Post partum pneumothorax: two case reports and discussion

Spontaneous pneumothorax following caesarean section under spinal anaesthesia

“…The possible proposed mechanisms which can increase the risk of bleb rupture during pregnancy include valsalva manoeuvre during spontaneous labour, increased minute ventilation of pregnancy and positive pressure ventilation during general anaesthesia 4. Reported risk factors for pneumothorax during pregnancy include underlying respiratory infection, bronchial asthma, hyperemesis gravidarum, prior history of pneumothorax, cocaine and ecstasy abuse, iatrogenic causes (insertion of central venous line) and endotracheal intubation with positive pressure ventilation 3 5…”

“…Only three cases of pneumothorax have been reported following or during caesarean section 2 3. The details of those cases are summarised in table 1.…”

“…The proposed mechanisms for development of pneumothorax during caesarean section include presence of a clinically silent pneumothorax during antepartum period, which became manifest during general anaesthesia and positive pressure ventilation, presence of apical bullae, which ruptured during positive pressure ventilation, coexistent smoking and coexistent chest infection 2 3…”

“…However, spontaneous pneumothorax during pregnancy or postpartum period is rare. On performing a search of the English medical literature, we found only three previously reported cases of spontaneous pneumothorax associated with caesarean section 2 3. In all the three cases the patients had received endotracheal intubation and mechanical ventilation for surgery.…”

Bilateral primary spontaneous pneumothoraces postcaesarean section - another reason to avoid general anaesthesia in pregnancy

“…Before now, it has only twice been reported after caesarean section, with all three patients having had a general anaesthetic 2 3. Barotrauma secondary to positive pressure ventilation via the endotracheal tube is thought to be a key contributory factor, and coughing on the endotracheal tube before extubation can of itself produce high intrathoracic pressures.…”