We present a case of a 28-year-old primiparous woman with facial swelling followed by acute chest pain immediately after delivery. Chest radiograph revealed pneumomediastinum and surgical emphysema. She recovered well within 24 h of observation and conservative management. Postpartum spontaneous pneumomediastinum should be considered in the differential diagnosis of sudden-onset postpartum chest pain immediately or a few hours after delivery. It is a rare benign condition and usually resolves spontaneously without serious consequences. Chest X-ray is the single most important diagnostic test. It is important to rule out other serious and life-threatening conditions. Prolonged pushing, difficult labour and use of inhalational drugs place young primiparous women at higher risk. Recurrence is uncommon in subsequent pregnancy and management is unclear, although expectant management with epidural analgaesia to prevent recurrence in subsequent pregnancy is suggested.
2015 BMJ Publishing Group Ltd.