What is a pneumothorax during pregnancy?
A pneumothorax (PTX) is a condition in which air (or other gas) enters the intrapleural space (also called the pleural space), a potential space between the membrane that covers the outside of the lungs and the membrane that covers the inside of the chest wall. Typically, the intrapleural space contains only a small amount of fluid that helps the membranes glide over one another, and the intrapleural pressure (the pressure in the intrapleural space) is a few mmHg lower than the atmospheric pressure outside the chest and in the lungs. This pressure difference enables the lungs to expand like balloons when you inhale, making the chest cavity larger. The expansion of the lungs, in turn, draws in air. In a PTX, the intrapleural pressure rises within one side of the chest cavity, due to a leak, either through the lung, or through the wall of the chest cavity (chest, side, or back).
In such cases, expansion of the chest to inhale brings the intrapleural pressure closer to the pressure of the outside air and of the inside of the lung, making it difficult for the lung to inflate, so the lung collapses (PTX thus is known commonly as a collapsed lung). Small holes may close without treatment, in which case breathing improves as the intrapleural pressure gradually returns to normal. Holes also can remain open, making breathing difficult, because the lung on the affected side will either be collapsed entirely, or will inflate only slightly, but as long as air can move back and forth through the hole, the other lung will continue to work. On the other hand, rather than being open or closed, some injuries can act as a one-way valve, such that each time the person inhales, the intrapleural pressure on the affected side rises, yet it does not decrease during exhalation. Known as a tension PTX (TPx), this situation is mainly associated with traumatic injuries through the chest, side, or back wall, and with broken ribs. However, any type of PTX can transform into a TPx. Thus, a TPx can occur either at the time of an injury, or it can develop as a complication of a less severe PTX.
PTX can result from injury to the chest (including during cardiopulmonary resuscitation [CPR]), from lung disease, or as a complication of mechanical ventilation. It also can result from pulmonary barotrauma, lung injury resulting from a sudden change in pressure that causes the lungs to expand too much. This can happen, if youre holding your breath inside an aircraft at the moment of a sudden cabin depressurization, or if youre holding your breath while ascending during SCUBA diving. It also can happen to a victim of an explosion who is not holding her breath. Pregnant women should not SCUBA dive, but otherwise, PTX can occur during pregnancy for any of the reasons mentioned above. Additionally, women, whether pregnant or not, can suffer what is called a spontaneous PTX, meaning a PTX that occurs without a traumatic cause or an obvious disease cause. Relevant to non-pregnant women of reproductive age is another type of PTX called catamenial PTX (CTM), which is a PTX occurring in connection with menstruation.
How common is pneumothorax during pregnancy?
Only a handful of pneumothoraces have been reported during pregnancy. Apart from the setting of traumatic injury involving the chest cavity, factors increasing the chances of PTX include lung diseases, such as cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), asthma, and pneumonia. Factors increasing the risk of spontaneous PTX include smoking, tall, thin stature, and inherited connective tissue disorders, such as Marfan syndrome. As noted earlier, certain activities, such as SCUBA diving and flying, also increase the risk.
How is PTX during pregnancy diagnosed?
PTX is largely a clinical diagnosis, meaning that it is diagnosed based on symptoms notably breathing difficulty– and findings on the physical examination, notably absent breathing sounds on the affected side. Diagnosis can be aided by chest X-ray (CXR), which shows telltale signs, such as the absence of lung markings on the affected side. In the case of a TPx, a CXR can be even more revealing if it is performed, but such imaging really should not be performed; TPx is an extreme emergency, so the diagnosis must be entirely clinical. In such cases, physical examination reveals not only absent breathing sounds, but the breathing is typically getting more difficult with each breath. Due to the pressure increasing on the affected side, it is often possible to see or feel the trachea (the windpipe) deviated toward the unaffected side.
Does pneumothorax cause problems during pregnancy?
First of all, if you suffer a TPx, this is immediately life-threatening, because the continuous increase in pressure within the chest cavity on the affected side can soon cause the other lung to collapse, while also preventing venous blood from moving through the large veins that return blood to the heart and through the right side of the heart, where pressure is normally low. Second, in addition to causing breathing difficulty and chest pain, any PTX can transform into TPx.
Does a pneumothorax cause problems for the baby?
A PTX puts the mothers life in danger and therefore puts the babys life at risk too.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the PTX
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat pneumothorax during pregnancy?
Although medications are appropriate for certain complications or conditions co-existing with PTX, such as an infection, for instance, due to a wound, PTX does not generally require medications except in the case of a treatment called pleurodesis. In this treatment, medications are not given to affect your physiology but are administered directly into the intrapleural space as irritants to cause the outside of the lung to stick to the inside of the chest cavity. This helps to prevent future pneumothoraces and also helps to keep the lung from collapsing, even if there is another PTX.
Who should NOT stop taking medication for pneumothorax during pregnancy?
As noted above, medications are not the treatment strategy for PTX.
What should I know about choosing a medication for my pneumothorax during pregnancy?
It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.
You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for my pneumothorax when I am breastfeeding?
As noted earlier, medication is not the treatment for PTX, so there is no particular medication issue for breastfeeding. On the other hand, PTX is treated with thoracostomy, in which a large-bore needle is inserted into the intrapleural cavity, between two ribs. Usually, a tube is then inserted, and this can make it hard to breastfeed.< /p>
What alternative therapies besides medications can I use to treat my pneumothorax during pregnancy?
The therapy for PTX depends on the severity of the condition. If your condition does not suggest a possible TPx, doctors will order a CXR. If the CXR shows only partial collapse of the lung, this indicates that a minimal amount of air has entered from the outside, so your PTX may heal on its own, and doctors may choose to keep you under observation, which will include a series of CXR. Otherwise, the next option is needle thoracostomy, which is to make a hole into the chest cavity with a needle and aspirate by drawing up the plunger of an attached syringe. This also can be done using a vacuum sample tube, though its easier to control the suction with an old-style syringe. In either case, the aspiration lowers the pressure in the intrapleural space. If needle thoracostomy is not enough, the next option is to insert a chest tube through a thoracostomy that is made either with a large-bore needle or with an incision. The advantage of this technique is that a one-way valve can be attached to the chest tube with negative pressure (aspiration). This means one way, such that air can move from the intrapleural cavity to outside the chest, which is to say opposite the TPx-causing one-way valve that we do not want to develop. Treatment of a TPx must be immediate, so usually, what is done is that a large-bore needle is inserted. If the person has a TPx, air will gush out through the needle as soon as the needle reaches the intrapleural space. Effectively, this transforms the TPx into a regular, open PTX. The woman will feel much better, and if not, there will be time to insert a chest tube and perform CXR.
Treatment of the injury or defect that caused the PTX can take the form of pleurodesis (described above) to fix a wound that is acting as an air leak or to remove ruptured blebs from the lung.
What can I do for myself and my baby when I have a pneumothorax during pregnancy?
Follow the instructions of your physician. Immediately report any worsening of your breathing difficulty or chest pain.
Resources for pneumothorax in pregnancy:
For more information about PTX during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations: