aspiration in 14.1%. Surgery was often timed during caesarean section or the second trimester. Benzimidazole therapy was administered to 31 patients, most commonly during pregnancy. Caesarean delivery occurred in 43.3% and vaginal delivery in 34.3% of cases. Adverse pregnancy outcomes included miscarriage (4.5%), termination of pregnancy (3.0%), one maternal death (1.5%), and one neonatal death (1.5%). Among the 36 pregnancies with reported gestational age at delivery, 13 (36.1%) resulted in preterm birth. Conclusion: Abdominopelvic CE during pregnancy is rare and clinically challenging, with substantial heterogeneity in presentation and management across the published literature. Given the limited available evidence, management should be individualised within a multidisciplinary team, while prospective international registries are needed to strengthen the evidence base.