Three Days After an Uncomplicated Cesarean Delivery, a 23-Year-Old Woman

question 294

Multiple Choice

Three days after an uncomplicated cesarean delivery, a 23-year-old woman, gravida 1 para 1, is evaluated on the postpartum floor due to bilateral breast pain and fatigue.  The patient has been attempting to breastfeed but has had difficulty getting the infant to latch, requiring her to supplement with formula.  The patient's pregnancy was complicated by insulin-controlled gestational diabetes mellitus.  She had a progestin-containing subcutaneous implant placed a day ago for contraception.  Temperature is 37.4 C (99.4 F) , blood pressure is 130/70 mm Hg, and pulse is 100/min.  Bilateral breasts are full, erythematous, and diffusely tender.  There is no axillary lymphadenopathy.  The uterine fundus is firm, nontender, and palpable 3 cm below the umbilicus.  Which of the following is the most likely diagnosis in this patient?

• A)Breast abscess
• B)Breast engorgement
• C)Galactocele
• D)Lactational mastitis
• E)Mammary candidosis
• F)Plugged duct

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