Cardiac instability due to Pneumomediastinum during second stage of labour

Abstract

This case reports spontaneous pneumomediastinum in the second stage of labour leading to cardiovascular instability. Forceps were used to expedite delivery. Examination revealed characteristic crepitus of subcutaneous emphysema in the neck region, which was confirmed on chest X-Ray and CT scan. The patient was managed in the high dependency unit (HDU) for 48 hours and made a full recovery.Case report:An 18-year-old primigravida was admitted to hospital in established labour at 40 weeks of gestation.She had an uneventful antenatal period with no significant past medical or surgical history. Her personal history revealed she smoked 5 cigarettes a day with cannabis. The first stage of labour lasted for 15 hours and she received epidural analgesia. Labour was augmented with oxytocin. After thirty minutes into the active second stage, the patient began to complain sudden sharp central chest pain. Her pulse rate was 147/min, normal blood pressure and O 2 saturations were normal at 99% in air. The epidural was topped up and forceps were used to expedite delivery. The second stage lasted for one hour. She delivered a healthy male baby weighing 3742 grams. The APGAR scores were 8 and 9 at 1 and 5 minutes respectively. The severity of chest pain decreased over the next 30 minutes.An ECG was requested, which showed sinus tachycardia of 150/min.One hour post-delivery, her vital signs suddenly become unstable with blood pressure at 79/35

Postpartum pneumomediastinum manifested by surgical emphysema. Should we always worry about underlying oesophageal rupture?

“…Only a single case manifesting as a tension pneumomediastinum with cardiovascular instability in the second stage of labour has been reported 8. The patient recovered following intravenous fluid resuscitation and no surgical intervention was required.…”

“…Many case reports reflect this and often oesophageal contrast studies and occasionally CT have been performed 8 9…”