Postpartum Spontaneous Pneumomediastinum: Role of Patient Position in Pathologic Process

Abstract

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.