Postpartum pneumomediastinum and subcutaneous emphysema

Sagar, Diaeddin; Rogers, Trevor; Adeni, Aldrin

doi:10.1136/bcr-2018-224800

Cited by 4 publications

(2 citation statements)

References 9 publications

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“…pathogenesis of the condition is that the sudden increase in intrathoracic and intra-alveolar pressure from Valsalva leads to alveolar rupture and subsequent leakage of air into the mediastinum and subcutaneous tissue following fascial planes. Case reports have been written about the appropriate diagnosis and management of this rare condition, but to our knowledge no reports have commented on the role of patient position as a possible risk factor [1][2][3][4][5][6][7][8]. The patient presented in this report pushed in an inverted position on hands and knees with her head down for the duration of the second stage of her labor.…”

Section: Initial Diagnostic Evaluationmentioning

confidence: 91%

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Postpartum Spontaneous Pneumomediastinum: Role of Patient Position in Pathologic Process

Lila,

Chloe,

Zimeng

et al. 2023

Obstet Gynecol Cases Rev

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Background: Spontaneous pneumomediastinum (SPM) is rare complication of labor that has been associated with the Valsalva maneuver. While the available literature has elucidated the appropriate diagnosis and management, no reports have commented on patient position as a risk factor for the development of SPM. Case: Herein we present the case of a healthy 29-yearold primigravida who had a spontaneous term vaginal delivery complicated by postpartum development of pneumomediastinum with mild pneumothorax, after pushing in an inverted hands-and-knees position for 3 hours. She was managed conservatively and experienced complete resolution of symptoms without intervention. Conclusions: We argue that the inverted hands-andknees position alters intrathoracic pressure dynamics in a similar manner to the effect of Trendelenburg position on ventilation. We suggest that performing the Valsalva maneuver in this position could increase risk of pulmonary barotrauma, and propose that this is a topic on which further research is indicated.

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Section: Initial Diagnostic Evaluationmentioning

confidence: 91%

“…SPM can be associated with pneumothorax, but this is usually mild and does not require invasive intervention. Management of SPM is conservative in nature consisting of supportive care, although uses of supplemental oxygen and bronchodilators have been reported [1][2][3][4][5][6][7][8].…”

mentioning

confidence: 99%

Postpartum Spontaneous Pneumomediastinum: Role of Patient Position in Pathologic Process

Lila,

Chloe,

Zimeng

et al. 2023

Obstet Gynecol Cases Rev

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Neumomediastino y enfisema subcutáneo espontáneo: síndrome de Hamman

García‐García

Parra-Virto

Galeano‐Valle

et al. 2019

Archivos de Bronconeumología

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Hamman’s Syndrome after Vaginal Delivery: A Case of Postpartum Spontaneous Pneumomediastinum with Subcutaneous Emphysema and Review of the Literature

Olafsen-Bårnes,

Kaland,

Kajo

et al. 2024

Healthcare

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Hamman’s syndrome is a rare condition that mostly affects young males, often with a predisposition to asthma. It includes the presence of free air in the mediastinum and subcutaneous emphysema with no other underlying cause such as trauma, infection, or administration of any sort of mask support with hyperpressure. It occurs spontaneously and often in association with a prolonged Valsalva maneuver. This might explain why there are some cases of Hamman’s syndrome among young females giving birth. Here, we present a case report of a 24-year-old non-smoker primigravida with Hamman’s syndrome. She presented with symptoms a few hours after an uncomplicated vaginal delivery at 40 + 1 weeks of pregnancy where the active phase of labor lasted for three hours with normal progress. The second stage lasted for 30 min, with no signs of distress on CTG. The symptoms (pain in the right ear, swelling and pain in the neck, chest tightness, shortness of breath, dysphagia, odynophagia, and pain in the upper thorax on the right side) and objective findings as subcutaneous crepitations in the neck, parasternal region, right axillary fossa, clavicle and over the chest resolved spontaneously after a few days of observation and conservative management. We also give a systemic review of reported cases since 2000 to provide an overview of the pathomechanism, symptoms, diagnostics, treatment, and management of this condition. Hamman’s syndrome is a rare, usually benign, but potentially serious complication that can occur during the second stage of labor. Diagnostics include inquiring about typical symptoms, clinical examination, and chest x-ray or CT scan. Treatment is usually conservative with oxygen, bronchodilators, and pain relief. The recurrence rate is low and there is no contraindication to vaginal delivery in future pregnancies. However, it is suggested that physicians and midwives be cautious and consider a low threshold for instrumental delivery or cesarean section to avoid excessive Valsalva maneuvers.

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Postpartum pneumomediastinum and subcutaneous emphysema

Cited by 4 publications

References 9 publications

Postpartum Spontaneous Pneumomediastinum: Role of Patient Position in Pathologic Process

Postpartum Spontaneous Pneumomediastinum: Role of Patient Position in Pathologic Process

Neumomediastino y enfisema subcutáneo espontáneo: síndrome de Hamman

Hamman’s Syndrome after Vaginal Delivery: A Case of Postpartum Spontaneous Pneumomediastinum with Subcutaneous Emphysema and Review of the Literature

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