IBCLC EXAM: Maternal Pathology Study
Guide
Hypoplasia/ Amastia - abnormally shaped breasts with insufficient glandular tissue
-widely spaced
-asymmetric
-pt may have had breast augmentation to correct appearance
-few breast changes during pregnancy
-no engorgement postpartum
-possible connection to thyroid disease
-low supply likely
-monitor infant growth
-counseling necessary
-may improve with subsequent pregnancies
-utilize pumping/galactogogues
Galactorrhea - spontaneous lactation, milk production post weaning
-d/t medications or health problem
Hyperprolactinemia - elevated prolactin levels
-d/t hypo or hyperthyroidism, psychosis/anxiety meds, renal failure,
pituitary/uterine/ovarian tumors
Pitting edema - excessive swelling
-d/t breast abscess, cancer, malignant condition: peau d'orange, trauma to breast,
inflammation of breast, obstruction of milk ducts/glands, benign breast lump/cyst
Candidiasis (thrush) - yeast infection, likely candida
-d/t nipple trauma, mastitis, antibiotic use, vaginal yeast infection, contraceptives,
steriods
-passed between mom and baby: treat both
-thrush can cause gassy/fussy baby
-mother c/o nipple/areolar pain, burning and radiating through breast
-areola appears shiny pink
-use good cleaning techniques
-don't stop breastfeeding
-tx with nystatin/diflucan
, -keep nipples dry, use clean breast pads, expose breasts to sunlight, decease sugar
and dairy
Vasospasm/Raynaud's - stinging, tingling, burning with triphasic color changes:
white/blue/red
-triggered by emotional stress, cold; infants who clench, chew, bite the nipple
-initiate let down before putting baby to breast
-feed on less tender side first, ensure good positioning
-avoid cold, apply heat, cover nipples, avoid caffeine, nicotine
-use ibuprofen, nifedipine, compress end of nipple
-more common with: scleroderma, lupus, rheumatoid arthritis, arteriosclerosis,
pulmonary hypertension
Engorgement - Normal: fullness when tissues swell from milk "coming in."
Pathologic: hard, tight, shiny, red, painful, unable to extract milk, can be aggravated by
mismanagement of breastfeeding
-at risk for permanent damage to alveolar cells
-affects letdown and milk transfer
-tx with breastfeeding often, warmth (if able to express milk), hand expression,
massage, reverse pressure softening, cold compresses (if cannot express milk),
cabbage leaves
-avoid restrictive clothing
Plugged duct - tender sot or lump on breast from duct blocked by milk, localized pain,
low grade fever, and flu like sx
-d/t missed feedings, restrictive clothing, pressure on breasts
-frequent feedings, hand massage, positioning baby's mouth in direction of duct,
warmth, ibuprofen, decreasing saturated fat intake
-can become mastitis
Milk blister - also called bleb, caused by a blocked nipple pore, painful
-soak nipple in warm water and express
-sterile needle extraction
Mastitis - swollen, tender, red, infected breast, generally bacterial cause. flu like sx,
fever >101, breast throbbing, red streaks
-often from poor breastfeeding technique, milk stasis: engorgement, plugged duct,
fatigue, stress
-tx with antibiotics, ibuprofen, milk removal, moist heat, bed rest, fluids, may need to
culture milk if recurrent
Guide
Hypoplasia/ Amastia - abnormally shaped breasts with insufficient glandular tissue
-widely spaced
-asymmetric
-pt may have had breast augmentation to correct appearance
-few breast changes during pregnancy
-no engorgement postpartum
-possible connection to thyroid disease
-low supply likely
-monitor infant growth
-counseling necessary
-may improve with subsequent pregnancies
-utilize pumping/galactogogues
Galactorrhea - spontaneous lactation, milk production post weaning
-d/t medications or health problem
Hyperprolactinemia - elevated prolactin levels
-d/t hypo or hyperthyroidism, psychosis/anxiety meds, renal failure,
pituitary/uterine/ovarian tumors
Pitting edema - excessive swelling
-d/t breast abscess, cancer, malignant condition: peau d'orange, trauma to breast,
inflammation of breast, obstruction of milk ducts/glands, benign breast lump/cyst
Candidiasis (thrush) - yeast infection, likely candida
-d/t nipple trauma, mastitis, antibiotic use, vaginal yeast infection, contraceptives,
steriods
-passed between mom and baby: treat both
-thrush can cause gassy/fussy baby
-mother c/o nipple/areolar pain, burning and radiating through breast
-areola appears shiny pink
-use good cleaning techniques
-don't stop breastfeeding
-tx with nystatin/diflucan
, -keep nipples dry, use clean breast pads, expose breasts to sunlight, decease sugar
and dairy
Vasospasm/Raynaud's - stinging, tingling, burning with triphasic color changes:
white/blue/red
-triggered by emotional stress, cold; infants who clench, chew, bite the nipple
-initiate let down before putting baby to breast
-feed on less tender side first, ensure good positioning
-avoid cold, apply heat, cover nipples, avoid caffeine, nicotine
-use ibuprofen, nifedipine, compress end of nipple
-more common with: scleroderma, lupus, rheumatoid arthritis, arteriosclerosis,
pulmonary hypertension
Engorgement - Normal: fullness when tissues swell from milk "coming in."
Pathologic: hard, tight, shiny, red, painful, unable to extract milk, can be aggravated by
mismanagement of breastfeeding
-at risk for permanent damage to alveolar cells
-affects letdown and milk transfer
-tx with breastfeeding often, warmth (if able to express milk), hand expression,
massage, reverse pressure softening, cold compresses (if cannot express milk),
cabbage leaves
-avoid restrictive clothing
Plugged duct - tender sot or lump on breast from duct blocked by milk, localized pain,
low grade fever, and flu like sx
-d/t missed feedings, restrictive clothing, pressure on breasts
-frequent feedings, hand massage, positioning baby's mouth in direction of duct,
warmth, ibuprofen, decreasing saturated fat intake
-can become mastitis
Milk blister - also called bleb, caused by a blocked nipple pore, painful
-soak nipple in warm water and express
-sterile needle extraction
Mastitis - swollen, tender, red, infected breast, generally bacterial cause. flu like sx,
fever >101, breast throbbing, red streaks
-often from poor breastfeeding technique, milk stasis: engorgement, plugged duct,
fatigue, stress
-tx with antibiotics, ibuprofen, milk removal, moist heat, bed rest, fluids, may need to
culture milk if recurrent
