00:01
Now, let's discuss breastfeeding.
00:05
So there are several
benefits to breastfeeding.
00:07
Both maternal and fetal.
00:08
For that reason we do
encourage breastfeeding
in most situations.
00:12
There are some indications such
as moms are infected with HIV
Where breastfeeding
is contraindicated.
00:20
However, in most situation
it is definitely encouraged.
00:23
So let's go through some
of those maternal benefits.
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Weight loss after pregnancy.
00:28
Decreased unintended pregnancy.
00:30
As it can sometimes
inhibit ovulation.
00:33
Decreased rates of hypertension
and cardiovascular disease
in the mom over her lifetime.
00:37
There's also a decreased rate
of breast and ovarian cancer
over her lifetime.
00:42
This is thought to be because
during the time of breastfeeding
estrogen levels are lower.
00:47
And without having an ovulation
that thought to be protected
against ovarian cancer.
00:54
And then the lower rates
of postpartum depression.
00:56
And this is thought that
because of breastfeeding
there's an increased bonding
between mom and the baby.
01:02
So fetal benefits.
01:03
Decreased childhood
common illnesses.
01:06
So through the IgA antibodies
when baby breast feeds,
he's able to get some antibodies
from mom to protect him
from different illnesses.
01:16
Decreased rates of obesity
in babies that were breast fed.
01:18
And again there's increased bonding
between mother and infant.
01:22
So that not only helps mom to
decrease the risk of postpartum
depression but it
also helps infant.
01:27
And although this is not
a completely proven,
we think that babies that
are breast fed are also
cognitively perform better
in school.
01:38
So let's take a case.
01:40
A 27 year old Para 1 female
that delivered
a healthy female by vaginal
delivery 2 weeks earlier,
presents to your office
with complaint
of bilateral breast pain.
01:50
She reports the baby has had
difficult latch so she is mostly
pumping to produce breast milk.
01:56
She reports a low grade fever.
01:58
On physical exam both breast
are firm and tender
with no erythema.
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What diagnosis best describes
this patient's condition?
A. Mastitis.
02:08
B. Engorgement.
02:09
C. Galactocele.
02:10
or D. Breast abscess.
02:12
Well let's talk about some issues
that we can have
with breastfeeding and see
if we can find the answer.
02:18
So there four common breast
conditions that we see
with breastfeeding.
02:22
Engorgement, Mastitis,
Galactocele and Breast abscess.
02:25
With Engorgement, the breast
are full of milk
and they're just not completely
emptying.
02:31
This can be bilateral.
02:33
Patients can have
a low grade fever.
02:36
It's common when there is
problem with the latch.
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And treatment is just to
increase breastfeeding,
warm compression and massage.
02:44
You are just trying to get
those milk ducts to empty.
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Next is mastitis.
02:49
Now this is actually
an infectious process.
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Mastitis is usually unilateral.
02:55
The breast is usually warm.
02:56
There is erythematous streaking.
02:59
The most common culprit is
Staphylococcus aureus
and the treatment is antibiotic.
03:03
Dicloxacillin as well as
continue breastfeeding.
03:09
The next is Galactocele.
03:10
So this is a cyst that can
form in the breast
because of a blocked milk duct.
03:16
So with the galactocele,
there's usually a palpable tender,
firm mass.
03:20
There's no fever because
remember it's not infectious.
03:24
Usually unilateral.
03:25
And the treatment is
the same as Engorgement.
03:27
Increased breastfeeding,
warm compresses and massage.
03:30
Again you're just trying to
get that milk duct to empty.
03:35
And then finally we can have
breast abscess which is actually
an infectious process.
03:41
This is usually unilateral.
03:42
There's fluctuant mass.
03:45
Patients can have
fever, malaise.
03:47
And the treatment for
this abscess is the same
as any abscess.
03:50
It's incision and drainage
followed by antibiotics.
03:53
So let's go back to our patient.
03:56
Again she's a 27 year old para 1
female that delivered
a healthy female by vaginal
delivery 2 weeks earlier.
04:02
She's coming to your office
with complaint of breast pain.
04:04
She reports the baby
had difficult latching.
04:07
And she is mostly pumping
to produce breast milk.
04:10
She reports a low grade fever.
04:12
On physical exam both breasts
are firm and tender
with no erythema.
04:18
So what do you think is
going on with this patient?
Is it A. Mastitis.
04:22
B. Engorgement.
04:24
C. Galactocele.
04:27
or the D. Breast abscess.
04:27
That's right the answer
is Engorgement.
04:31
Remember with Engorgement,
is bilateral,
such as with our patient.
04:34
They have low grade fever.
04:36
That will take out the option
of Mastitis
as that's usually unilateral.
04:41
Galactocele remember
has no fever.
04:43
And with Breast abscess,
that's also unilateral
and there's a fluctuant mass
on physical exam.