Breast feeding

Question 1

when would you treat mastitis ?

Answer 1

if systemically unwell
if nipple fissure present
if symptoms don’t improve within 12 - 24 hours after effective milk removal
if culture indicates infection

Question 2

first line medication for mastitis ?

Answer 2

flucloxacillin

Question 3

first line medication for suppression of lactation ?

Answer 3

cabergoline

Question 4

advice for suppression of lactation ?

Answer 4

stop lactation reflex;
- stop sucking and expression

supportive measures;

• supportive bras
• analgesia

cabergoline

Question 5

intermittent nipple pain during and shortly after feeding. blanching of the nipple followed by erythema/cyanosis.
diagnosis ?

Answer 5

reynaulds disease of the nipple

Question 6

management for reynaulds disease of the nipple ?

Answer 6

minimise exposure to cold, heat packs following a breast feed, smoking cessation and avoid caffeine

if symptoms persist then referral to specialist to try oral nifedipine (off licence)

Question 7

pain in both breasts a few days after birth. Often worse just before a feed. infant finds it hard to attach and suckle.
diagnosis ?

Answer 7

engorgement

Question 8

management of engorgement ?

Answer 8

encouraging feeding / hand expression to relieve pain

Question 9

drug contraindications during breast feeding ?

Answer 9

antibiotics:
- ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

psychiatric: benzodiazepines, lithium

aspirin 
carbimazole 
methotrexate 
sulphonylureas 
cytotoxic drugs 
amiodarone

Question 10

hat drugs are safe to prescribe during pregnancy ?

Answer 10

antibiotics:
- penicillins, cephalosporins, trimethoprim

psychiatric:
- antipsychotics, antidepressants (avoid fluoxetine)

epilepsy:
- carbamazepine, sodium valproate

hypertension:
- betablockers, hydralazine

anticoagulants;
- warfarin, heparin

digoxin

endocrine:

• glucocorticoids
• levothyroxine

asthma:
- salbutamol, theophylline

Question 11

woman has recently stopped breastfeeding. Find a painless cystic lesion in her breast.
diagnosis ?

Answer 11

galactocele

due to occlusion of a lactiferous duct