Spontaneous intra-partum pneumothorax and subcutaneous emphysema

Fatima and Irvine present a case of a 26-year-old primigravida who was admitted at 42 weeks in spontaneous labor to a low risk birthing unit. Postnatally, the patient was reviewed by the anesthetist and physicians and a diagnosis of spontaneous pneumothorax with subcutaneous emphysema was made clinically and confirmed by chest X-ray. As it was a very small pneumothorax and the patient was haemodynamically stable, conservative management was appropriate. The mechanism of development of pneumomediastinum and subcutaneous emphysema involves rupture of peripherally situated alveoli because of the Valsalva maneouvre resulting from bearing down and pushing efforts in the second stage. They also highlights the importance of a significant, although rare complication of the second stage of labor.