Also termed the milk line, this line extends from the axilla to the groin bilaterally. In some women, rests of accessory breast tissue can be found in the mons pubis or vulva (Wagner, 2013). In the general population, the incidence of accessory breast tissue ranges from 0.22 to 6 percent (Loukas, 2007).
hese breasts may be so small as to be mistaken for pigmented moles, or if without a nipple, for lymphadenopathy or lipoma.
Polymastia has no obstetrical significance, although occasion ally enlargement of these accessory breasts during pregnancy and anxiety.
Galactocele is a milk duct that becomes obstructed by inspis sated secretions. The amount is ordinarily limited, but an excess pressure symptoms and have the appearance of an abscess. It may resolve spontaneously or require aspiration.
Among individuals, the volume of milk secreted varies markedly. This depends not on general maternal health but on breast glandular development. Rarely, there is complete lack of mammary secretion-agalactia. Occasionally, mammary secretion is excessive-poygalactia.
For 2 hours after delivery, blood pressure and pulse are taken every 15 minutes, or more frequently if indicated. Temperature is assessed every 4 hours for the first 8 hours and then at least every 8 hours subsequently (American Academy of Pediatrics, 2017). The amount of vaginal bleeding is monitored, and the fundus palpated to ensure that it is well contracted. If relaxation is detected, the uterus should be massaged through the abdominal wall until it remains contracted. U terotonics are also sometimes required. Blood can accumulate within the uterus without external bleeding. his may be detected early by uterine enlargement during fundal palpation in the irst postdelivery hours. Because the likelihood of signiicant hemorrhage is greatest immediately postpartum, even in normal births, the uterus is closely monitored for at least 1 hour after delivery. Postpartum hemorrhage is discussed in Chapter 41 (p. 758). If regional analgesia or general anesthesia was used for labor or delivery, the mother should be observed in an appropriately equipped and stafed recovery area.
Women are out of bed within a few hours after delivery. n attendant should be present for at least the irst time, in case the woman becomes syncopal. he many conirmed advantages of early ambulation include fewer bladder complications, less frequent constipation, and reduced rates of puerperal venous thromboembolism. As discussed on page 655, deep-vein thrombosis and pulmonary embolism are common in the puerperium (see Fig. 36-3). In an audit of puerperal women at Parkland Hospital, the frequency of venous thromboembolism was found to be 0.008 percent after a vaginal birth and 0.04 percent following cesarean delivery. We attribute this low incidence to early ambulation. Risk factors and other measures to diminish the frequency of thromboembolism are discussed in Chapter 52 (p. 1004).
here are no dietary restrictions for women who have been delivered vaginally. Two hours after uncomplicated vaginal delivery, a woman is allowed to eat. With breastfeeding, the level of calories and protein consumed during pregnancy are increased slightly as recommended by the Food and Nutrition Board of the National Research Council (Chap. 9, p. 167). If the mother does not breastfeed, dietary requirements are the same as for a nonpregnant woman. We recommend oral iron supplementation for at least 3 months after delivery and hematocrit evaluation at the first postpartum visit.
As noted earlier, profound drops in estrogen levels follow removal of the placenta. Reminiscent of the menopause, postpartum women may experience hot lushes, especially at night. Importantly, the patientr's temperature is assessed to diferentiate these physiological vasomotor events from infection.