breast complications in puerperium
TRANSCRIPT
BREAST COMPLICATIONS IN
PUERPERIUM
It includes Breast engorgementCracked and retracted nipple
Mastitis Breast Abscess
BREAST ENGORGEMENTBreast
engorgement is due to exaggerated normal venous and lymphatic engorgement of the breast which precede lactation. This in turn prevents escape of milk from the lacteal system.
SYMPTOMS Firm, tender or painful breasts The areola may be hard and the
nipple may be flattened-out. Swelling and tenderness may
extend up into the axillary area. The skin may be taut, shiny and
feel warm to the touchGeneralized malaise Transient rise of temperature.
PREVENTION Initiate breast feeding early and unrestricted
Exclusive breast feeding on demand
Feeding in correct positionAvoid early use of prelacteal feeds, bottles and pacifiers while baby is learning to breastfeed
Allow baby to start and end the feeding.
Gently massage and compress the breast when baby pauses between sucks. This helps to drain the breast, leaving less milk behind.
If a feeding is missed or if baby is not nursing well, use hand expression or a breast pump to remove the milk.
Always wean gradually.
MANAGEMENT Before breastfeeding Ibuprofen 200 mg-1 tablet every
3 hours for pain. For comfort, the mother can
apply warmth or cold to her breasts
Gentle breast massage may help improve milk flow and reduce engorgement
Pumping once to completely soften the breasts can resolve engorgement for some women.
While breastfeeding• Gently massage and
compress the breast when baby pauses between sucks. This can help drain the breast, leaving less milk behind.
Between feeds• If breasts are uncomfortably
full, express a little milk. Avoid over-stimulating. Use manual expression or a quality breast pump on a low setting.
• A well-fitted, supportive nursing bra
Acute infection of the breast.
Invasion of breast tissue by an infectious organism
MASTITIS
Infection involves breast parenchymal tissues leading to cellulitis.
Usually the infection gain access through lactiferous duct
If not treated properly it can lead to breast abscess
Infection
SYMPTOMSGeneralized
malaise and headache
Fever with chills
Severe pain, tenderness and swelling on the breast resembling shape of a wedge with apex at nipple
Overlying skin become red, hot, flushed & tender
Commonly affects upper outer quadrant which may affect one or both breast. I t is almost always unilateral.
MANAGEMENT Breast support and Plenty of
fluidsContinue Breast feeding with
good attachment as this prevents proliferation of staphylococcus in the stagnant milk
Manual emptying of infected breast
Flucoxacillin 500mg 6th hourly or erythromycin and this is continued for atleast 7 days
Analgesics for pain
PREVENTION Metriculous hand washing before
each feedCleaning the nipple before and after
each feedEarly and frequent feeding Proper positioning of baby on breastGood support of breast without
constrictionCleansing with water only and no
drying agentsDaily observation of baby for skin and
cord infectionAvoid close contact with a known
staphylococcal infection
BREAST ABCESS SYMPTOMS
Purulent nipple dischargeBrawny edema of overlying skin
Flushed breast not responding to antibiotics properly
Marked tenderness with fluctuation
Swinging temperature
MANAGEMENT Incision and drainage under GA
by a deep radical incision extending from near the areolar margin to prevent injury of the lactiferous ducts.
Serial percutaneous needle aspiration under USG guidance.
Continue breast feeding on the uninvolved breast. Infected breast to be mechanically pumped every 2 hrs and with every let down
CRACKED NIPPLE The nipple becomes painful due to loss of surface epithelium or due to a fissure situated either at the tip or base of the nipple.
Causes
• Unclean hygiene resulting in formation of crust over nipple
• Retracted nipple • Trauma from baby’s mouth due to incorrect attachment to breast
TREATMENTCorrect attachment to breast.Fresh human milkPurified lanonin with the mothers
milk is applied 3 to 4 times a dayUse breast pumpMiconazole lotion for oral thrush. Nipple shieldsThe persistence of nipple ulcer in
spite of above therapy needs biopsy to exclude malignancy.
RETRACTED AND FLAT NIPPLE
Treatment Oil massaging
Expressed breast feeding
Reference Dutta D C. text book of obstetrics. Sixth edition.
Kolkata: New central book agency; 2006 Novak C J, Broom L B. Maternal and child health
nursing. Ninth edition. Missouri. Mosby; 1999 Varney H, Kriebs JM , Gregor CL. Varneys
textbook of midwifery . 4th edition. New Delhi: Elsevier; 2005
Fraser DM, Cooper MA. Myles textbook for midwives. 14th edition. London: Churchill Livingstone; 2003