We have a good-sized antepartum/high risk unit.  I have seen MANY cases of
ante-partum lactation and several cases of breast engorgement.  This is
probably related more to why the mothers are getting terbutaline than to the
terbutaline itself.  If the placenta is not functioning well, producing
hormones that allow the pregnancy to fare well, perhaps it is not producing
adequate amounts of prolactin inhibiting factor that stops lactogenesis.
 Think about moms with delayed lactogenesis related to retained placental
fragments.  Same process is probably involved here.  I have tried to get our
perinatologist interested in doing some research on this area.  wouldn't it
be neat if we could figure out and analyze the PIF with a blood test?  If we
detected low levels, we might be able to predict pre-term labor related to
placental malfunction and do something to prevent.  If we detected high
levels, we could look at retained fragments as a cause of delayed production.
 I have also seen early engorgment and production with women with HELLP and
other forms of pre-eclampsia which is also thought to have some relationship
to placental function.

Thanks,
Jane Kershaw  mailto [log in to unmask]