I need your advice. Don't want to be missing something with this lady.

I have a lady in her late 20's, very large, had breast tenderness only
during pregnancy no enlargement. She delivered after PROM for 27 hours,
failed "walking epidural" that was topped up several times with ever
increasing doses of meds until they determined it was in the "wrong spot"
then given another normal epidural, Mid forceps rotation. Baby had apgars
of 3 and 7. Babies temp would not stay up so admitted to NICU and baby
worked up for sepsis. It was allowed to breastfeed from day 2. Lactation
consultant involved is excellent and says baby had a good latach. Mom had
no colostrum evident at any time. Pumped and still none. Breasts never
changed at all postpartum. She is now 8 days and still no changes.

I have put her on Domperidone, initially 10 mg po TID, increased to QID,
and then after 2.5 days I did a prolactin level, TSH, Hgb as she still
had no milk or breast changes. Her prolactin was only 11. (Repeated and
came in at 10 the second time) TSH is normal. Hgb 127. Her pelvic US and
transvaginal US were normal with no retained products or placenta seen.
No abnormal vag bleeding or fevers etc. She is pumping initially very
frequently, then slowed down but I have asked her to continue as I have
increased her Domperidone to 20 mg po QID. She is also on fenugreek now.

What else can I do???? I called a gyne enocrinologist and he said I was
doing everything he could think of and he will let me know after doing a
lit search if he comes up with anything else.


Thanks Karen
(Family doc in London)

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