Spontaneous pneumothorax rarely occurs during pregnancy. The most common cause is almost always related to the presence of apical blebs or bullae. The most frequent symptoms are chest pain and dyspnea and chest radiography usually confirms the diagnosis. The treatment of choice is insertion of a chest drain and surgery should be considered in recurrent pneumothorax or persistent air leaks. The most controversial issues in spontaneous pneumothorax during pregnancy are the timing of surgery and delivery route. We describe the case of a pregnant patient in the third trimester with spontaneous pneumothorax and persistent air leaks who was successfully treated with combined elective cesarean section and videothoracoscopy in the same intervention. We believe that combined fetal extraction and videothoracoscopy in the same intervention could be a valid alternative for the definitive treatment of complicated spontaneous pneumothorax in full term pregnancies in order to avoid risks to the mother and fetus.