A 26-year-old woman is evaluated on postoperative day 3 following an uncomplicated primary cesarean delivery. She reports bilateral breast pain and swelling that began earlier today. She is exclusively breastfeeding her newborn. Her temperature is 37.9°C (100.2°F), blood pressure is 112/72 mm Hg, and pulse is 84/min. Physical examination demonstrates bilateral, symmetrically firm, warm, and tender breasts without focal erythema, induration, or fluctuance. The cesarean abdominal incision is clean, dry, and intact with no surrounding erythema. The uterine fundus is firm and palpable below the umbilicus. Which of the following is the most appropriate next step in management?
- Reassurance, continued breastfeeding, and nonsteroidal anti-inflammatory drugsAnswer
- BPrescription of oral dicloxacillin
- CChest radiograph and urinalysis
- DCessation of breastfeeding and tight breast binding
- EBilateral targeted breast ultrasound
Answer
The correct approach is reassurance, continued breastfeeding, and the use of nonsteroidal anti-inflammatory drugs for pain relief.
The correct answer advocates for reassurance, continued breastfeeding, and nonsteroidal anti-inflammatory drugs. This patient is experiencing physiologic breast engorgement, a common and benign condition that peaks between postpartum days 3 and 5 as colostrum transitions to mature milk. The rapid increase in milk volume, combined with vascular and lymphatic congestion, causes the breasts to become bilaterally firm, swollen, warm, and tender. A mild, transient temperature elevation (up to 38.3°C / 101°F) can also occur. The most effective management is to promote frequent and effective milk removal through breastfeeding or pumping, supplemented by cool compresses and analgesics like ibuprofen.
Step-by-Step Solution
Key Concept
Diagnosis and conservative management of physiologic postpartum breast engorgement
Estimated Time:50s