Pneumomediastinum following spontaneous vaginal delivery: re
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A young female primigravida patient with no previous past medical history underwent an uncomplicated SVD of a healthy newborn following spontaneous rupture of membranes at full term. The antenatal period was uneventful, and the patient delivered a healthy female newborn weighing 3.61 kg after 6 hours in labor with no analgesic requirement. Four hours following delivery, the patient alerted the on duty medical team to a swelling in the face and neck, which was noticeable bilaterally. Observations revealed blood pressure, heart rate, respiratory rate and oxygen saturation all within normal limits and the patient was afebrile. On physical examination, widespread crepitus was present across the right side of the neck radiating toward the jaw. Respiratory examination revealed no pathology with clear lungs on auscultation, equal bilateral air entry and no tracheal deviation.

An urgent chest X-ray revealed extensive bilateral subcutaneous emphysema throughout the thorax and base of the neck with no visible pneumothorax or pleural effusion. Thoracic and cervical computed tomography (CT) with contrast revealed a moderate pneumomediastinum and extensive subcutaneous emphysema throughout the neck, supraclavicular fossae, axillae and upper chest wall with no overt evidence of esophageal injury.

The patient was advised to remain nil-by-mouth for 5 days due to concern regarding an esophageal tear and further investigations including a water-soluble contrast swallow were carried out to exclude esophageal perforations. The esophagus was revealed to be intact, and there was no extravasation of oral contrast giving no evidence of an esophageal tear. In view of these results and improving symptoms, the patient was allowed to resume oral intake after 5 days. The patient underwent a repeat chest X-ray which confirmed the resolution of pneumomediastinum, and she was managed conservatively in hospital for a further 2 days (7 days post-partum in total) prior to discharge. Complete regression of symptoms and full recovery was noted on follow-up in the outpatient clinic 1 month later.