O&G: The postpartum period

Question 1

A 39 year-old woman presents to her general practitioner with a grape-sized breast lump that she noticed one week ago whilst in the bath. It is firm and non-tender, with no surrounding skin changes. She feels well in herself with no temperatures, and has no history of breast disease. She stopped breastfeeding one month ago. An ultrasound scan shows a well-circumscribed lesion and aspiration yields a white fluid. What is the likely diagnosis?

Answer 1

Galactocele

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Galactocele typically occurs in women who have recently stopped breastfeeding and is due to occlusion of a lactiferous duct. A build up of milk creates a cystic lesion in the breast. The lesion can be differentiated from an abscess by the fact that a galactocele is usually painless, with no local or systemic signs of infection.

The ultrasound findings and aspiration results make fibrocystic change, breast cancer and fat necrosis unlikely.

Question 2

On routine antenatal swabs, a mother is found to be colonised with Group B Streptococcus. However, she did not receive adequate intrapartum antibiotic prophylaxis and she delivers a healthy baby girl by vaginal delivery. Her baby does not require any resuscitation and remains well in the post natal ward. The mother is eager for discharge home. What is the most appropriate course of action with regards to her child?

Answer 2

Regular observations for 24 hours

Question 3

If neonatal sepsis is suspect, what antibiotics do you give?

Answer 3

Benzylpenicillin and Gentamicin