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