A 25-year-old woman, gravida 1 para 1, comes to the office for evaluation of fever and right breast pain. The patient is 2 weeks postpartum after an uncomplicated pregnancy and vaginal delivery. She has been breastfeeding every 2-3 hours; however, the infant has had difficulty with latching due to the mother's inverted nipples. Yesterday, the patient developed constant sharp pain in the side of her right breast as well as fever, chills, nausea, and body aches. The pain is worsening, especially during breastfeeding. She has been taking acetaminophen and ibuprofen with minimal relief. The patient has no chronic medical conditions. She is on maternity leave from her engineering job. The patient has no drug allergies and is taking a daily prenatal vitamin. Temperature is 38.9 C (102 F), blood pressure is 110/70 mm Hg, and pulse is 100/min. Examination reveals the upper outer quadrant of the right breast to be erythematous, tender, and swollen but without fluctuance. The left breast has no erythema or tenderness. The patient had planned to breastfeed her infant exclusively for the first year of life but is now discouraged by the infection and the discomfort that occurs during latching. Which of the following is the most appropriate advice for this patient?

Question

A 25-year-old woman, gravida 1 para 1, comes to the office for evaluation of fever and right breast pain.  The patient is 2 weeks postpartum after an uncomplicated pregnancy and vaginal delivery.  She has been breastfeeding every 2-3 hours; however, the infant has had difficulty with latching due to the mother's inverted nipples.  Yesterday, the patient developed constant sharp pain in the side of her right breast as well as fever, chills, nausea, and body aches.  The pain is worsening, especially during breastfeeding.  She has been taking acetaminophen and ibuprofen with minimal relief.  The patient has no chronic medical conditions.  She is on maternity leave from her engineering job.  The patient has no drug allergies and is taking a daily prenatal vitamin.  Temperature is 38.9 C (102 F), blood pressure is 110/70 mm Hg, and pulse is 100/min.  Examination reveals the upper outer quadrant of the right breast to be erythematous, tender, and swollen but without fluctuance.  The left breast has no erythema or tenderness. The patient had planned to breastfeed her infant exclusively for the first year of life but is now discouraged by the infection and the discomfort that occurs during latching.  Which of the following is the most appropriate advice for this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bf89_9d73_8f63_dfe6cac2e627_MD0005_00 In addition to antibiotics and analgesia, treatment of lactational mastitis requires effective and frequent milk drainage. Milk ducts are most effectively drained by direct breastfeeding. However, many women cease breastfeeding due to breast pain associated with or independent of mastitis. Rather than discontinuation of breastfeeding, the first step in management of breast pain is to assess breastfeeding technique and positioning; this is best achieved with an evaluation by a lactation consultant. The correct position for optimal milk intake involves the infant forming a tight seal around most of the areola. However, a common cause of severe pain during latching occurs when the infant suckles on only the nipple. This improper position can cause nipple blistering. (Choices B and E) Breastfeeding using both the infected and uninfected breasts is safe during treatment for lactational mastitis, and formula supplementation is not required if the milk supply is adequate. In addition, emptying of the breast via breastfeeding may decrease the pain associated with mastitis and prevent recurrence. Interruption of breastfeeding can decrease maternal milk production and should be avoided. (Choice C) Formula supplementation is indicated for an inadequate maternal milk supply as evidenced by newborn weight loss or dehydration. A reduction in the frequency of breastfeeding and/or breast emptying can decrease maternal milk production and should therefore be avoided. Pain during breastfeeding is not an indication for formula feeding but rather an indication to evaluate for infection or improper technique. (Choice D) Pumping after completion of feeding can alleviate pain associated with incomplete emptying. This patient experiences discomfort during latching and would not benefit from both breastfeeding and pumping. Educational objective: Breast pain and mastitis are common reasons for early discontinuation of breastfeeding. Pain during breastfeeding is frequently due to poor positioning or latching, which can be evaluated by a lactation consultant. References: Breast pain: engorgement, nipple pain, and mastitis. (http://www.ncbi.nlm.nih.gov/pubmed/26512442)

A 25-Year-Old Woman, Gravida 1 Para 1, Comes to the Office