Nipple discharge is common and expected during pregnancy as the breasts prepare for lactation. Physiological discharge is called colostrum early in pregnancy and milk later. Non-pregnant women may also experience milk discharge due to high prolactin levels. In pregnancy, women may see blood-stained, yellow, black, or clear discharges from one or both nipples due to benign breast conditions, skin disorders, or malignancies like Paget's disease or ductal carcinoma. Persistent or unilateral bloody discharge raises the possibility of cancer and requires investigation.

1. Breast / Nipple Discharge In
Pregnancy
PROF. M.C. BANSAL
MBBS., MS., FICOG. MICOG.
EX PRINCIPAL & CONTROLLER ,.
JHALAWAR MEDICAL COLLEGE & HOSPITAL
JHALWAR.
MGMC & HOSPITAL , SITAPURA , JAIPUR.

2. Nipple discharge In Pregnancy
 Function of breast is to produce milk and
preparation for lactation start in early weeks of
pregnancy. Hence discharge from breast is expected
called cholostrum.
 Later it is called milk .
 Non pregnant women suffering from hyper
prolactinaemia may have milk discharge in varying
amount.
 In pregnancy some women may report blood stained
, yellow discharge like pus , black colored discharge
from one or both the nipples.

3. Causes of nipple discharge in Pregnancy
 Intrinsic to pregnancy (physiological).
 Skin disorder—eczema.
 Benign breast problem
Duct Ectasia.
Intraductal papilloma
 Malignancy
Pagets disease of the nipple ( carcinoma
presenting at nipple )
Ductal carcinoma in situ ( this may occur
concurrently with an invasive carcinoma of breast).

4. Blood discharge from nipple
 A persistent discharge , unilaterally , raises the
possibility of ductal carcinoma in situ or actual
carcinoma of breast.
 Discharge is usually bright red and persistent.
 Some women develop cupious discharge of blood ,
bilaterally , towards the end of pregnancy and in
puerperium .investigations are require but often no
serious pathology is detected. There is also no
explanation is available .
 Both intra ductal carcinoma and ductal carcinoma in
situ can present with persistent clear discharge also.

5. Breast nipple discharge establishing the
diagnosis
 History
 Clinical examination of both the breasts and
maxillae.
 Cytology of discharge.
 Ultra sound scan and / or mammogram after
shielding the fetus in uteri.
 If there is a mass lesion :
FNAC.
core biopsy.
excision biopsy.

6. Ducal ecstasies
 There is no special relation with pregnancy.
 It is no more than a nuisance value.
 Ecstasies means dilatation of a hollow organ.
 Primary problem is a nonspecific inflammatory condition labeled as
periodical mastitis.
 Secondary bacterial infection when super imposed ecstasies
increases .

8. Ductal Ectasia
 It is typically seen in smokers of 30 -4oyrs women.
 Discharge may be from multiple duct of both the nipples .
It can be of various colors and some times tinged with
blood .
 Some women may have nipple inversion and facing
difficulty in feeding
 Some time a fistula may develop following drainage of an
abscess, between a duct and ducal opening in nipple .,
which is eccentric to the nipple.

9. Paget’ s disease
 Carcinoma presenting at the nipple.
 Usual presentation is unhealed ulcer, but in some cases
complaint may be of slight discharge , with or without
blood , not having noticed the erosive / ulcerative lesion .
 clinical examination is to be followed by scan and
biopsy.
 It is to be differentiated from eczema , the most common
benign problem is often bilateral and affects periareolar
area rather the nipple. It is associated with itching and
florid inflammation . serum leaking from eczema may
stain the bra.
 The management of Paget’s disease is on the line of
treatment of carcinoma irrespective of pregnancy.