breast problems after delivery and their management
TRANSCRIPT
Breast problems after delivery and its management
Sunil Kumar Daha
Breast complications in puerperium
1. Breast engorgement
2. Cracked and retracted nipple
3. Mastitis
4. Breast abscess
5. Lactation failure
Breast EngorgementCommon in primiparous and patient with inelastic breasts
Onset: 3 to 5 days after delivery (if do not breast feed) exaggerated normal venous and lymphatic engorgement of breast which precede lactation
Prevents the escape of milk from lacteal system
SymptomsConsiderable pain and feeling of heaviness in both the breasts
Generalized malaise or even transient rise of temperature and
Painful breast feeding.
Prevention Avoid prelacteal feeds
Initiate breast feeding early and unrestricted
Exclusive breast feeding on demand,
Feeding in correct position
Treatment Support the breasts with a binder or brassiere
Manual expression of any remaining milk after each feed
To administer analgesics for pain
The baby should be put to the breast regularly at frequent intervals
In a severe case gentle use of a breast pump may be helpful.
Cracked nippleThe nipple may be painful due to:
Loss of surface epithelium Due to a fissure situated at tip or base of nipple or at both area
Causes:Poor hygiene formation of crust over the nippleRetracted nippleTrauma from baby’s mouth due to incorrect attachment to mother’s breastInfection with candida albicans and S. aureus
*Condition may be asymptomatic but becomes painful when the infant sucks the breast
Prophylaxis
Local cleanliness during pregnancy and puerperium, before and after each
breastfeeding to prevent crust formation in the nipple
Treatment
Latch on will provide immediate relief from pain and rapid healing
Purified lanonin with mother’s milk applied 3-4 times a day to hasten healing
*Fresh human milk and saliva have got healing properties
Treatment cotd…Miconazole lotion applied over nipple as well as in the baby’s mouth (if there
is oral thrush).
If fails to heal, rest is given to affected nipple using breast pump while the nipple heals.
*Biopsy is needed to exclude malignancy, if nipple ulcer persists in spite of above therapy
Retracted and flat nippleCommon in primigravidae
Babies can attach and are able to suck adequately
If unable to suck, manual expression of milk and fed
Acute Mastitisincidence:
2-5% in Lactating mothers
<1% in non-lactating mothers
Organisms involved:Staphylococcus aureus
Staphylococcus epidermidis
Viridans streptococci
Risk factorsPoor nursing
Maternal fatigue and cracked nipple
Types of mastitis (based upon site of infection)Infection in breast parenchymal tissue cellulitis
Infection in lactiferous ducts primary mammilary adenitis
Non-infective mastitis due to milk stasis
Clinical featuresSymptoms:Generalized malaise and headache, nausea, vomiting Fever (102°F or more) with chills Severe pain and tender swelling in one quadrant of the breast
Signs includetoxic featuresswelling on the breast The overlying skin- red, hot and flushed and feels tense and tender.
ManagementBreast support
Plenty of oral fluids
Continued breastfeeding in the unaffected side
Infected side manually emptied
Dicloxacillin is drug of choice 500 mg 6 hourly for 7 days
Erythromycin is alternative to the people allergic to penicillin
Analgesics for pain *Breast feeding maintains flow- prevents proliferation of staphylococcus in the stagnant milk
ProphylaxisHand wash before each feed
Clean nipple before and after each feed with mild soap
Keep nipple dry
Complicationsbreast abscess due to variable destruction of breast tissues
Breast AbscessClinical features
Flushed breast not responding to antibiotics promptly
Edema of overlying skin
Marked tenderness with fluctuation
Swinging temperature
Breast pain : due to engorgement, infection (Candida albicans)
nipple trauma, mastitis or occasionally with let down reflex
Management:
Surgical draining of abscess (Incision and drainage under general anesthesia)
Breast feeding is continued from uninvolved side
Infected breast is mechanically pumped every 2 hours and with every let down
Lactation failureInadequate milk production
Causes:
Infrequent suckling
Depression or anxiety state in puerperium
Reluctant or apprehension to nursing
Ill development of nipples
Painful breast lesions
Endogenous suppression of prolactin(retained placental bits)
Prolactin inhibition(pyridoxine, ergot preparation, diuretics)
Treatment guidelinesAntenatal
Counsel mother
Take care of breast abnormalities (retracted nipples)
Puerperium
Encourage adequate fluid intake
Nurse baby regularly
Treat painful local lesions
Selective dopamine antagonist (Metoclopramide 10mg TDS Po)
References
• Konar.H, DC Dutta’s Textbook of obstetrics 8th edition, Jaypee
publication
• Cunningham ,Bloom, Spong,Dashe,Hoffan,Casey,Sheffield,
Williams obstetrics,24th edition ,Mc Graw Hill education
Thank You