According to the authors of this week’s study, approximately 45% of people who undergo a 2nd trimester pregnancy termination or loss will experience either breast tenderness, engorgement, or milk leakage.
These symptoms can trigger emotional distress, and many physicians/providers are not familiar with preventive interventions. Many individuals who experience breast engorgement after such procedures are advised to use ice, cabbage leaves, a supportive bra, and some are referred for acupuncture, massage, and/or are advised to use herbs.
A Cochrane review of treatments for breast engorgement during lactation found that nonpharmacologic interventions for engorgement had low quality evidence and the review did not include cabergoline as an option.
Cabergoline is a prescription medication that is a dopamine agonist. Because dopamine agonists decrease prolactin, it is FDA approved for treatment of high prolactin levels due to pituitary growths.
A systematic review of the use of cabergoline for postpartum lactation inhibition concluded that cabergoline is generally safe and effective for postpartum women who wish to suppress lactation. In the United States, cabergoline use for lactation suppression is considered off-label, which often deters physicians and other providers from offering this option for the prevention of postpartum or post-procedural engorgement.
This week’s study is a randomized double-blind placebo-controlled trial on the use of a single 1mg dose of cabergoline vs placebo among 72 individuals who had undergone a 2nd trimester pregnancy abortion or management of fetal death.
The average gestational age was 21 weeks, and approximately 35-38% of subjects were insured by Medicaid, 39% were Asian, 35% white, and 34% Hispanic.
The participants were given either cabergoline 1mg or placebo within 4 hours of the procedure or loss of the fetus. All were given standard care instructions including breast support and ice packs as needed.
The participants were surveyed on days 2,3,4,7, and 14 post-procedure and asked to rate their overall experience with engorgement. At each time point, the participants who received cabergoline reported fewer breast symptoms (engorgement, breast tenderness, leaking milk, and requiring pharmacologic pain relief).
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mónica waisman
In Argentina, where I live and work as an Pediatrician IBCLC, Cabergoline may be offeresd with no restriction. It must be labelled.