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Pneumothorax and Pregnancy^*

^* From the Departments of Respiratory Medicine (Drs. Lal, Anderson, and Arnold) and Cardiothoracic Surgery (Dr. Cowen), Castle Hill Hospital, Cottingham, UK; and Hull Royal Infirmary (Dr. Lindow), Hull, UK.

Correspondence to: Anthony G. Arnold, MD, Department of Respiratory Medicine, Castle Hill Hospital, Castle Rd, Cottingham HU16 5JQ, UK; e-mail: anthony.arnold{at}hey.nhs.uk

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.

Key Words: aspiration • pneumothorax • pregnancy • video-assisted thoracoscopic surgery