DOCSLIB.ORG

Diagnosis and Management of Breast Milk Oversupply

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diagnosis and Management of Breast Milk Oversupply J Am Board Fam Med: first published as 10.3122/jabfm.2016.01.150164 on 14 January 2016. Downloaded from CLINICAL REVIEW Diagnosis and Management of Breast Milk Oversupply Lauren Trimeloni, MD, and Jeanne Spencer, MD Managing breastfeeding problems is an essential part of newborn care. While much is written on breast milk undersupply, little is written on oversupply, sometimes known as hyperlactation or hypergalactia. Infants of mothers with oversupply may have increased or decreased weight gain. Some may have large, frothy stools. They may develop a disordered latch. Mothers may report overly full, leaking breasts. Thyroid function should be assessed. Treatment is mostly anecdotal and includes methods to maintain breast fullness, such as block feedings. Pseudoephedrine and oral contraceptive pills may decrease the supply. Dopamine agonists such as carbergoline can be used as a last resort. (J Am Board Fam Med 2016;29:139–142.) Keywords: Breast Feeding; Lactation Disorders; Review, Systematic Managing breastfeeding problems is an essential Literature Search skill for family physicians. Exclusive breastfeeding PubMed Clinical Queries was searched using the provides an optimal start to an individual’s nutri- key search terms hypergalactia, breast milk oversupply, tional life, reducing their lifelong risk of many breast milk oversupply, and hyperlactation. We also copyright. devastating diseases, including obesity, asthma, di- searched Clinical Evidence, the Cochrane database, abetes mellitus, and childhood leukemia and lym- and the CINAL database using the same terms and phoma.1 The American Academy of Family Physi- the reference lists of retrieved articles. Our initial cians and the American Academy of Pediatrics search date was April 2015. recommend exclusive breastfeeding until 6 months, and then continued breastfeeding until at least age Clinical Presentation 1 year for optimal health.1,2 The CDC tracks Although there is a large body of literature on the breastfeeding initiation and continuation rates, as problems accompanying a low milk supply, little http://www.jabfm.org/ 4 well as provider support of breastfeeding, in their has been written concerning oversupply. In addi- Breastfeeding Report Card.3 Maintaining optimal tion, the prevalence of oversupply is unclear be- breastfeeding initiation and duration should be a cause of a lack of diagnostic criteria and research on primary concern of health care providers. Although the topic. Most define oversupply as milk produc- breast milk oversupply occurs rarely and is often tion in excess of that needed for normal growth of the infant.4 Other terms for this include hyperga- underreported, the damage it can cause to the on 28 September 2021 by guest. Protected breastfeeding relationship can be irreparable. lactia or hyperlactation. The term galactorrhea is usu- ally applied only to nonlactating women or men. Early signs of an oversupply can include excessive infant weight gain (Ͼ30 g (1 oz)/day up to age 3 months).5 It is important to use the World Health This article was externally peer reviewed. Organization growth charts when assessing infant Submitted 19 May 2015; revised 30 July 2015; accepted 10 August 2015. weight gain because these are normed with breast- From the Conemaugh Family Medicine Residency Pro- feeding infants.6 Other infants of mothers with gram, Johnstown, PA. Funding: none. oversupply have poor weight gain because of exces- Conflict of interest: none declared. sive exposure to the carbohydrate-rich foremilk and Corresponding author: Jeanne Spencer, MD, DLP, Cone- 7 maugh FMRP, 1086 Franklin St, Johnstown, PA 15905 a lack of fat-rich hind milk. These infants may be ͑E-mail: [email protected]͒. fussy, particularly at the beginning of a feeding, and doi: 10.3122/jabfm.2016.01.150164 Diagnosis and Management of Breast Milk Oversupply 139 J Am Board Fam Med: first published as 10.3122/jabfm.2016.01.150164 on 14 January 2016. Downloaded from have difficulty maintaining a latch. They may cry breastfeeding, having an unhappy, uncomfort- or act averse to the offer of feeding. They may able baby and being in continual pain herself can gulp frequently and break off multiple times dur- quickly lead to a determination that breastfeed- ing a feeding, and then later exhibit signs of ing will not work for her and that formula is a gassiness. Stools may be frequent, large, frothy, better feeding option. and green, especially when the infant is consum- ing inadequate protein-rich hind milk. Infants Differential Diagnosis may develop a disordered latch and move the While breast milk oversupply is often idiopathic, tongue to the tip of the nipple to avoid being it can sometimes (albeit rarely) be a sign of seri- 7 choked by an aggressive let-down reflex. An ous underlying disorders, including pituitary ad- overactive let-down can cause the baby to pull off enomas and prolactinomas.11 Any cause of hyper- and refuse to re-latch, often damaging the moth- prolactinemia, including hyperthyroidism, can 8 er’s nipple. Infants of mothers with oversupply result in a breast milk oversupply (Table 1). Thy- may be misdiagnosed with gastroesophageal re- roid function tests should generally be ordered. 9 flux disease, colic, or milk protein allergies. Interpretation of prolactin concentrations in Mothers with breast milk oversupply may report breastfeeding mothers can be problematic since full, leaking breasts that are not noticeably softened lactation increases prolactin concentrations, with 7 by a feeding. In the presence of a baby who is a wide variation of concentrations among women gaining weight adequately or excessively, excess who are successfully breastfeeding.12 Women leaking should raise the question of an oversupply. with known prolactinomas can often successfully Breast pain, severe engorgement, and painful milk breastfeed.13 Remission occurs in approximately ejection reflexes or let-downs are common. Moth- one third of prolactinomas during pregnancy and ers may report leaking continually between feed- lactation.13 Although retained placenta is usually ings, an ability to pump several ounces after a associated with decreased milk production, a case copyright. feeding, or being awakened at night by painful report described overproduction relieved by the engorgement when the baby seems satisfied and removal of a retained placental fragment.14 Ex- not yet ready to eat. Engorgement persisting for cessive pumping, overuse of galactogogues, and longer than 1 to 2 weeks should raise a question overstimulation by the baby may also result in of oversupply. Nipple trauma resulting from a oversupply4 (Table 2). poor latch may lead to cracked, sore, fissured nipples, increasing the likelihood of breast infec- tions, including infections with Candida.7 Incom- Management Breast milk oversupply is generally caused by plete emptying of the breast can lead to blocked http://www.jabfm.org/ ducts and mastitis, and over time it can produce either breastfeeding mismanagement, hyperpro- 7 chronic mastitis and scarring in the breast tis- lactinemia, or a congenital predisposition. Most sue.7,9 Striae on the skin overlying the breast have been reported.8 Table 1. Causes of Elevated Prolactin Concentrations Mothers experiencing oversupply often report feelings of frustration and loneliness. Breastfeed- Hypothalamic/pituitary stalk damage ing becomes very difficult, and excessive leaking Pituitary disorders on 28 September 2021 by guest. Protected and breast pain make social and professional in- Chronic renal failure Cirrhosis teractions challenging. Having too much milk is Cranial radiation often viewed as desirable, which can lead to in- Polycystic ovary disease adequate support from friends and family, as well Medications as by medical personnel who fail to grasp the Antidepressants 10 severity of the problem. Women may be ad- Antihistamines vised to wean following recurrent bouts of severe Antihypertensives mastitis or after breast abscesses, which may re- quire surgical drainage. Working mothers may Adapted with permission from Melmed S, Casanueva FF, Hoffman AR, et al; Endocrine Society. Diagnosis and treatment of hyperp- lack the time needed for increased pumping. Re- rolactinemia: an Endocrine Society clinical practice guideline. gardless of a mother’s initial commitment to J Clin Endocrinol Metab 2011;96:273–88. 140 JABFM January–February 2016 Vol. 29 No. 1 http://www.jabfm.org J Am Board Fam Med: first published as 10.3122/jabfm.2016.01.150164 on 14 January 2016. Downloaded from Table 2. Differential Diagnosis Breastmilk Oversupply dose may reduce breast milk production by 25% 20 Overuse of galactogogues (level of evidence, 2). Early use of estrogen- Excessive breast-pumping containing oral contraceptives may help reduce Normal engorgement in the early postpartum weeks supply and can be considered when conservative Excessive prolactin* measures fail (strength of recommendation, C). As a final resort, mothers may need use dopamine From ref. 4. agonists such as carbergoline, especially if they *See Table 1. are discontinuing nursing.4,17 interventions available for the treatment of over- References supply are anecdotal and not well studied. 1. American Academy of Pediatrics Work Group on Through complex interactions of prolactin re- Breastfeeding. Breastfeeding and the use of human ceptors and the feedback inhibitor of lactation, milk. Pediatrics 2012;129:e827–41. retention of milk within the breast decreases pro- 2. American Academy Family Physicians Breastfeeding duction.7,15 Most interventions
Load more

Recommended publications
  • Spectrum of Benign Breast Diseases in Females- a 10 Years Study
    Original Article Spectrum of Benign Breast Diseases in Females- a 10 years study Ahmed S1, Awal A2 Abstract their life time would have had the sign or symptom of benign breast disease2. Both the physical and specially the The study was conducted to determine the frequency of psychological sufferings of those females should not be various benign breast diseases in female patients, to underestimated and must be taken care of. In fact some analyze the percentage of incidence of benign breast benign breast lesions can be a predisposing risk factor for diseases, the age distribution and their different mode of developing malignancy in later part of life2,3. So it is presentation. This is a prospective cohort study of all female patients visiting a female surgeon with benign essential to recognize and study these lesions in detail to breast problems. The study was conducted at Chittagong identify the high risk group of patients and providing regular Metropolitn Hospital and CSCR hospital in Chittagong surveillance can lead to early detection and management. As over a period of 10 years starting from July 2007 to June the study includes a great number of patients, this may 2017. All female patients visiting with breast problems reflect the spectrum of breast diseases among females in were included in the study. Patients with obvious clinical Bangladesh. features of malignancy or those who on work up were Aims and Objectives diagnosed as carcinoma were excluded from the study. The findings were tabulated in excel sheet and analyzed The objective of the study was to determine the frequency of for the frequency of each lesion, their distribution in various breast diseases in female patients and to analyze the various age group.
    [Show full text]
  • The Key to Increasing Breastfeeding Duration: Empowering the Healthcare Team
    The Key to Increasing Breastfeeding Duration: Empowering the Healthcare Team By Kathryn A. Spiegel A Master’s Paper submitted to the faculty of the University of North Carolina at Chapel Hill In partial fulfillment of the requirements for the degree of Master of Public Health in the Public Health Leadership Program. Chapel Hill 2009 ___________________________ Advisor signature/printed name ________________________________ Second Reader Signature/printed name ________________________________ Date The Key to Increasing Breastfeeding Duration 2 Abstract Experts and scientists agree that human milk is the best nutrition for human babies, but are healthcare professionals (HCPs) seizing the opportunity to promote, protect, and support breastfeeding? Not only are HCPs influential to the breastfeeding dyad, they hold a responsibility to perform evidence-based interventions to lengthen the duration of breastfeeding due to the extensive health benefits for mother and baby. This paper examines current HCPs‘ education, practices, attitudes, and extraneous factors to surface any potential contributing factors that shed light on necessary actions. Recommendations to empower HCPs to provide consistent, evidence-based care for the breastfeeding dyad include: standardized curriculum in medical/nursing school, continued education for maternity and non-maternity settings, emphasis on skin-to-skin, enforcement of evidence-based policies, implementation of ‗Baby-Friendly USA‘ interventions, and development of peer support networks. Requisite resources such as lactation consultants as well as appropriate medication and breastfeeding clinical management references aid HCPs in providing best practices to increase breastfeeding duration. The Key to Increasing Breastfeeding Duration 3 The key to increasing breastfeeding duration: Empowering the healthcare team During the colonial era, mothers breastfed through their infants‘ second summer.
    [Show full text]
  • Breastfeeding and Women's Mental Health
    BREASTFEEDING AND WOMEN’S MENTAL HEALTH Julie Demetree, MD University of Arizona Department of Psychiatry Disclosures ◦ Nothing to disclose, currently paid by Banner University Medical Center, and on faculty at University of Arizona. Goals and Objectives ◦ Review the basic physiology involved in breastfeeding ◦ Learn about literature available regarding mood, sleep and breastfeeding ◦ Know the resources available to refer to regarding pharmacology and breast feeding ◦ Understand principles of psychopharmacology involved in breastfeeding, including learning about some specific medications, to be able to counsel a woman and obtain informed consent ◦ Be aware of syndrome described as Dysphoric Milk Ejection Reflex Lactation Physiology https://courses.lumenlearning.com/boundless-ap/chapter/lactation/ AAP Material on Breastfeeding AAP: Breastfeeding Your Baby 2015 AAP Material on Breastfeeding AAP: Breastfeeding Your Baby 2015 A Few Numbers ◦ About 80% of US women breastfeed ◦ 10-15% of women suffer from post partum depression or anxiety ◦ 1-2/1000 suffer from post partum psychosis Depression and Infant Care ◦ Depressed mothers are: ◦ More likely to misread infant cues 64 ◦ Less likely to read to infant ◦ Less likely to follow proper safety measures ◦ Less likely to follow preventative care advice 65 Depression is Associated with Decreased Chance of Breastfeeding ◦ A review of 75 articles found “women with depressive symptomatology in the early postpartum period may be at increased risk for negative infant-feeding outcomes including decreased breastfeeding duration, increased breastfeeding difficulties, and decreased levels of breastfeeding self-efficacy.” 1 Depressive Symptoms and Risk of Formula Feeding ◦ An Italian study with 592 mothers participating by completing the Edinburgh Postnatal Depression Scale immediately after delivery and then feeding was assessed at 12-14 weeks where asked if breast, formula or combo feeding.
    [Show full text]
  • Unilateral Galactorrhea Associated with Low-Dose Escitalopram
    Case Report Unilateral Galactorrhea Associated with Low-dose Escitalopram P. Bangalore Ravi, K. G. Guruprasad1, Chittaranjan Andrade2 ABSTRACT Galactorrhea is a rare adverse effect of selective serotonin reuptake inhibitor treatment. We report a 27-year-old woman who developed unilateral breast engorgement with galactorrhea 18 days after initiation of escitalopram (10 mg/day). The symptom remitted 7 days after withdrawal of escitalopram and did not subsequently recur during maintenance therapy with agomelatine (25 mg/day). Key words: Agomelatine, escitalopram, galactorrhea, prolactin, selective serotonin reuptake inhibitor, unilateral breast engorgement INTRODUCTION about the future, low self-confidence, diminished interest in daily activities, and diminished interest in social life, Galactorrhea refers to the discharge of milk from the poor appetite, and poor sleep. These symptoms were breast, unassociated with recent childbirth or nursing. exacerbated by domestic stress and absence of social Galactorrhea occurs when serum prolactin levels are support. A diagnosis of moderate depression with raised for reasons ranging from pituitary tumors to drug somatic symptoms was made, and she was started on treatments. A number of drugs, including psychotropic escitalopram 5 mg/day along with clonazepam 0.75 mg/day. She was instructed to increase the dose of drugs, cause hyperprolactinemia, some doing so consistently escitalopram to 10 mg/day after 4 days and taper and (e.g., certain antipsychotics), and some, rarely (e.g., certain withdraw the clonazepam at the rate of 0.25 mg/week. antidepressants).[1,2] We herein report an unusual case of galactorrhea resulting from escitalopram use. After about 18 days of treatment, she developed painless engorgement of her left breast associated with CASE REPORT galactorrhea.
    [Show full text]
  • Breast Concerns
    Section 12.0: Preventive Health Services for Women Clinical Protocol Manual 12.2 BREAST CONCERNS TITLE DESCRIPTION DEFINITION: Breast concerns in women of all ages are often the source of significant fear and anxiety. These concerns can take the form of palpable masses or changes in breast contours, skin or nipple changes, congenital malformation, nipple discharge, or breast pain (cyclical and non-cyclical). 1. Palpable breast masses may represent cysts, fibroadenomas or cancer. a. Cysts are fluid-filled masses that can be found in women of all ages, and frequently develop due to hormonal fluctuation. They often change in relation to the menstrual cycle. b. Fibroadenomas are benign sold tumors that are caused by abnormal growth of the fibrous and ductal tissue of the breast. More common in adolescence or early twenties but can occur at any age. A fibroadenoma may grow progressively, remain the same, or regress. c. Masses that are due to cancer are generally distinct solid masses. They may also be merely thickened areas of the breast or exaggerated lumpiness or nodularity. It is impossible to diagnose the etiology of a breast mass based on physical exam alone. Failure to diagnose breast cancer in a timely manner is the most common reason for malpractice litigation in the U.S. Skin or nipple changes may be visible signs of an underlying breast cancer. These are danger signs and require MD referral. 2. Non-spontaneous or physiological discharge is fluid that may be expressed from the breast and is not unusual in healthy women. 3. Galactorrhea is a spontaneous, multiple duct, milky discharge most commonly found in non-lactating women during childbearing years.
    [Show full text]
  • Management of Prolonged Decelerations ▲
    OBG_1106_Dildy.finalREV 10/24/06 10:05 AM Page 30 OBGMANAGEMENT Gary A. Dildy III, MD OBSTETRIC EMERGENCIES Clinical Professor, Department of Obstetrics and Gynecology, Management of Louisiana State University Health Sciences Center New Orleans prolonged decelerations Director of Site Analysis HCA Perinatal Quality Assurance Some are benign, some are pathologic but reversible, Nashville, Tenn and others are the most feared complications in obstetrics Staff Perinatologist Maternal-Fetal Medicine St. Mark’s Hospital prolonged deceleration may signal ed prolonged decelerations is based on bed- Salt Lake City, Utah danger—or reflect a perfectly nor- side clinical judgment, which inevitably will A mal fetal response to maternal sometimes be imperfect given the unpre- pelvic examination.® BecauseDowden of the Healthwide dictability Media of these decelerations.” range of possibilities, this fetal heart rate pattern justifies close attention. For exam- “Fetal bradycardia” and “prolonged ple,Copyright repetitive Forprolonged personal decelerations use may onlydeceleration” are distinct entities indicate cord compression from oligohy- In general parlance, we often use the terms dramnios. Even more troubling, a pro- “fetal bradycardia” and “prolonged decel- longed deceleration may occur for the first eration” loosely. In practice, we must dif- IN THIS ARTICLE time during the evolution of a profound ferentiate these entities because underlying catastrophe, such as amniotic fluid pathophysiologic mechanisms and clinical 3 FHR patterns: embolism or uterine rupture during vagi- management may differ substantially. What would nal birth after cesarean delivery (VBAC). The problem: Since the introduction In some circumstances, a prolonged decel- of electronic fetal monitoring (EFM) in you do? eration may be the terminus of a progres- the 1960s, numerous descriptions of FHR ❙ Complete heart sion of nonreassuring fetal heart rate patterns have been published, each slight- block (FHR) changes, and becomes the immedi- ly different from the others.
    [Show full text]
  • Evaluation of Nipple Discharge
    New 2016 American College of Radiology ACR Appropriateness Criteria® Evaluation of Nipple Discharge Variant 1: Physiologic nipple discharge. Female of any age. Initial imaging examination. Radiologic Procedure Rating Comments RRL* Mammography diagnostic 1 See references [2,4-7]. ☢☢ Digital breast tomosynthesis diagnostic 1 See references [2,4-7]. ☢☢ US breast 1 See references [2,4-7]. O MRI breast without and with IV contrast 1 See references [2,4-7]. O MRI breast without IV contrast 1 See references [2,4-7]. O FDG-PEM 1 See references [2,4-7]. ☢☢☢☢ Sestamibi MBI 1 See references [2,4-7]. ☢☢☢ Ductography 1 See references [2,4-7]. ☢☢ Image-guided core biopsy breast 1 See references [2,4-7]. Varies Image-guided fine needle aspiration breast 1 Varies *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level Variant 2: Pathologic nipple discharge. Male or female 40 years of age or older. Initial imaging examination. Radiologic Procedure Rating Comments RRL* See references [3,6,8,10,13,14,16,25- Mammography diagnostic 9 29,32,34,42-44,71-73]. ☢☢ See references [3,6,8,10,13,14,16,25- Digital breast tomosynthesis diagnostic 9 29,32,34,42-44,71-73]. ☢☢ US is usually complementary to mammography. It can be an alternative to mammography if the patient had a recent US breast 9 mammogram or is pregnant. See O references [3,5,10,12,13,16,25,30,31,45- 49]. MRI breast without and with IV contrast 1 See references [3,8,23,24,35,46,51-55].
    [Show full text]
  • Tips for Sore/Cracked Nipples
    Tips for Sore/Cracked Nipples Nipples can become sore and cracked due to many reasons such as a shallow latch, tongue-tie or other anatomical variations, thrush, a bite, milk blister, etc. Keep in mind that one of the most important factors in healing is to correct the source of the problem. Continue to work on correct latch and positioning, thrush treatment, etc. as you treat the symptoms, and talk to a board certified lactation consultant (IBCLC). During the nursing session • Breastfeed from the uninjured (or less injured) side first. Baby will tend to nurse more gently on the second side offered. • Experiment with different breastfeeding positions to determine which is most comfortable. • If breastfeeding is too painful, it is very important to express milk from the injured side to reduce the risk of mastitis and to maintain supply. Pump on a low setting. Salt water rinse after nursing This special type of salt water, called normal saline, has the same salt concentration as tears and should not be painful to use. To make your own normal saline solution: Mix 1/2 teaspoon of salt in one cup (8 oz) of warm water. Make a fresh supply each day to avoid bacterial contamination. • After breastfeeding, soak nipple(s) in a small bowl of warm saline solution for a minute or so–long enough for the saline to get onto all areas of the nipple. Avoid prolonged soaking (more than 5-10 minutes) that “super” hydrates the skin, as this can promote cracking and delay healing. • Pat dry very gently with a soft paper towel.
    [Show full text]
  • Position Latch Breastfeeding
    UW MEDICINE | PATIENT EDUCATION Full of format problems, sorry! This chapter has illustrations that need to be moved! | | Position and Latch for Breastfeeding | | Laid- back, cr oss-cradle, football, and side-lying positions This handout describes 4 positions for breastfeeding: laid-back, cross- cradle, football hold, and side-lying. Drawings are included to help you see the positions for you and your baby. Your nurses are also ready and happy to help you as needed. It is best for your baby’s first feeding to happen right after birth. That is when babies are usually awake and ready to discover your breast. It is easiest to position your baby at your breast without blankets. Your body will keep your baby DRAFTwarm. While you are still lying back in the delivery bed, you can gently put your baby on your abdomen with her face near your breast. Many babies will make movements toward your breast and even latch onto It is best for your baby’s first feeding your breast without much help. to happen right after birth. If you wish, you can lift your breast toward your baby and let your nipple touch your baby’s face. You will probably notice that your nipple stands out a bit. Your breast is getting ready for the feeding. Wait for your baby to open his mouth wide before bringing him to your breast. Many babies will then take hold and suck for several minutes. When your baby is latched onto your breast correctly, you will probably feel a strong pulling. Any discomfort should lessen after the first few sucks.
    [Show full text]
  • Preparing to Breastfeed Ome Women Wonder What They Need to Do • Room for Expansion
    Preparing to Breastfeed ome women wonder what they need to do • Room for expansion. Your breasts may go up a full cup during pregnancy to prepare for breastfeeding. size when your milk comes in. Actually, your body knows what to do. Lactation • Breathable fabrics are best while breastfeeding. S(milk production) naturally follows pregnancy. The • Consider buying only 1 or 2 bras during the final hormones produced during pregnancy prepare your weeks of pregnancy and waiting until a couple of breasts to make milk once your baby is born. The best weeks postpartum to add more to your wardrobe. preparation, and what most women need in order (A gift certificate for a new bra makes a great shower to breastfeed effectively, is accurate information and gift.) Many mothers-to-be like to know that their someone to provide support and encouragement. breast size will settle into a moderately larger size after about three months. During Pregnancy At one time a great deal of emphasis was placed on Concerns About Nipple Size or Shape preparing your nipples during pregnancy. However, it is In order for the baby to suck effectively, he needs to now recognized that correct positioning and latch-on draw your nipple far back into his mouth. Babies can of the baby in the early days is the best prevention for breastfeed effectively with a large variety of nipple nipple soreness. So what shapes. The nipple is only a part of the breast called the should you expect before nipple-areola complex. The softness and stretchiness the baby is born? of the tissue just behind the nipple is actually more • Your breasts will likely important than the nipple shape.
    [Show full text]
  • Burns, Hypertrophic Scar and Galactorrhea
    Karimi H et al. Injury & Violence 117 J Inj Violence Res. 2013 Jun; 5(2): 117-119. doi: 10.5249/ jivr.v5i2.314 Case Report Burns, hypertrophic scar and galactorrhea Hamid Karimi a , Samad Nourizad a ,* , Mahnoush Momeni a, Hosein Rahbar a, Mazdak Momeni b, Khosro Farhadi c a Faculty of Medicine, Tehran University of Medical Sciences,Tehran, Iran. b Baylor College of Medicine, Houston, Texas, USA. c Department of Anesthesiology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Abstract: An 18-year old woman was admitted to Motahari Burn Center suffering from 30% burns. KEY WORDS Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs. At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four Burns months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the Hypertrophic scar high level of prolactin were detected. Galactorrhea She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients. Received 2012-09-28 Accepted 2013-01-23 © 2013 KUMS, All rights reserved *Corresponding Author at: Dr. Samad Nourizad: Department of Anesthesiology, Tehran University of Medical Science, Tehran, Iran, Email: [email protected] (Nourizad S.). © 2013 KUMS, All rights reserved Introduction sis, i.e.
    [Show full text]
  • OBGYN-Study-Guide-1.Pdf
    OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test.
    [Show full text]