A 28-year-old primigravida at day 3 postpartum presents with severe bilateral breast engorgement, erythema, and tenderness. She is unable to breastfeed due to pain. What is the drug of choice for symptomatic relief and to facilitate continued breastfeeding?

Explanation

## Management of Postpartum Breast Engorgement **Key Point:** Ibuprofen is the first-line analgesic and anti-inflammatory agent for postpartum breast engorgement because it reduces pain and inflammation while remaining safe during breastfeeding. ### Why Ibuprofen is Preferred 1. **Anti-inflammatory action** — reduces swelling and erythema more effectively than simple analgesics 2. **Breastfeeding safety** — minimal transfer to breast milk; <1% of maternal dose reaches the infant 3. **Timing** — most effective when given 30 minutes before feeds to allow peak analgesia during nursing 4. **Evidence-based** — recommended by AAP, ACOG, and WHO for postpartum analgesia ### Dosing in Postpartum Period | Drug | Dose | Frequency | Rationale | |------|------|-----------|----------| | **Ibuprofen** | 400–600 mg | Every 6–8 hours | Anti-inflammatory + analgesic | | Paracetamol | 500–1000 mg | Every 4–6 hours | Analgesic only; less anti-inflammatory | | Aspirin | 500–650 mg | Every 4–6 hours | Risk of Reye syndrome in infant; avoid | | Naproxen | 250–500 mg | Every 6–8 hours | Longer half-life; less ideal postpartum | **Clinical Pearl:** Concurrent use of cold compresses, proper latch correction, and frequent emptying of breasts (hand expression if needed) should accompany pharmacotherapy. **High-Yield:** NSAIDs (especially ibuprofen) are preferred over acetaminophen in breast engorgement because the anti-inflammatory effect is crucial for symptom relief. **Warning:** Aspirin is contraindicated postpartum due to theoretical risk of Reye syndrome in the infant, even though actual risk is minimal. [cite:AAP Breastfeeding Handbook for Physicians, ACOG Obstetric Care Consensus]