A rare case of spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in the II stage of labour

Abstract

BackgroundPneumomediastinum associated with pneumothorax and subcutaneous emphysema also known as Hamman's syndrome is a rare obstetric complication that usually happens during the second stage of labor. The causal mechanism of Hamman’s syndrome is thought to be due to excessive intrathoracic pressure associated with Valsalva maneuver which leads to distal alveolar rupture. The released alveolar air from alveolar rupture dissects along the vascular sheets down a pressure gradient toward the pulmonary hila and into the mediastinum. Prognosis is generally favorable. Case presentationWe report the case of physiologic pregnancy in a multipara parturient, which was complicated in the late second stage of labor with subcutaneous emphysema, pneumomediastinum, and severe pneumothorax. Recovery occurred after seven days of active management and a chest tube insertion. No complications were seen afterwards. ConclusionPneumomediastinum associated with pneumothorax and subcutaneous emphysema in the absence of an obvious precipitating cause is a rare obstetric complication and is called “Hamman’s syndrome”. The incidence of relapse is unknown, due to the number of reported cases. It could be reasonable to develop a delivery plan at 37 weeks of gestation for women with the history of Hamman syndrome. In case of tendency for a large fetus it might be wise to consider earlier induction of childbirth. Non-aggressive management of the second period of childbirth is recommended. In case of prolonged labour surgical delivery by caesarean section could be considered.