Extensive Subcutaneous Emphysema and Pneumomediastinum Following Forceps-Assisted Vaginal Delivery: A Rare Case of Postpartum Hamman’s Syndrome

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Spontaneous pneumomediastinum associated with subcutaneous emphysema, also known as Hamman's syndrome, is a rare but important complication of vaginal delivery.It is thought to result from increased intrathoracic pressure during prolonged and forceful Valsalva manoeuvres in the second stage of labour, leading to alveolar rupture and the dissection of air along the bronchovascular sheaths into the mediastinum and surrounding cervical soft tissues.We present the case of a primiparous woman who developed extensive cervicofacial subcutaneous emphysema and pneumomediastinum following forceps-assisted vaginal delivery after a prolonged second stage of labour lasting approximately two hours.On the evening following delivery, she reported progressive facial and neck swelling, discomfort on swallowing both liquids and solids, and a sensation of chest heaviness.Clinical examination revealed facial puffiness and palpable cervical crepitus.Despite these findings, she remained clinically stable, with no breathlessness, chest pain, or evidence of respiratory compromise.Her respiratory rate was 17 breaths per minute, and oxygen saturation was 98% on room air.Chest auscultation revealed good bilateral air entry, and the initial chest radiograph demonstrated cervical and upper mediastinal emphysema.Contrast-enhanced computed tomography of the neck, thorax, and abdomen subsequently confirmed extensive surgical emphysema extending from the angle of the jaw throughout the cervical soft tissues into the upper chest, accompanied by widespread pneumomediastinum and associated extrapleural air around the lung apices and adjacent to the mediastinum.Importantly, there was no definite pneumothorax, oesophageal leak, tracheal wall injury, or underlying pulmonary abnormality.Following assessment by the obstetric and surgical teams, conservative management with close clinical observation and supportive care was recommended, as no surgical intervention was indicated.Her facial and neck swelling improved significantly over the subsequent days, without evidence of respiratory deterioration.This case highlights the importance of recognising postpartum Hamman's syndrome in women presenting with cervicofacial swelling and subcutaneous crepitus following vaginal delivery.Despite extensive radiological abnormalities, the patient remained clinically stable and improved with conservative management.Appropriate imaging and multidisciplinary assessment are important for identifying associated complications and guiding individualised treatment.As this is a single case report, the findings should not be generalised to all patients with postpartum pneumomediastinum.