Intrapartum spontaneous pneumomediastinum: recognizing and treating a rare entity

A 20-year-old nulliparous woman presented to our obstetric unit in spontaneous labour at 39+1 weeks gestation following an uncomplicated pregnancy. After a short labour she progressed to a spontaneous vaginal delivery of a live male infant. Immediately after delivery she experienced retrosternal chest pain, facial swelling and dyspnoea. On examination her chest was clear to auscultation, but extensive subcutaneous emphysema was noted over the chest, neck and face. She remained a diagnostic dilemma until a plain chest radiograph revealed a large volume pneumomediastinum and a CT chest and barium swallow excluded an oesophageal perforation leading to the diagnosis of Hamman’s syndrome. She responded well to supportive cares and was discharged home on day three postpartum. Spontaneous pneumomediastinum or Hamman's syndrome has been rarely reported in the literature as a complication of labour. Although it runs a benign course it often masquerades as more lethal conditions and clinicians should have a good understanding of its diagnosis and management to ensure good outcomes.