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Old 11-30-2011
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ObGyn Contraindication to breast feeding

You examine a 28-year-old woman who is 2 days status post-cesarean delivery for a non-reassuring fetal heart rate tracing in labor. Her prenatal course was complicated by her developing acute tuberculosis in the days immediately before her delivery. When you diagnosed her with tuberculosis, she decided to hold off on therapy until after the baby was born. She was also found to be Group B Streptococcus–positive on a 36-week vaginal culture. She has a past medical history significant for chronic hepatitis B. Her past surgical history is significant for a breast reduction 4 years ago. Postpartum she is doing well, with no complaints, normal vital signs, and a normal postpartum physical examination. She wants to know if she is able to breast feed her infant. Which of the following conditions precludes this patient from breastfeeding?

A. Chronic hepatitis B
B. Group B Streptococcus colonization
C. Status-post breast reduction
D. Status-post cesarean delivery
E. Untreated tuberculosis
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Old 11-30-2011
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the breast reduction can be a problem in nursing if the areola n nerves or ducts in breast were damaged..TB n Hep.B dont pass through breast milk.
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Old 11-30-2011
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Untreated tuberculosis!
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Old 11-30-2011
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E. Untreated tuberculosis
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Old 11-30-2011
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E.

Untreated tuberculosis
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Old 12-01-2011
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Hep B is transferred through any body fluid including sweat.the baby could be infected in utero and in such case the baby would receive active n pasive immunisation at birth.
TB does not spread through breast milk but due to the close contact associated with the mother doing breast feeding there is a chance the baby may get infected.
So i will go with
E.Untreated TB
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Old 12-01-2011
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The correct answer is E. Breastfeeding is a normal and natural function that provides numerous benefits to the mother and child. Mothers who breast feed have less postpartum blood loss and improved infant attachment, as well as a decreased risk of ovarian and premenopausal breast cancer. Regarding the infant, there is strong evidence that breastfed infants have decreased rates of diarrhea, respiratory infections, otitis media, bacterial meningitis, botulism, urinary tract infections, and necrotizing enterocolitis. Breastfeeding is also associated with increased intelligence. Some studies suggest that breastfeeding protects against sudden infant death syndrome (SIDS), insulin-dependent diabetes mellitus (IDDM), Crohn's disease, ulcerative colitis, allergic diseases, and lymphoma. Still following are the contraindications to breast feeding-

1. Active HIV
2. Active TB
3. Breast Cancer
4. Alcohol or Drug Abuse
5. Galactosemia in Neonate
6. Taking Chemotherapeutic Agents

Unfortunately, this patient has active, untreated pulmonary tuberculosis. In this case she should not be allowed to breast feed or bottle feed her infant because such close and prolonged contact increases the risk of infection in the neonate. The mother should not breast feed until she has been treated for 2 full weeks. Pumped breast milk may be given to the neonate because it does not contain Mycobacterium tuberculosis.
Chronic hepatitis B (choice A) does not represent a contraindication to breastfeeding. Women with hepatitis A, hepatitis B, or hepatitis C should be allowed to breast feed.
Group B Streptococcus colonization (choice B) is not a contraindication to breastfeeding. Approximately 30% of all pregnant women are Group B Strep–positive and these women should be treated with penicillin (or an alternative agent if penicillin-allergic) during labor and delivery.
Patients who are status-post breast reduction (choice C) should attempt to breastfeed. Some women who have had breast reduction surgery are able to successfully breastfeed. Whether or not breastfeeding is successful depends upon the exact nature of the breast reduction surgery.
Patients who are status-post cesarean delivery (choice D) should be encouraged to breast feed. Breastfeeding can be difficult in the early days after a cesarean, but it is certainly not contraindicated.
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