A 28-year-old primigravida at 3 days postpartum presents with severe breast engorgement, pain, and difficulty in breastfeeding. She has intact skin over the breast with no signs of infection. What is the drug of choice for symptomatic relief in this case?

Explanation

## Management of Breast Engorgement ### Pathophysiology Breast engorgement occurs due to venous and lymphatic congestion combined with interstitial edema in the first 3–5 days postpartum. It is self-limiting but causes significant pain and impairs latch. ### First-Line Pharmacological Treatment **Key Point:** NSAIDs (ibuprofen or paracetamol) are the first-line drugs for symptomatic relief of breast engorgement in lactating mothers. **High-Yield:** Ibuprofen is preferred over paracetamol because: - Superior anti-inflammatory action reduces interstitial edema - Faster onset of pain relief - Minimal excretion into breast milk (< 0.1% of maternal dose) - Safe for continued breastfeeding - Typical dose: 400–600 mg 6-hourly ### Supportive Measures (Equally Important) 1. Frequent, effective breastfeeding (8–12 times/day) 2. Cold compresses between feeds (reduces edema) 3. Warm compresses before feeds (improves milk flow) 4. Proper latch assessment and correction 5. Hand expression or gentle pumping if needed ### Clinical Pearl Engorgement is NOT an indication to stop breastfeeding; continued lactation is the most effective long-term solution. Antibiotics are unnecessary unless infection (mastitis) develops. ### Timeline Engorgement typically resolves within 24–48 hours with appropriate management, or within 5–7 days even without intervention. [cite:Park 26e Ch 8]