Spontaneous surgical emphysema and pneumomediastinum is a rare and potentially serious intrapartum complication. It occurs in 1:100,000 deliveries with around 200 cases reported worldwide in the last century, although few have been published in the last decade. Management is often conservative with favourable outcome, however there is potential for poor outcome and appropriate management of subsequent pregnancies remains unclear.Case
We present a case of a healthy 16 year old primiparous woman with an uneventful antenatal history who developed a spontaneous facial surgical emphysema, pneumomediastinum and pneumothorax during a prolonged first stage of labour. She had no past medical history of note, no underlying lung disease and had not smoked during the pregnancy. She laboured spontaneously at 38 weeks and 4 days and presented with insidious onset of facial swelling and chest tightness following intramuscular pethidine administration. She was treated unsuccessfully for anaphylaxis, xray findings were of a marked pneumo-mediastinum, bilateral face, neck and supraclavicular subcutaneous emphysema and a small left apical pneumothorax. Her airway remained patent throughout and she was managed successfully with conservative treatment. No abnormality was detected on follow up investigations.Conclusion
This case raises awareness of a rare and potentially under reported intrapartum complication. Clinicians should have raised index of suspicion of pneumomediastinum with subcutaneous emphysema in their differential diagnosis of intrapartum facial swelling once medical emergencies, such as anaphylaxis, have been ruled out. Our findings add to the current literature and support the role of conservative management.