Pathological postpartum breast engorgement: prediction, prevention, and resolution

Abstract

Background: Severe breast engorgement can cause substantial discomfort for mothers and interfere with an infant's ability to feed at the breast. This study explored the possibility of prediction of pathological postpartum breast engorgement in lactating women in relation to intense breast engorgement at the end of the luteal phase of the menstrual cycle and the possibility of prevention and resolution of postpartum breast engorgement with expression with a breast pump of colostrum before the appearance of transitional milk.

Subjects and methods: The first group included 70 women with pathological postpartum breast engorgement. The second group included 52 postpartum women, with 24 women having colostrum extracted by the breast pump from each breast once or twice for a duration of 20-25 minutes sequentially in the first 2-3 days after delivery in addition to the removal of colostrum by the baby, before engorgement developed. Twenty-eight women had colostrum removed only by the baby. The degree of breast engorgement was assessed using the previously published Robson four-level scale.

Results: Of the 70 patients with severe postpartum engorgement studied in the first group, 90% showed intense breast engorgement in the late luteal phase of the menstrual cycle. Expression of colostrum milk in the first experimental group from each breast eliminated excessive breast engorgement in breastfeeding mothers.

Conclusions: Presence of intense breast engorgement at the end of the luteal phase of the menstrual cycle may be one of the most important indicators useful for predicting severe postpartum breast engorgement. Extraction of colostrum before the appearance of transitional milk lowers the risk of excessive engorgement in breastfeeding women.

FIG. 1.

Effect of preliminary pumping of the breasts on the occurrence of a pathological postpartum engorgement: (A) experimental group and (B) control group. For all histograms, 1=the total number of women, 2=the number of women with moderate postnatal engorgement, and 3=number of women with a strong pathological engorgement.