Breastfeeding

Question 1

What advice would you give for a mother exclusively breastfeeding who took ulipristal acetate?

Answer 1

Express and discard breastmilk for 7 days after dose

Question 2

T1DM with wound infection post csection, noted to be MRSA. Which antibiotic is safe for breastfeeding?
A. Amoxcillin
B. Doxycycline
C. Metronidazole
D. Nitrofurantoin
E. Teicoplanin

Answer 2

Teicoplanin

Has a spectrum of activity close to vancomycin but is safe in breastfeeding and is the drug of choice

Question 3

What is the clinical definition of mastitis?

Answer 3

A tender, hot, swollen, wedge-shaped area of the breast associated with chills, fever, flu-like aching and systematic illness.

Question 4

Treatment for mastitis? What advice would you give the mother?

Answer 4

Most women can be treated with antibiotics and anti-inflammatory meds on an outpatient basis.

Antibiotics of choice are: -Penicillinase resistant penicillin DICLOXACILLIN 500mg po qid

or (if she has a penicillin allergy)

• Cephalexin 500mg po qid OR
• Clindamycin 300mg po qid

Duration: 10-14days to prevent recurrence from suboptimally treated mastitis

• Mother should be reassured that the medications are safe for her infant.
  *She should continue to breastfeed or express her breast milk, because milk stasis is often the initiating factor in mastitis. As such, effective and frequent milk removal is essential during treatment.

Question 5

No clinical response of mastitis to antibiotics. Next step?

Answer 5

Consider a methiciillin resistant staph aureus as the causative agent or an abscess.
- untreated abscesses can cause maternal sepsis

Question 6

Risk factors for mastitis?

Answer 6

Milk oversupply
Nipple injury
Poor latch/latching difficulties
Skipped feedings