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Facial swelling and dysphonia during labour: a case of Hamman’s syndrome
  1. Rhian Elin James1,
  2. Cini Bhanu2,
  3. Sharleen Hapuarachi1 and
  4. Erick Leyva Caraballo3
  1. 1 Obstetrics and Gynaecology, Hinchingbrooke Health Care NHS Trust, Huntingdon, UK
  2. 2 Department of Primary Care and Population Health, University College London Research, London, UK
  3. 3 Women Services, Hinchingbrooke Hospital, Huntingdon, UK
  1. Correspondence to Dr Rhian Elin James, rhian.james2{at}


We present the case of a previously fit and well 30-year-old primiparous woman who developed Hamman’s syndrome during the second stage of labour. This is an unusual and peculiar condition, characterised by spontaneous pneumomediastinum and subcutaneous emphysema. The rarity of the condition means it can easily be misdiagnosed. Its exact aetiology is unknown, but it is believed that extreme Valsalva manoeuvre during prolonged or difficult labours may contribute to its development. Chest X-ray is the first investigation of choice in this presentation, followed by CT scanning. Fortunately, it is usually a benign condition that can be managed conservatively and resolved quickly, with no long-term effects and low risk of recurrence in future pregnancies. We are pleased to say that this case does not differ in this respect. It is, however, important to rule other more serious pathologies that present in a similar way, for example, Boerhaave syndrome, pneumothorax or pulmonary embolism.

  • pregnancy
  • obstetrics and gynaecology

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  • Contributors REJ is primary author and collected images. CB primarily performed literature search. SH proofread and assisted in revision of text. ELC identified the case, supervised, assisted in literature search and proofread the text.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.