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the patient underwent right uniportal video-assisted thoracoscopic surgery &#40;VATS&#41; following the standard technique with a port at the level of the 4th intercostal space&#46; The procedure involved performing a bullectomy and mechanical pleurodesis involving resection of the dystrophic&#47;bullous right apical lung parenchyma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Her postoperative course was uneventful&#44; leading to a discharge from hospital after 72<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">At 35 WG&#44; the patient was diagnosed with preterm premature rupture of membranes&#46; Labor was induced using oxytocin with a successful dilation completed under epidural anesthesia&#46; Delivery was uncomplicated&#44; resulting in the birth of a healthy male infant&#46; The postpartum period was without any signs of pneumothorax or other complications&#46; 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with organogenesis having completed and the risk of preterm labor being comparatively lower than at later gestational stages&#46; VATS is the preferred surgical approach&#44; with mechanical pleurodesis recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In most cases&#44; spontaneous vaginal delivery at or near term&#44; facilitated by regional anesthesia&#44; is the preferred technique as it reduces strain during the second stage of labor&#46; Cesarean section should be reserved for cases with obstetric indications&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; women with a history of spontaneous pneumothorax planning a pregnancy and who have not had definitive surgical treatment should be counseled on the risk of recurrence&#46; The therapeutic plan and role of surgical intervention should be determined through a multidisciplinary discussion&#46; 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Case Report
Spontaneous Pneumothorax During Pregnancy
Álvaro Fuentes-Martín
Corresponding author
alvarofuentesmartin@gmail.com

Corresponding author.
, Begoña Gregorio Crespo, José María Matilla González
Thoracic Surgery Department, Universitary Clinic Hospital of Valladolid, Valladolid, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Chest X-ray showing the presence of a right apical pneumothorax &#40;red arrow&#41;&#46; &#40;B&#41; Intraoperative image&#58; Dystrophic&#47;bullous complex observed in the right apical lung parenchyma &#40;red arrow&#41; and the stapler used for its surgical resection&#46; &#40;C&#41; Postoperative follow-up chest X-ray shows no evidence of complications&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Spontaneous pneumothorax occurring during pregnancy is an exceedingly rare condition&#44; with fewer than 100 cases documented&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Analysis of these rare instances affords several insights into therapeutic strategies for mitigating maternal&#8211;fetal risk&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of a 32-year-old non-smoking patient&#44; who at 13 weeks gestation &#40;WG&#41;&#44; presented to the emergency department with symptoms of pleuritic pain in the right hemithorax&#46; Her medical history included a spontaneous right-sided pneumothorax managed conservatively the preceding year&#46; Initial examination found her hemodynamically stable&#44; SpO<span class="elsevierStyleInf">2</span> 97&#37;&#46; Further examination revealed diminished vesicular breath sounds at the right apex&#46; Chest radiography&#44; conducted with abdominal shielding&#44; confirmed a diagnosis of partial right pneumothorax &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was admitted for ongoing clinical and radiological surveillance&#46; Given that the degree of lung collapse was at the threshold for pleural drainage placement&#44; the decision was made for conservative management&#46; After a 72-h hospital stay&#44; the patient was discharged following radiological control showing no progression&#46; A follow-up chest X-ray was performed at 3 weeks to confirm resolution of the pneumothorax&#46; A multidisciplinary team involving the departments of Gynecology and Obstetrics and Anesthesia subsequently scheduled an elective surgical procedure for the second trimester&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">During the 21 WG&#44; the patient underwent right uniportal video-assisted thoracoscopic surgery &#40;VATS&#41; following the standard technique with a port at the level of the 4th intercostal space&#46; The procedure involved performing a bullectomy and mechanical pleurodesis involving resection of the dystrophic&#47;bullous right apical lung parenchyma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Her postoperative course was uneventful&#44; leading to a discharge from hospital after 72<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">At 35 WG&#44; the patient was diagnosed with preterm premature rupture of membranes&#46; Labor was induced using oxytocin with a successful dilation completed under epidural anesthesia&#46; Delivery was uncomplicated&#44; resulting in the birth of a healthy male infant&#46; The postpartum period was without any signs of pneumothorax or other complications&#46; A thoracic ultrasound evaluation was performed to rule out the presence of pneumothorax in the peripartum period&#44; specifically after labor&#46; At a 6-month follow-up&#44; the patient remained asymptomatic with no signs of recurrent pneumothorax&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Spontaneous pneumothorax should be considered as a differential in all pregnant women presenting with chest pain and&#47;or dyspnea&#46; Chest radiography&#44; when performed with abdominal protection&#44; serves as a safe diagnostic tool&#46; Management of spontaneous pneumothorax during pregnancy&#44; labor&#44; or postpartum generally follows the same principles as for non-pregnant individuals&#46; A conservative approach can be employed in the context of small pneumothorax &#40;&#60;2<span class="elsevierStyleHsp" style=""></span>cm&#41; in the absence of dyspnea or fetal distress&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The second trimester is considered optimal for surgical intervention&#44; with organogenesis having completed and the risk of preterm labor being comparatively lower than at later gestational stages&#46; VATS is the preferred surgical approach&#44; with mechanical pleurodesis recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In most cases&#44; spontaneous vaginal delivery at or near term&#44; facilitated by regional anesthesia&#44; is the preferred technique as it reduces strain during the second stage of labor&#46; Cesarean section should be reserved for cases with obstetric indications&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; women with a history of spontaneous pneumothorax planning a pregnancy and who have not had definitive surgical treatment should be counseled on the risk of recurrence&#46; The therapeutic plan and role of surgical intervention should be determined through a multidisciplinary discussion&#46; Each patient&#39;s treatment strategy should be optimally tailored to their individual case&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests&#46;</p></span></span>"
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