Recurrent pneumothorax in pregnancy: what should we do after placing an intercostal drain

MK Wong, WC Leung, JK Wang, TT Lao, MS Ip, WK Lam, JC Ho
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong

Recurrent pneumothorax is rare during pregnancy. We describe a Chinese woman, with a history of spontaneous pneumothorax managed with an intercostal drain, who developed a recurrent pneumothorax during her 32nd week of pregnancy. There is no consensus on management in this situation. We review the literature and discuss different management approaches. Thirty-six cases of antepartum pneumothorax have been reported in 31 case reports. An intercostal drain only (n=11) or surgeries (thoracotomy, n=9; or video-assisted thoracoscopy, n=2) were common treatment options with no surgical complications reported. Twenty-two (61%) patients progressed to a normal vaginal delivery, while the rest required forceps delivery (22%) or Caesarean section (14%). No single treatment option outweighed the others. There were no maternal or foetal complications reported in those who underwent antepartum surgical intervention. Surgical management of recurrent pneumothorax during pregnancy is well tolerated.

Hong Kong Med J 2006;12:375-80

Key words: Pneumothorax/surgery; Pregnancy, Thoracic surgery, video-assisted