A Rare Complication during Vaginal Delivery, Hamman’s Syndrome: A Case Report and Systematic Review of Case Reports

Marco La Verde, Adriano Palmisano, Irene Iavarone, Carlo Ronsini, Domenico Labriola, Stefano Cianci, Ferdinando Schettino, Alfonso Reginelli, Gaetano Riemma and Pasquale De Franciscis
Additional contact information
Marco La Verde: Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Adriano Palmisano: Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Irene Iavarone: Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Carlo Ronsini: Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Domenico Labriola: Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Stefano Cianci: Department of Obstetrics and Gynecology, University of Messina, 98122 Messina, Italy
Ferdinando Schettino: Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Alfonso Reginelli: Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Gaetano Riemma: Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Pasquale De Franciscis: Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy

IJERPH, 2022, vol. 19, issue 8, 1-11

Abstract: Background: Spontaneous pneumomediastinum (SPM) during pregnancy or labor is a rare event. We presented a case report and a systematic review of the literature to provide comprehensive symptoms, treatments, and complications analysis in the pregnant population affected by SPM. Methods: We conducted a comprehensive search of four databases for published papers in all languages from the beginning to 1 September 2021; Results: We included 76 papers with a total of 80 patients. A total of 76% patients were young primiparous, with a median age of 24 ± 5.4 years. The median gestational age was 40 ± 2.4 weeks, with a median duration of labor of 7.4 ± 4.2 h. In 86%, the ethnic origin was not specified. SPM develops in 55% of cases during the second stage of labor. Subcutaneous swelling and subcutaneous emphysema were present in 91.4%. Chest pain and dyspnea were present in 51.4% and 50% of the patients, respectively. We found that 32.9% patients had crepitus, and less common symptoms were dysphonia and tachycardia (14.3% and 14.3%, respectively). Oxygen and bronchodilators were used in 37.7% of the cases. Analgesics or sedatives were administered in 27.1%. Conservative management or the observation was performed in 21.4% and 28.6%, respectively. Antibiotics treatment was offered in 14.3%, whereas invasive procedures such as chest-tube drainage were used in just 5.7% of patients. There were no complications documented in most SPM (70.0%). We found that 16.7% of the SPM developed a pneumothorax and 5% developed a pneumopericardium.; Conclusions: In pregnancy, SPM occurs as subcutaneous swelling or emphysema during the second stage of labor. The treatment is usually conservative, with oxygen and bronchodilators and a low sequela rate. A universal consensus on therapy of spontaneous pneumomediastinum in pregnancy is necessary to reduce the risk of complications.

Keywords: uncommon complication; chest discomfort; spontaneous pneumomediastinum; pregnancy; mediastinal emphysema; active labor stages; subcutaneous emphysema; chest tube drainage (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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