Pneumothorax and Pregnancy: A Systematic Review of the Current Literature and Proposal of Treatment Recommendations

Abstract

Introduction Spontaneous pneumothorax occurs rarely during pregnancy with less than 100 cases reported in the English literature. There is no strong evidence concerning the treatment of spontaneous pneumothorax during pregnancy and labor. The aim of this study is to systematically review all the reported cases and to suggest recommendations for its diagnosis and treatment. Methods A PubMed research was conducted. The following data were collected: maternal age, gestation age (weeks), presence of underlying lung pathology, initial management, definitive management, obstetric outcome, and the complications for the mother and the fetus. Results Eighty-seven cases were identified. The mean maternal age was 27 years (standard deviation [SD] ± 6). The mean gestational age was 25 weeks (SD ± 11.4). In 37.9% of cases, there was no underlying lung disease. In the majority of cases (67.4%), the initial treatment was the placement of a chest tube. In 48% of cases, the pneumothorax was resolved with conservative treatment. Surgical therapy was performed either antepartum or postpartum. In 58.6% of cases, there was a vaginal delivery, spontaneous or instrumental. In three cases (3.4%), there were fetal complications. Conclusion The analysis of the current literature provides low evidence, since there are only case reports and small case series. It is likely that the frequency of this condition is underestimated. However, this analysis permits to draw some conclusions concerning the timing of pneumothorax treatment, the operative strategy, and the mode of delivery to decrease the risk for the mother and the fetus.

Primary Spontaneous Pneumothorax in a 32-Week Complicated Pregnancy

“…PSP during pregnancy is a relatively rare entity, although its exact incidence is unknown and might actually be underestimated in cases of partially collapsed lung or mild clinical symptoms [ 3 ]. Nonetheless, less than 100 cases have been reported in the literature, and medical guidelines to aid clinical management are totally lacking [ 3 ]. PSP usually affects young pregnant women below 30 years of age, during the second and third trimesters of pregnancy [ 3 ].…”

“…Nonetheless, less than 100 cases have been reported in the literature, and medical guidelines to aid clinical management are totally lacking [ 3 ]. PSP usually affects young pregnant women below 30 years of age, during the second and third trimesters of pregnancy [ 3 ]. It is, however, a potentially serious condition for both the pregnant woman and her fetus.…”

“…Vaginal delivery is not contraindicated in case of a successfully treated PSP during pregnancy, but other maternal or fetal indications should be considered. Notably, hyperventilation and Valsalva maneuver during labor are thought to increase the risk for recurrent PSP [ 3 ]. Therefore, the obstetric team should be prepared for this event and a thoracic surgeon should be readily available.…”

“…Naturally, the operation theater should be also informed beforehand, in case that an emergency cesarean section is needed for maternal respiratory compromise and/or fetal hypoxia. Based on the reported cases in the literature, obstetric outcome is generally favorable and fetal complications are rare [ 3 ]. However, publication bias may be heavily affecting the reported outcomes, since all data arise from single-case reports rather than cohort studies or consecutive case series and unfavorable outcomes are less likely to be reported in the literature.…”

Recurrent spontaneous pneumothorax in pregnancy-a case report

“…Spontaneous pneumothorax during pregnancy is a rare clinical entity with only 87 cases been reported in literature till date. 1 Changes in respiratory physiology and limitations on the use of radiological tests, such as chest X-rays and computed tomographic scans as the definitive diagnostic tools make the management more challenging. Impaired ventilation is not as well tolerated during pregnancy due to a decrease in functional residual capacity as well as increased oxygen demand of approximately 20% during pregnancy and 50% during labour.…”