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Subject:
From:
Becky Severson <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 21 Sep 2000 10:02:58 -0500
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We have a patient in labor right now who has a prolactin-secreting pituitary
tumor.  She was on Parlodel to decrease her prolactin levels in order to get
pregnant and has continued on Parlodel throughout her pregnancy.  She would
like to breastfeed after delivery. Her Perinatologist plans to keep her on
the Parlodel post-delivery, as the patient is very concerned about the
adenoma growing.  Have any of you had a patient with this, who took Parlodel
and still was successful at breastfeeding?

Gabbe's "Obstetrics, Normal & Problem Pregnancies", states:
Breastfeeding is not contraindicated in the presence of a
prolactin-secreting microadenoma.  Furthermore, treatment with bromocriptine
(Parlodel) is safe as well and is apparently not causally related to cases
of stroke or seizure during the postpartum period.

This morning I spoke with the CNM caring for the patient and we're thinking
we might proceed as follows:

- Consider drawing a prolactin level postdelivery to see what her
  level is (since she's been on Parlodel her whole pregnancy), is it
  elevated close to the range normally seen in pregnancy?
- If her serum prolactin level is elevated, initiate early and frequent
  BF and double-pumping to stimulate lactogenesis.
- Follow mom closely through our BF follow-up clinic to assure
  lactation and adequate milk volume after discharge.
- If the mom's prolactin level post-delivery is low, see if the
  Peri/mom would consider stopping the Parlodel for a certain period
  of time to allow lactation to be initiated (ie, a month or more) and
  then re-implement the Parlodel once milk volume is assured (and
  attempting to match the time the prolactin normally decreases
  anyway, so it probably wouldn't hurt to go back on parlodel then)
- We also spoke to the mom's pediatrician this morning to fill him in
  on plans for following baby post-delivery.

If any of you have dealt with this and have suggestions on her plan of care,
I'd appreciate it.   Should we not be able to establish adequate lactation
(and can't stop the Parlodel), we'll switch to plan B which supports
continuation of breastfeeding, but using an SNS or device to provide
adequate volume for baby.

Sorry for the long post!  Thanks for any advice/suggestions you might have.
You can email me privately if you prefer.

Thanks!
        Becky Severson, RNC, IBCLC

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