Case report: Postpartum pneumomediastinum and subcutaneous emphysema

Postpartum pneumomediastinum is a rare complication of labour and delivery, where air leaks into the mediastinum following rupture of marginal alveoli. It follows prolonged and forceful Valsalva manoeuvres that increase intra-thoracic pressure. Subcutaneous emphysema may also develop. A chest radiograph can confirm the diagnosis, however a computed tomography thorax maybe required. Treatment is conservative as it is usually self-limiting. We present a case of postpartum pneumomediastinum following a delay in the second stage of labour and subsequent instrumental delivery. She developed chest pain and dyspnea 40 min post-delivery, and subcutaneous emphysema was palpable. Supplementary nasal flow oxygen was administered for 24 h prior to discharge. There is sparse evidence or guidance as to the management of postpartum pneumomediastinum, but consensus appears to be supplemental oxygen for 24 h. More data are needed on the type and duration of oxygen therapy, need for repeat imaging and management of subsequent pregnancies.