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Perinatal pneumomediastinum

Last edited: 4/13/2026

Overview

Perinatal pneumomediastinum is a rare but serious condition characterized by air leakage into the mediastinum, often associated with high-pressure events during labor and delivery, such as prolonged or precipitous labor, meconium aspiration, or instrumental delivery 11.

Diagnosis

  • Clinical Presentation: Sudden respiratory distress, cyanosis, subcutaneous emphysema, and chest pain 11.
  • Imaging: Chest X-ray often reveals pneumomediastinum with air bubbles in the mediastinum and possibly subcutaneous emphysema 11.
  • Radiographic Signs: Look for linear lucencies along the tracheal and esophageal borders, and air in the superior mediastinal region 11.

    • Management

  • Supportive Care: Oxygen therapy, close monitoring of respiratory status, and management of associated complications such as respiratory distress syndrome 11.
  • Consultation: Early involvement of neonatology and pediatric pulmonology for complex cases 11.
  • Avoidance of Aggravation: Minimize interventions that could increase intrathoracic pressure, such as endotracheal intubation if possible 11.

    • Special Populations

  • Pregnancy: No specific guidelines noted for pregnant women beyond general supportive care 11.
  • Pediatrics: Focus on neonatal respiratory support and monitoring for associated conditions like RDS 11.
  • Comorbidities: Management may need adjustment in cases with pre-existing respiratory conditions, requiring multidisciplinary care 11.

    • Key Recommendations

  • Prompt Recognition and Imaging: Early identification through clinical assessment and chest imaging to confirm pneumomediastinum 11 (Evidence: Moderate).
  • Supportive Respiratory Management: Implement supportive respiratory care including oxygen therapy and close monitoring 11 (Evidence: Moderate).
  • Multidisciplinary Approach: Engage neonatology and pediatric pulmonology early in management to address complex cases 11 (Evidence: Expert opinion).

    • References

    1 Cohen SR, Calkins K, Kaiser JE, Breeze Harris H, Auricchio E, Blumenfeld J. Precepting Through Perinatal Emergencies: A Simulation-Based Training for Midwifery Educators. Journal of midwifery & women's health 2025. link 2 Myttaraki E, Zorro C, Ashoor G, Greenough A. Obstetric Neonatal Interest Teaching (ONIT): multi-disciplinary learning in perinatal medicine. BMJ paediatrics open 2025. link 3 Cullinane M, Zugna SA, McLachlan HL, Newton MS, Forster DA. Evaluating the impact of a maternity and neonatal emergencies education programme in Australian regional and rural health services on clinician knowledge and confidence: a pre-test post-test study. BMJ open 2022. link 4 Mubeen A, Makary R. Pathologic examination of placenta: a study on 500 live births to assess conformity to College of American Pathologists (CAP) guidelines and clinicopathologic correlation. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2022. link 5 Quincer E, Philipsborn R, Morof D, Salzberg NT, Vitorino P, Ajanovic S et al.. Insights on the differentiation of stillbirths and early neonatal deaths: A study from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. PloS one 2022. link 6 Moller AB, Welsh J, Gross MM, Petzold M, Ayebare E, Chipeta E et al.. Assessment of midwifery care providers intrapartum care competencies, in four sub-Saharan countries: a mixed-method study protocol. Reproductive health 2021. link 7 Bellieni CV. The Congress "Yes to Life": A Hand Offered in Dialogue. Perspectives in biology and medicine 2020. link 8 Reed R, Grossman T, Askin G, Gerber LM, Kasdorf E. Joint periviability counseling between neonatology and obstetrics is a rare occurrence. Journal of perinatology : official journal of the California Perinatal Association 2020. link 9 Barclay K, Baranowska-Rataj A, Kolk M, Ivarsson A. Interpregnancy intervals and perinatal and child health in Sweden: A comparison within families and across social groups. Population studies 2020. link 10 Welton M, Vélez Vega CM, Murphy CB, Rosario Z, Torres H, Russell E et al.. Impact of Hurricanes Irma and Maria on Puerto Rico Maternal and Child Health Research Programs. Maternal and child health journal 2020. link 11 Strauss A, Rath W, Gräsner JT. [Perinatal Emergencies in Emergency Medical Aid - Obstetric Emergencies Series, Part 4]. Zeitschrift fur Geburtshilfe und Neonatologie 2019. link 12 Kilby MD, Gibson JL, Ville Y. Falling perinatal mortality in twins in the UK: organisational success or chance?. BJOG : an international journal of obstetrics and gynaecology 2019. link 13 Bingham D, Jones DK, Howell EA. Quality Improvement Approach to Eliminate Disparities in Perinatal Morbidity and Mortality. Obstetrics and gynecology clinics of North America 2019. link 14 Bakhbakhi D, Burden C, Storey C, Heazell AE, Lynch M, Timlin L et al.. PARENTS 2 Study: a qualitative study of the views of healthcare professionals and stakeholders on parental engagement in the perinatal mortality review-from 'bottom of the pile' to joint learning. BMJ open 2019. link 15 Gruszka M, Kudela G, Wolny A, Koszutski T, Hyla-Klekot L. Perinatal hospice care in the opinion of nurses and midwives. Ginekologia polska 2019. link 16 Adams N, Tudehope D, Gibbons KS, Flenady V. Perinatal mortality disparities between public care and private obstetrician-led care: a propensity score analysis. BJOG : an international journal of obstetrics and gynaecology 2018. link 17 Rajmil L, Taylor-Robinson D, Gunnlaugsson G, Hjern A, Spencer N. Trends in social determinants of child health and perinatal outcomes in European countries 2005-2015 by level of austerity imposed by governments: a repeat cross-sectional analysis of routinely available data. BMJ open 2018. link 18 Jincharadze N, Kazakhashvili N, Sakvarelidze I, Gerzmava O. HEALTH OF CHILDREN UNDER 12 MONTHS OF AGE IN GEORGIA. Georgian medical news 2018. link 19 Goossen W. Architecture for Variable Data Entry into a National Registry. Studies in health technology and informatics 2017. link 20 . Charities call for staff and funds to reduce infant death levels. Nursing children and young people 2016. link 21 Raman S, Iljadica A, Gyaneshwar R, Taito R, Fong J. Improving maternal and child health systems in Fiji through a perinatal mortality audit. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2015. link 22 Chervenak FA, McCullough LB. Ethics in perinatal medicine: A global perspective. Seminars in fetal & neonatal medicine 2015. link 23 Schoeps D, Lefevre F, Silva ZP, Novaes HM, Raspantini PR, de Almeida MF. Social representations of obstetricians and neonatologists about fetal and early neonatal death certificate in the city of São Paulo. Revista brasileira de epidemiologia = Brazilian journal of epidemiology 2014. link 24 Santos JV, Correia C, Cabral F, Bernardes J, Costa-Pereira A, Freitas A. Should European perinatal indicators be revisited?. European journal of obstetrics, gynecology, and reproductive biology 2013. link 25 Pasha O, McClure EM, Wright LL, Saleem S, Goudar SS, Chomba E et al.. A combined community- and facility-based approach to improve pregnancy outcomes in low-resource settings: a Global Network cluster randomized trial. BMC medicine 2013. link 26 Costain DA. Bayesian partitioning for mapping disease risk using a matched case-control approach to confounding. Biostatistics (Oxford, England) 2013. link 27 Vendittelli F, Rivière O, Crenn-Hébert C, Giraud-Roufast A. Do perinatal guidelines have an impact on obstetric practices?. Revue d'epidemiologie et de sante publique 2012. link 28 Tucker Edmonds B, Krasny S, Srinivas S, Shea J. Obstetric decision-making and counseling at the limits of viability. American journal of obstetrics and gynecology 2012. link 29 Tokunaga S, Sameshima H, Ikenoue T. Applying the ecology model to perinatal medicine: from a regional population-based study. Journal of pregnancy 2011. link 30 Reisner DP, Landers S. Collaboration between obstetricians and neonatalogists: perinatal safety programs and improved clinical outcomes. Clinics in perinatology 2010. link 31 Orlando S, Danna D, Giarratano G, Prepas R, Johnson CB. Perinatal considerations in the hospital disaster management process. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN 2010. link 32 Borchert M, Bacci A, Baltag V, Hodorogea S, Drife J. Improving maternal and perinatal health care in the Central Asian republics. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2010. link 33 Flenady V, Mahomed K, Ellwood D, Charles A, Teale G, Chadha Y et al.. Uptake of the Perinatal Society of Australia and New Zealand perinatal mortality audit guideline. The Australian & New Zealand journal of obstetrics & gynaecology 2010. link 34 Matijasevich A, Santos IS, Barros AJ, Menezes AM, Albernaz EP, Barros FC et al.. Perinatal mortality in three population-based cohorts from Southern Brazil: trends and differences. Cadernos de saude publica 2008. link 35 Kennedy HP. A concept analysis of optimality in perinatal health. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN 2006. link 36 Higgins RD, Delivoria-Papadopoulos M, Raju TN. Executive summary of the workshop on the border of viability. Pediatrics 2005. link 37 Yu VY, Dunn PM. Development of regionalized perinatal care. Seminars in neonatology : SN 2004. link 38 Snowdon C, Elbourne DR, Garcia J. Perinatal pathology in the context of a clinical trial: a review of the literature. Archives of disease in childhood. Fetal and neonatal edition 2004. link 39 Snowdon C, Elbourne DR, Garcia J. Perinatal pathology in the context of a clinical trial: attitudes of neonatologists and pathologists. Archives of disease in childhood. Fetal and neonatal edition 2004. link 40 Dunn PM. Dr Erasmus Darwin (1731-1802) of Lichfield and placental respiration. Archives of disease in childhood. Fetal and neonatal edition 2003. link 41 Zupan J. Perinatal mortality and morbidity in developing countries. A global view. Medecine tropicale : revue du Corps de sante colonial 2003. link 42 Lack N, Zeitlin J, Krebs L, Künzel W, Alexander S. Methodological difficulties in the comparison of indicators of perinatal health across Europe. European journal of obstetrics, gynecology, and reproductive biology 2003. link 43 Dunn PM. Stéphane Tarnier (1828-1897), the architect of perinatology in France. Archives of disease in childhood. Fetal and neonatal edition 2002. link 44 Nkata M. Perinatal mortality in breech delivery. Tropical doctor 2001. link 45 De Reu PA, Nijhuis JG, Oosterbaan HP, Eskes TK. Perinatal audit on avoidable mortality in a Dutch rural region: a retrospective study. European journal of obstetrics, gynecology, and reproductive biology 2000. link00135-9) 46 Dunster KR. Physiologic variability in the perinatal period. Origins, measurement, and applications. Clinics in perinatology 1999. link 47 Burton AJ, Lancaster P. Obstetric profiles and perinatal mortality among Pacific Island immigrants in New South Wales, 1990-93. Australian and New Zealand journal of public health 1999. link 48 Milunsky JM, Milunsky A. Genetic counseling in perinatal medicine. Obstetrics and gynecology clinics of North America 1997. link70286-2) 49 Miranda JA, Herruzo AJ, Mozas J, Calderón MA, Agüera J, Biel E et al.. Influence of obstetric and perinatal care on perinatal mortality. European journal of obstetrics, gynecology, and reproductive biology 1996. link02434-7) 50 Mattson S. Culturally sensitive perinatal care for southeast Asians. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN 1995. link 51 Mekbib TA. Breech delivery and foetal outcome: a review of 291 cases. Ethiopian medical journal 1995. link 52 Chadwick J. Perinatal mortality and antenatal care. Modern midwife 1994. link 53 Nichols FH. Issues in perinatal education. AWHONN's clinical issues in perinatal and women's health nursing 1993. link 54 Stevens KA. Developing a perinatal education program. AWHONN's clinical issues in perinatal and women's health nursing 1993. link 55 Kirkup B. Perinatal mortality and associated morbidity. Current opinion in obstetrics & gynecology 1991. link 56 Cardwell MS, Gay JW. Improving perinatal outcome for rural Missouri. Missouri medicine 1990. link 57 Peel A, Clarke M. Pregnant women at work: a study of ethnic minority risk in Leicestershire. British journal of industrial medicine 1990. link 58 Bacchi D, Phillips D, Kessel W, Smith D. Federal programs affecting rural perinatal health care. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association 1989. link 59 Hetherington J, Dickersin K, Chalmers I, Meinert CL. Retrospective and prospective identification of unpublished controlled trials: lessons from a survey of obstetricians and pediatricians. Pediatrics 1989. link 60 Raines E. Hospital risk management for perinatal care: theory and practice. Journal of perinatology : official journal of the California Perinatal Association 1988. link 61 Carlomagno G, Benussi G, Candussi G, Gallucci S. A simple local database for audit and epidemiologic studies. Clinical and experimental obstetrics & gynecology 1988. link 62 Kennell JH, Klaus MH. The perinatal paradigm: is it time for a change?. Clinics in perinatology 1988. link 63 Crump WJ. The Alabama Perinatal Outcome Project: some methodological issues. Family practice research journal 1987. link 64 Pecorari D, Romanini C, Tanganelli E. Score systems in perinatal medicine. Biological research in pregnancy and perinatology 1985. link 65 Keirse MJ. Perinatal mortality rates do not contain what they purport to contain. Lancet (London, England) 1984. link91405-3) 66 Clarke M, Clayton DG. Quality of obstetric care provided for Asian immigrants in Leicestershire. British medical journal (Clinical research ed.) 1983. link 67 Rahbar F, Westney L, Momeni J. Prenatal factors affecting perinatal mortality in blacks. Journal of the National Medical Association 1982. link 68 Briend A. Maternal physical activity, birth weight and perinatal mortality. Medical hypotheses 1980. link90138-3) 69 Ryan GM, Fielden JG. The impact of regionalization programs on patterns of perinatal care. Obstetrics and gynecology 1979. link 70 Shamsi HH, Petrie RH, Steer CM. Changing obstetric practices and amelioration of perinatal outcome in a university hospital. American journal of obstetrics and gynecology 1979. link90301-6) 71 Reeves BD, Anderson ER. Perinatal mortality rate at a community hospital, 1956 to 1975. American journal of obstetrics and gynecology 1977. link90216-2) 72 Yudkin P. Problems in assessing effects of induction of labour on perinatal mortality. British journal of obstetrics and gynaecology 1976. link 73 Hein HA, Christopher MC, Ferguson NN. Rural perinatology. Pediatrics 1975. link

    Original source

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      Precepting Through Perinatal Emergencies: A Simulation-Based Training for Midwifery Educators. — Cohen SR, Calkins K, Kaiser JE, Breeze Harris H, Auricchio E, Blumenfeld J Journal of midwifery & women's health (2025)
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      Obstetric Neonatal Interest Teaching (ONIT): multi-disciplinary learning in perinatal medicine. — Myttaraki E, Zorro C, Ashoor G, Greenough A BMJ paediatrics open (2025)
    3. [3]
      Evaluating the impact of a maternity and neonatal emergencies education programme in Australian regional and rural health services on clinician knowledge and confidence: a pre-test post-test study. — Cullinane M, Zugna SA, McLachlan HL, Newton MS, Forster DA BMJ open (2022)
    4. [4]
      Pathologic examination of placenta: a study on 500 live births to assess conformity to College of American Pathologists (CAP) guidelines and clinicopathologic correlation. — Mubeen A, Makary R The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians (2022)
    5. [5]
      Insights on the differentiation of stillbirths and early neonatal deaths: A study from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. — Quincer E, Philipsborn R, Morof D, Salzberg NT, Vitorino P, Ajanovic S et al. PloS one (2022)
    6. [6]
      Assessment of midwifery care providers intrapartum care competencies, in four sub-Saharan countries: a mixed-method study protocol. — Moller AB, Welsh J, Gross MM, Petzold M, Ayebare E, Chipeta E et al. Reproductive health (2021)
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      The Congress "Yes to Life": A Hand Offered in Dialogue. — Bellieni CV Perspectives in biology and medicine (2020)
    8. [8]
      Joint periviability counseling between neonatology and obstetrics is a rare occurrence. — Reed R, Grossman T, Askin G, Gerber LM, Kasdorf E Journal of perinatology : official journal of the California Perinatal Association (2020)
    9. [9]
      Interpregnancy intervals and perinatal and child health in Sweden: A comparison within families and across social groups. — Barclay K, Baranowska-Rataj A, Kolk M, Ivarsson A Population studies (2020)
    10. [10]
      Impact of Hurricanes Irma and Maria on Puerto Rico Maternal and Child Health Research Programs. — Welton M, Vélez Vega CM, Murphy CB, Rosario Z, Torres H, Russell E et al. Maternal and child health journal (2020)
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      [Perinatal Emergencies in Emergency Medical Aid - Obstetric Emergencies Series, Part 4]. — Strauss A, Rath W, Gräsner JT Zeitschrift fur Geburtshilfe und Neonatologie (2019)
    12. [12]
      Falling perinatal mortality in twins in the UK: organisational success or chance? — Kilby MD, Gibson JL, Ville Y BJOG : an international journal of obstetrics and gynaecology (2019)
    13. [13]
      Quality Improvement Approach to Eliminate Disparities in Perinatal Morbidity and Mortality. — Bingham D, Jones DK, Howell EA Obstetrics and gynecology clinics of North America (2019)
    14. [14]
      PARENTS 2 Study: a qualitative study of the views of healthcare professionals and stakeholders on parental engagement in the perinatal mortality review-from 'bottom of the pile' to joint learning. — Bakhbakhi D, Burden C, Storey C, Heazell AE, Lynch M, Timlin L et al. BMJ open (2019)
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      Perinatal hospice care in the opinion of nurses and midwives. — Gruszka M, Kudela G, Wolny A, Koszutski T, Hyla-Klekot L Ginekologia polska (2019)
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      Perinatal mortality disparities between public care and private obstetrician-led care: a propensity score analysis. — Adams N, Tudehope D, Gibbons KS, Flenady V BJOG : an international journal of obstetrics and gynaecology (2018)
    17. [17]
      Trends in social determinants of child health and perinatal outcomes in European countries 2005-2015 by level of austerity imposed by governments: a repeat cross-sectional analysis of routinely available data. — Rajmil L, Taylor-Robinson D, Gunnlaugsson G, Hjern A, Spencer N BMJ open (2018)
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      Architecture for Variable Data Entry into a National Registry. — Goossen W Studies in health technology and informatics (2017)
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      Charities call for staff and funds to reduce infant death levels. Nursing children and young people (2016)
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      Improving maternal and child health systems in Fiji through a perinatal mortality audit. — Raman S, Iljadica A, Gyaneshwar R, Taito R, Fong J International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics (2015)
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      Ethics in perinatal medicine: A global perspective. — Chervenak FA, McCullough LB Seminars in fetal & neonatal medicine (2015)
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      Social representations of obstetricians and neonatologists about fetal and early neonatal death certificate in the city of São Paulo. — Schoeps D, Lefevre F, Silva ZP, Novaes HM, Raspantini PR, de Almeida MF Revista brasileira de epidemiologia = Brazilian journal of epidemiology (2014)
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      Should European perinatal indicators be revisited? — Santos JV, Correia C, Cabral F, Bernardes J, Costa-Pereira A, Freitas A European journal of obstetrics, gynecology, and reproductive biology (2013)
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      A combined community- and facility-based approach to improve pregnancy outcomes in low-resource settings: a Global Network cluster randomized trial. — Pasha O, McClure EM, Wright LL, Saleem S, Goudar SS, Chomba E et al. BMC medicine (2013)
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      Bayesian partitioning for mapping disease risk using a matched case-control approach to confounding. — Costain DA Biostatistics (Oxford, England) (2013)
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      Do perinatal guidelines have an impact on obstetric practices? — Vendittelli F, Rivière O, Crenn-Hébert C, Giraud-Roufast A Revue d'epidemiologie et de sante publique (2012)
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      Obstetric decision-making and counseling at the limits of viability. — Tucker Edmonds B, Krasny S, Srinivas S, Shea J American journal of obstetrics and gynecology (2012)
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      Applying the ecology model to perinatal medicine: from a regional population-based study. — Tokunaga S, Sameshima H, Ikenoue T Journal of pregnancy (2011)
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      Collaboration between obstetricians and neonatalogists: perinatal safety programs and improved clinical outcomes. — Reisner DP, Landers S Clinics in perinatology (2010)
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      Perinatal considerations in the hospital disaster management process. — Orlando S, Danna D, Giarratano G, Prepas R, Johnson CB Journal of obstetric, gynecologic, and neonatal nursing : JOGNN (2010)
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      Improving maternal and perinatal health care in the Central Asian republics. — Borchert M, Bacci A, Baltag V, Hodorogea S, Drife J International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics (2010)
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      Perinatal mortality in three population-based cohorts from Southern Brazil: trends and differences. — Matijasevich A, Santos IS, Barros AJ, Menezes AM, Albernaz EP, Barros FC et al. Cadernos de saude publica (2008)
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      Development of regionalized perinatal care. — Yu VY, Dunn PM Seminars in neonatology : SN (2004)
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      Methodological difficulties in the comparison of indicators of perinatal health across Europe. — Lack N, Zeitlin J, Krebs L, Künzel W, Alexander S European journal of obstetrics, gynecology, and reproductive biology (2003)
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      Perinatal mortality in breech delivery. — Nkata M Tropical doctor (2001)
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      Genetic counseling in perinatal medicine. — Milunsky JM, Milunsky A Obstetrics and gynecology clinics of North America (1997)
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      Breech delivery and foetal outcome: a review of 291 cases. — Mekbib TA Ethiopian medical journal (1995)
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