Summary: This is a case report of a spontaneous pneumomediastinum and surgical emphysema in a 32-year-old woman presenting a few hours after forceps vaginal delivery with symptoms of chest tightness, shortness of breath and swelling in the neck, which resolved with conservative management. It is a rare but potentially dangerous complication of labour, which can be accurately diagnosed with clinical features and chest X-ray. The treatment is conservative as it is usually self-limiting and recurrence in subsequent pregnancies is extremely rare.Keywords: high-risk pregnancy, thoracic medicine, pneumomediastinum CASE REPORTA 32-year-old fit and well Caucasian woman with an uneventful pregnancy presented in spontaneous labour at 40 weeks. This was her second pregnancy and the previous was a miscarriage at eight weeks. She was a non-smoker and her body mass index was 23. The progress in the first stage was good and lasted 10 hours. She had an epidural for analgesia and after one hour of passive descent started pushing. The baby weighing 4.2 kg was delivered by forceps due to failure to progress after 1 and a 1/2 hours of pushing.Twelve hours after delivery, she reported swelling in the neck, chest tightness and shortness of breath. Her vital signs were stable and oxygen saturation on air was 98%. On examination, there was subcutaneous crepitus in the neck and chest. Chest auscultation revealed bilateral decreased air entry. Chest X-ray was performed which showed pneumomediastinum and minimal pneumothorax (Figure 1). She was reviewed by the medical team and a diagnosis of Hamman's syndrome was made. She was managed conservatively and the symptoms slowly settled over the next two days. Subcutaneous emphysema continued to resolve and repeat chest X-ray after 72 hours revealed resolving pneumomediastinum. She was discharged home with no other postpartum problems. The six-week postnatal check showed complete resolution of subcutaneous emphysema.

Summary: We present a case report of a successful pregnancy outcome in a woman diagnosed with Ehlers -Danlos syndrome (EDS) hypermobility type or type III. EDS is a group of connective tissue disorders that has a common genotypic defect, but heterogeneous phenotypic presentations. The variation in EDS manifestations can result in moderate to severe effects on life-expectancy for some types. A number of studies and a review of the literature indicate that generally in pregnant women with EDS, maternal and neonatal outcomes are favourable. However, in EDS type IV, pregnancy can be associated with serious maternal complications. Therefore, obstetrical management should be individualized. This paper discusses the obstetric management of a patient with EDS hypermobility type and compares it to other studies in the literature.

Obesity in women, a global issue, is being widely managed with bariatric surgery worldwide. According to recommended guidelines, pregnancy should be avoided for 12 to 24 months following surgery due to various risks. We assessed if surgery-to-conception time has a relation with pregnancy outcomes taking into account gestational weight gain. A cohort study between 2015 and 2019 followed-up pregnancies after various types of bariatric surgeries performed (e.g. Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding, gastric bypass with Roux-en-Y gastroenterostomy) in Tawam Hospital, Al Ain, United Arab Emirates. There were 5 surgery-to-conception groups: <6 months, 6 to 12 months, 13 to 18 months, 19 to 24 months, and >24 months. There were 3 gestational weight gain groups: inadequate, adequate, or excessive (based on the National Academy of Medicine classification). Maternal and neonatal outcomes were compared using analysis of variance and chi-square tests. There were 158 pregnancies. Booking maternal body mass index and weight were higher among mothers who conceived <6 months following surgery (P < .001). Gestational weight gain was not related to the type of bariatric surgery (P = .24), but it was far more often inadequate in mothers who conceived <12 months following surgery (P = .002). Maternal (including pregnancy-induced hypertension and gestational diabetes mellitus) and neonatal outcomes were not statistically significantly associated with surgery-to-conception duration. However, birth weight was lower when gestational weight gain was inadequate (P = .03). There is a negative relationship between shorter bariatric surgery-to-conception interval and gestational weight gain, a feature related to neonatal birth weight. Conception should be delayed to improve pregnancy outcomes following bariatric surgery.