Chest
Volume 132, Issue 3, September 2007, Pages 1044-1048
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SELECTED REPORTS
Pneumothorax and Pregnancy

https://doi.org/10.1378/chest.06-2719Get rights and content

Background

Though more common in male patients, primary spontaneous pneumothorax might be expected to occur reasonably often in female patients of child-bearing age. However, < 50 cases of pneumothorax in pregnancy have been previously reported. Special risks are posed for both the mother and the fetus in this situation. Previous management strategies have varied widely, without describing the more modern and less invasive techniques, and existing pneumothorax guidelines do not incorporate this difficult scenario.

Methods

A retrospective search of our database of 250 spontaneous pneumothorax patients over a 10-year period, in a stable local population of 500,000 patients, identified five cases of pneumothorax occurring in pregnancy. We report our experience, the largest series yet described, review the medical literature, and make management recommendations.

Results

We found favorable outcomes for both mothers and infants in our series, with modern techniques such as simple aspiration, elective assisted delivery at or near term with regional anesthesia, and video-assisted thoracoscopic surgery.

Conclusions

Future guidelines on the management of pneumothorax should consider the inclusion of advice on the problems of pregnancy, based on previous published experience, and utilizing the modern and less invasive techniques. Such advice would inform and support those specialists involved in managing a potentially hazardous situation to the benefit of both mother and child.

Section snippets

Case 1

Chest pain and breathlessness of acute onset developed in a 26-year-old smoker who was in the first trimester of pregnancy. A moderate-sized pneumothorax resolved satisfactorily following aspiration. The previous obstetric history was of one normal pregnancy and delivery. An elective assisted delivery (forceps or ventouse extraction) was planned for 38 weeks, using an epidural anesthetic to avoid the mechanical stresses of labor. However, a failure to progress to the second stage of labor

Discussion

The development of spontaneous pneumothorax in an otherwise healthy young adult has relatively minor physiologic consequences unless a tension pneumothorax supervenes. During pregnancy, the functional residual capacity of the lungs is decreased, and the respiratory rate and tidal volume increase (due to raised progesterone levels) with a consequent 70% increase in alveolar ventilation and a 20% increase in oxygen consumption.1516 Oxygen consumption can increase by 50% during labor. Observation

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    Citation Excerpt :

    Moreover, elective assisted delivery with an epidural or caesarean section under regional anesthesia is recommended to avoid the punctuated surges in intrathoracic pressure associated with spontaneous childbirth. The stakes involved at parturition, and the limited capacity for a reliable examination in cases of pneumothorax, make the deliberate path of elective delivery a safer option.7,8 Two types of secondary spontaneous pneumothorax in pregnancy have also been documented in the literature.

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The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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