Breast: Postpartum Engorgement

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Chapter 198 Breast: Postpartum Engorgement

INTRODUCTION

Description: Postpartum breast engorgement is characterized by tender, swollen, hard breasts caused by accumulation of milk in the postpartum period or during weaning.

Prevalence: Common.

Predominant Age: Reproductive, 3 to 4 days after delivery.

Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Increased milk production relative to use. Generally occurs 3 to 4 days after delivery when milk first comes in or during weaning.

Risk Factors: High fluid intake, infrequent nursing, poor suckling by the infant, abrupt cessation of nursing.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Warm, hard, sore breasts with no fever or erythema

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Mild fluid restriction, analgesics, ice packs, support (well-fitting brassiere). The use of cabbage leaves (applied to the breast) has been advocated, but conclusive studies are lacking.

Specific Measures: More frequent breastfeeding (if breastfeeding is to continue), firm binding.

Diet: Mild fluid restriction. If breastfeeding is to continue, adequate calories (additional 200 kcal/day) and protein are required.

Activity: No restriction.

Patient Education: Reassurance, support, specific suggestions; American College of Obstetricians and Gynecologists Patient Education Pamphlet AP029 (Breastfeeding Your Baby), AB005 (You and Your Baby: Prenatal Care, Labor and Delivery, and Postpartum Care).

Drug(s) of Choice

Analgesics. Medication to suppress lactation has little value and recommendations for its use have been withdrawn.

FOLLOW-UP

Patient Monitoring: Normal health maintenance; watch for possible infection.

Prevention/Avoidance: Gradual weaning reduces engorgement.

Possible Complications: Ductal obstruction and ectasia (uncommon).

Expected Outcome: Generally resolves in 24 to 48 hours.

MISCELLANEOUS

ICD-9-CM Code: 676.2.

Anonymous. Single dose cabergoline versus bromocriptine in inhibition of puerperal lactation: randomised, double blind, multicentre study. European Multicentre Study Group for Cabergoline in Lactation Inhibition. BMJ. 1991;302:1367.

Dewhurst CJ, Harrison RF, Biswas S. Inhibition of puerperal lactation. A double blind study of bromocriptine and placebo. Acta Obstet Gynecol Scand. 1977;56:327.

Nikodem VC, Danziger D, Gebka N, et al. Do cabbage leaves prevent breast engorgement? A randomized, controlled study. Birth. 1993;20:61.

Caballero-Gordo A, Lopez-Nazareno N, Calderay M, et al. Oral cabergoline. Single-dose inhibition of puerperal lactation. J Reprod Med. 1991;36:717.

Evans K, Evans R, Simmer K. Effect of the method of breast feeding on breast engorgement, mastitis and infantile colic. Acta Paediatr. 1995;84:849.

Roberts KL, Reiter M, Schuster D. A comparison of chilled and room temperature cabbage leaves in treating breast engorgement. J Hum Lact. 1995;11:191.

Shapiro AG, Thomas L. Efficacy of bromocriptine versus breast binders as inhibitors of postpartum lactation. South Med J. 1984;77:719.

Almeida ODJr, Kitay DZ. Lactation suppression and puerperal fever. Am J Obstet Gynecol. 1986;154:940.

Renfrew MJ, Lang S, Martin L, Woolridge MW. Feeding schedules in hospitals for newborn infants. Cochrane Database Syst Rev. 2, 2000. CD000090

Spitz AM, Lee NC, Peterson HB. Treatment for lactation suppression: little progress in one hundred years. Am J Obstet Gynecol. 1998;179:1485.

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