Pathological postpartum breast engorgement: prediction, prevention, and resolution

The Influence of Breastfeeding Educational Interventions on Breast Engorgement and Exclusive Breastfeeding: A Systematic Review and Meta-Analysis

BACKGROUND

Breast engorgement and breast pain are the most common reasons for the early cessation of exclusive breastfeeding by mothers.

RESEARCH AIMS

(1) To examine the influence of breastfeeding educational interventions on breast engorgement, breast pain, and exclusive breastfeeding; and (2) to identify effective components for implementing breastfeeding programs.

METHODS

Randomized controlled trials of breastfeeding educational interventions were searched using five English and five Chinese databases. Eligible studies were independently evaluated for methodological quality, and data were extracted by two investigators. In total, 22 trials were identified, and 3,681 participants were included. A random-effects model was used to pool the results, and a subgroup analysis and meta-regression analysis were conducted.

RESULTS

Breastfeeding education had a significant influence on reducing breast engorgement at postpartum 3 days (odds ratio [OR]: 0.27, 95% CI [0.15, 0.48] p < .001), 4 days (OR: 0.16, 95% CI [0.11, 0.22], p < .001), and 5-7 days (OR: 0.24, 95% CI [0.08, 0.74], p = .013) and breast pain (standardized mean difference: -1.33, 95% CI [-2.26, -0.40]) at postpartum 4-14 days. Participants who received interventions had higher odds of exclusive breastfeeding. Breastfeeding educational interventions provided through lecture combined with skills practical effectively reduced breast engorgement (OR: 0.21; 95% CI [0.15, 0.28]; p = .001) and improved exclusive breastfeeding at postpartum 1-6 weeks (OR: 2.16; 95% CI [1.65, 2.83]; p = .001).

CONCLUSIONS

Breastfeeding educational interventions have been effective in reducing breast engorgement, breast pain, and improved exclusive breastfeeding. A combination of knowledge and skill-based education has been beneficial for sustaining exclusive breastfeeding by mothers.

The Effectiveness of Cabbage Leaf Compress and the Education of Lactation Management in Reducing Breast Engorgement in Postpartum

BACKGROUND: Breast engorgement is a common problem of breastfeeding. The combination of nursing interventions is expected to prevent and reduce breast engorgement promptly. AIM: This study aims to determine the effectiveness of cabbage leaf compress and education on lactation management for reducing breast engorgement in postpartum. METHODS: This study was a quasi-experimental study with a non-equivalent control group design. The sample was 60 postpartum women (n = 30 the intervention group and n = 30 the control group) selected by purposive sampling. The instrument was the Breast Engorgement Scale. The intervention included giving compress on women’s breast using the cabbage leaf and educating them about lactation management, while the control group was given treatment according to hospital standard procedures. The study was conducted in a national referral hospital for West Java Province areas, Indonesia. Data were analyzed using the Wilcoxon sign-rank test and the effectiveness of intervention tested using the NGain score test. RESULTS: There was a difference in breast engorgement scale before intervention with median value ± min max (3.00 ± 2-6) and after median ± min max (2.00 ± 1-2), while in the control group the breast engorgement scale before treatment showed the median was ± min-max (2.00 ± 2-5) and after treatment, was ± min-max (2.00 ± 1-5). The effectiveness of intervention was 77.56%. CONCLUSIONS: The combination interventions of cabbage leaf compress and lactation management education were effective in reducing the breast engorgement in postpartum. This intervention can be used as an alternative intervention to solve the breast engorgement problem in postpartum women, especially for a developing country like Indonesia, because the cabbage leaf is cheap and easy to get in the traditional market. Further research is expected to conduct research on a qualitative design to understand women’s experience after interventions and the possibility to apply this intervention at home.

Breastfeeding Challenges: ACOG Committee Opinion, Number 820

ABSTRACT

Breastfeeding is associated with a decrease in a woman's risk of breast cancer, ovarian cancer, diabetes mellitus, and hypertensive heart disease. Breastfeeding initiation rates in the United States are increasing, and many women are aware of the maternal and infant health benefits of breastfeeding. However, problems may arise that can keep women from achieving their breastfeeding goals, and only 25% of women in the United States are breastfeeding exclusively at 6 months. Many women experience early and undesired weaning because of persistent pain or nipple injury. A focused history and physical examination are essential to help obstetrician-gynecologists and other obstetric care professionals distinguish the specific cause of their patients' pain and determine appropriate treatment. Studies have shown that pain with breastfeeding may be associated with postpartum depression; therefore, postpartum depression screening is an important part of the medical history when caring for these patients. Some women choose not to initiate breastfeeding, stop breastfeeding sooner than intended, or are unable to complete treatment with prescribed medications because they may have concerns regarding medication use during lactation. Health care professionals prescribing medications during lactation should base their counseling on accurate, current information from resources such as the National Center for Biotechnology Information's Drugs and Lactation database (known as LactMed). Causes of early weaning also may be attributed to societal factors, such as limited access to paid maternity leave and barriers to breastfeeding in the workplace. Obstetrician-gynecologists and other obstetric care professionals are uniquely positioned to support women in these situations.

Evaluation of the response of breast cancer patients to neoadjuvant chemotherapy by combined contrast-enhanced ultrasonography and ultrasound elastography

The purpose of the present study was to investigate whether contrast-enhanced ultrasonography (CEUS) in combination with ultrasound elastography (UE) is able to accurately predict the efficacy of neoadjuvant chemotherapy (NAC) in breast cancer patients. A total of 65 breast cancer patients who received NAC at the First Affiliated Hospital of Zhejiang University (Hangzhou, China) between February 2016 and August 2017 and were recruited for the present study. Prior to and after NAC, examination by CEUS, UE or their combination was performed. Pathological results were obtained at the end of each chemotherapy cycle, based on which 41 cases were assigned to the response group and 24 to the non-response group. Kappa values were 0.710, 0.434 and 0.836 for CEUS, UE and CEUS+UE, respectively. The area under the receiver operating characteristic curves for CEUS, UE and CEUS+UE for determining the response to NAC was 0.864 [95% confidence interval (CI), 0.765–0.964], 0.715 (95% CI, 0.579–0.850) and 0.910 (95% CI, 0.826–0.993), respectively. It was identified that the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS+UE were higher than those of CEUS and US individually. The prediction accuracy was 89.2, 90.8 and 100% for CEUS, UE and their combination, respectively. CEUS and UE have their own advantages in evaluating the clinical efficacy of NAC in breast cancer, and a higher accuracy was achieved when the two techniques were applied in combination. Therefore, a combination of CEUS and UE may be a preferred method for the clinical assessment of the efficacy of NAC in breast cancer patients.

Effect of Herbal Compresses for Maternal Breast Engorgement at Postpartum: A Randomized Controlled Trial

BACKGROUND

Maternal breast engorgement is one of the most common problems in the postpartum period. There are several alternative treatments, but there have not been any randomized controlled trial studies about the effects of herbal compresses for breast engorgement.

OBJECTIVE

The objective is to investigate the effects of herbal compresses for maternal breast engorgement.

MATERIALS AND METHODS

A randomized controlled trial was conducted. The postpartum mothers who had breast engorgement were randomly assigned to herbal or hot compress treatments. The breast engorgement pain scores were assessed by visual analog scales pre- and post-treatment. The pain reduction scales of the herbal compress treatments were analyzed and compared with the hot compress treatments. The adverse effects of each treatment were recorded and collected after 24 hours from treatments.

RESULTS

The data from 500 postpartum mothers with breast engorgement were available for analyses, 250 from the herbal compress group and 250 from the hot compress group. The baseline characteristics of both groups were similar except baseline breast engorgement pain score (herbal compress group higher than hot compress group). There were statistically significant mean differences of breast engorgement pain before and after treatment between the herbal and hot compress groups. No serious complications were found after treatment from herbal compresses.

CONCLUSION

Among the postpartum mothers who had breast engorgement, the herbal compresses could decrease breast engorgement pain. The pain reduction after herbal compresses was found to be greater than with the hot compresses.

Progesterone-Containing Gel Does Not Eliminate Postpartum Breast Engorgement?

BACKGROUND

Severe breast engorgement can cause substantial discomfort for mothers and interfere with an infant's ability to feed at the breast. The aim of the study was to clarify the possibility that the percutaneous progesterone-containing gel (Progestogel) can eliminate severe postpartum breast engorgement in lactating women.

SUBJECTS AND METHODS

Twenty three patients were examined. The Progestogel for transdermal therapy in an amount of 2.5-3 g was applied to the breast. Before application and 20 min after application the density of the mammary glands was measured by a tonometer.

RESULTS

According to our observations, within 20 min application of 2.5-3 g of the Progestogel on the breast skin does not result in reducing breast swelling, engorgement and tenderness.

CONCLUSIONS

After 20 minutes, transdermal application of Progestogel does not reduce the degree of engorgement of the mammary glands in the postpartum period.

The Mechanics of Breast Pumping: Compression Stimuli Increased Milk Ejection

BACKGROUND

The use of breast pumps with a compression component has shown their higher efficacy compared with vacuum pumps. However, the direct role of the compression stimulus is not sufficiently proven in the removal of milk from the main milk ducts of the breast. The aim of this study was to determine the contribution pulsating compression component of the breast pump has on total volume milk ejection by vacuum and compression stimuli.

SUBJECTS AND METHODS

Twenty-four lactating women of 21-30 years of age, who volunteered to be included in this study, were examined. Experimental breast pump with vacuum and compressive components were used to express breast milk.

RESULTS

It was found that volume milk ejection together with vacuum and compression stimuli was 10-46% more than expressing only with vacuum stimuli. Average values were 40.5% ± 5% for expression only with vacuum stimuli and 59.5% ± 5% for expression with vacuum and compression stimuli.

CONCLUSIONS

Compression stimuli increased the efficacy of the breast pump, which is not only due to the effective formation milk ejection reflex but also directly to an additional squeezing of milk from the breast.

ABM Clinical Protocol #20: Engorgement, Revised 2016

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.