## Management of Postpartum Breast Engorgement **Key Point:** Breast engorgement in early postpartum period is managed with NSAIDs (ibuprofen or indomethacin) combined with supportive measures, NOT dopamine agonists. ### Why Ibuprofen is First-Line Ibuprofen is the drug of choice for postpartum breast engorgement because it: 1. Reduces inflammation and pain 2. Allows effective milk removal and continued breastfeeding 3. Is safe during lactation (minimal milk transfer) 4. Works synergistically with cold compresses and proper latch ### Mechanism in Engorgement Postpartum engorgement is primarily **inflammatory** (vascular congestion + interstitial edema), not hormonal. NSAIDs directly address this pathophysiology. **High-Yield:** Engorgement typically resolves within 24–48 hours with frequent milk removal + NSAIDs. Supportive measures include: - Cold compresses between feeds - Proper latch and positioning - Hand expression if needed - Well-fitting bra ### Comparison with Other Options | Drug | Role in Lactation | Engorgement Use | |------|-------------------|------------------| | **Ibuprofen** | Safe; anti-inflammatory | **First-line** | | Bromocriptine | Suppresses lactation | Contraindicated (worsens engorgement) | | Oxytocin | Stimulates milk letdown | Adjunct only; does not treat inflammation | | Metoclopramide | Increases prolactin | Not for engorgement; used for low supply | **Clinical Pearl:** Bromocriptine was historically used to suppress lactation in women who did not wish to breastfeed, but modern practice avoids it due to cardiovascular side effects and is reserved only for galactorrhea or prolactinoma. It is **contraindicated** in engorgement because it prevents milk removal, prolonging symptoms. **Warning:** Do NOT confuse engorgement (inflammatory, self-limited, managed with NSAIDs) with mastitis (infection, requires antibiotics) or abscess (requires drainage).
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