Looking for insights into a case I'm working with ( mom has given
permission to post)
 Healthy mother with well developed breasts flattened nipples with hx. of
minimal everting.
 First pregnancy, reported normal breast changes. Delivered at 25 weeks-
placed on pump and per mother " nipples were almost ripped from her chest"
and only ever expressed blood. Went through engorgement, etc. never any
leakage noted.
  Second pregnancy: Breasts larger, delivered at 35 weeks,. Babe nursed
very well but  never" got anything" from breasts. Mother never noted any
leakage, moisture, sweating, etc. Developed engorgement, saw LC. never
able to express any type of moisture from breasts
Third pregnancy: Mom states that 2 months into pregnancy, she would
develop reddeness on different aspects of the breasts, warm to touch and
very uncomfortable with areolar edema that was painful. Never sought any
treatment but denied lumps or temp.  Now has delivered Saturday. Breast
today, palpate like normal filling breasts, significant areolar edema 2+
pitting that reduced with RPS. Some nipple evert obtained. Nipple- smooth
skin with what appeared to be one skin "bleb/pore" appearing after RPS.
Otherwise, nipple very smooth with no variation  or in skin. Despite
everything, including babe latching and suckling- no signs of any
colostrum, moisture or anything.
 My thoughts: Possible blockage of ductal openings due to earlier trauma
or possibly no ductal outlets. The OB is a honey and has ordered an
ultrasound to see if we can track to ductal outlets.  ANyone have any
other suggestions?
Thanks in advance.
Lisa

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