Protracted Labor Complicated by Pneumomediastinum and Subcutaneous Emphysema: A Rare Case Report and Management Considerations

Abstract

Patient: Female, 29-year-old Final Diagnosis: Pneumomediastinum Symptoms: Dyspnea • emphysema Clinical Procedure: X ray Specialty: Obstetrics and Gynecology Objective: Rare disease Background: Spontaneous pneumomediastinum and subcutaneous emphysema (Hamman’s syndrome) presents with sudden and life-threatening symptoms. Clinical signs include crackles that synchronize with the heartbeat on chest auscultation (Hamman’s sign). This report describes the case of a 29-year-old woman with a protracted second stage of labor at 40 weeks of pregnancy with postpartum dyspnea, acute chest pain, and surgical emphysema due to pneumomediastinum (Hamman’s syndrome). Case Report: This case report describes the case of a 29-year-old primigravida admitted to the hospital ward for spontaneous labor at 40 weeks of pregnancy. Due to a protracted second stage of labor, the delivery was assisted by Thierry’s spatulas. Shortly after delivery, the patient developed dyspnea associated with subcutaneous emphysema in the inferior part of the face, neck, and anterior chest wall. As the clinical evaluation showed no signs of severity, we performed a chest X-ray, which confirmed the diagnosis of pneumomediastinum (Hamman’s syndrome), excluded any other life-threatening condition, and led to a conservative treatment approach. Conclusions: This report presents a rare association between protracted labor and Hamman’s syndrome and highlights the importance of rapid diagnosis and management. In this case, the postpartum presentation was distinguished from pulmonary embolism, and emergency life-saving management was initiated.

Pneumomediastinum and Pericardium During Labour: A Report on a Rare Postpartum Phenomenon

“…SPM in the setting of labour was first reported by Simmons in 1784 [9], but the combination of SPM and subcutaneous emphysema, known collectively as HS, was only first reported by Hamman in 1945 [1]. Overall, 70% of non-obstetric cases occur in males in their 20s [10], with risk factors including vomiting, labour, physical exercise, coughing, and convulsions, as well as those with chronic lung diseases, smokers, or those in labour [4]. The incidence of SPM in pregnancy is rare, occurring in approximately 1 in 100,000 vaginal deliveries [11].…”

“…For this reason, investigations such as a CXR are considered an important initial radiological modality in the diagnosis of HS [15,16]. CT chest with IV contrast, on the other hand, has better resolution and can detect smaller pockets of trapped air while also ruling out other life-threatening diagnoses [2,4,17]. A CT chest can also differentiate between pneumomediastinum and pneumopericardium which is reportedly less favourable and may require further treatment [8] if tamponade occurs [2,4].…”

“…CT chest with IV contrast, on the other hand, has better resolution and can detect smaller pockets of trapped air while also ruling out other life-threatening diagnoses [2,4,17]. A CT chest can also differentiate between pneumomediastinum and pneumopericardium which is reportedly less favourable and may require further treatment [8] if tamponade occurs [2,4]. Diagnosis of HS is, therefore, a combination of history, clinical signs, and radiological evidence excluding other complications [2,4].…”

“…A CT chest can also differentiate between pneumomediastinum and pneumopericardium which is reportedly less favourable and may require further treatment [8] if tamponade occurs [2,4]. Diagnosis of HS is, therefore, a combination of history, clinical signs, and radiological evidence excluding other complications [2,4].…”

“…HS is thought to be caused by repetitive hyperinflation of the lungs, barotrauma, and high intra-alveolar pressures due to excessive Valsava manoeuvre. This can result in alveolar rupture and air dissection into the mediastinum, hila, and subcutaneous tissues, a phenomenon known as the Macklin effect [2,[4][5][6].…”