Lactation and lactation disorders.Puerperal mastitis

Question 1

what are the most common breast complications in puerperium ?

Answer 1

breast engorgemnet

cracked and retracted nipple

Question 2

what causes breast engorgement ?

Answer 2

results of increased blood flow in your breasts in the days after the delivery of a baby. The normal increased blood flow helps your breasts make ample milk

Milk production may not occur until three to five days postpartum. Engorgement may occur for the first time in the first week or two after delivery

missing a feeding
skipping a

pumping session

Question 3

signs and symptoms of breast engorgement ?

Answer 3

pain and feeling of tenseness or heaviness in both the breasts

transient rise of temperature and

Painful breastfeeding

Question 4

prevention of breast engorgement ?

Answer 4

To initiate breastfeeding early and unrestricted,

breastfeeding on demand

Feeding in correct position,

Correct latch on

Question 5

treatment of breast engorgement ?

Answer 5

To support the breasts with a binder or brassiere,

Frequent suckling,

Manual expression of any remaining milk after each feed,

administer analgesics for pain,

The baby should be put to the breast regularly at frequent intervals,

Question 6

what is cracked nipple ?

Answer 6

Loss of surface epithelium
or issure situated either at the tip or the base of the nipple. These two conditions frequently coexist and are referred to as cracked nipple

Question 7

causes of cracked nipple ?

Answer 7

improper hygiene resulting in formation of a crust over the nipple,

(b) retracted nipple, and
(c) incorrect attachment of bab’s mouth

infection with Candida albicans and S. aureus

Question 8

what are the signs and symptoms of cracked nipple ?

Answer 8

painful when the infant sucks.

When infected, infection may spread to the deeper tissue producing mastitis.

Question 9

prophylaxis of cracked nipple

Answer 9

local cleanliness before and after each breastfeeding to prevent crust formation over the nipple

Question 10

treatmnet of cracked nipple

Answer 10

Correct latch on will provide immediate relief from pain and rapid healing.

Purified lanolin with the mother’s milk is applied three or four times a day to hasten healing.

When it is severe, mother should use a breast pump and

Inflamed nipple and areola may be due to thrush also. Miconazole lotion is applied over the nipple as well as in the baby’s mouth if there is oral thrush.

Nipple shields (thin latex) can be used

Question 11

what re the bacteria causes acute mastitis ?

Answer 11

S. aureus, Staphylococcus epidermidis and Streptococci viridans

The source of organisms is the infant’s nose and throat.

Question 12

what are the risk factors for acute mastitis ?

Answer 12

poor nursing
cracked nipple
poor nipple hygiene

Question 13

what are the two mode of infection acute mastitis ?

Answer 13

1) Infection that involves the breast parenchymal tissues leading to cellulitis. The lacteal system remains unaffected
(2) Infection gains access through the lactiferous duct leading to development of primary mammary adenitis

Noninfective mastitis may be due to milk stasis. Feeding from the affected breast solves the problem.

Question 14

clinical features of mastitis ?

Answer 14

Generalized malaise and headache, nausea, vomiting,

(b) Fever with chills, and
(c) Severe pain and tender swelling in one quadrant of the breast.

overlying skin is red, hot and flushed and feels tense and tender.

Question 15

diagnosis of acute mastitis ?

Answer 15

Microscopic examination of breast milk, showing leucocytes

and high bacterial coolant

Question 16

management of acute mastitis ?

Answer 16

Breast support,

(b) Plenty of oral fluids,
(d) The infected side is emptied manually with each feed, and breast feed continues on the non infected breast with correct attachment and hygiene
(e) Dicloxacillin orally.Erythromycin is an alternative to patients who are allergic to penicillin. Antibiotic therapy is continued for at least 7 days,
(f) Analgesics (ibuprofen) are given for pain,
(g) Milk flow is maintained through any means This prevents proliferation of Staphylococcus in the stagnant milk. The ingested Staphylococcus will be digested without any harm

Question 17

what are the features of breast abcess ?

Answer 17

Flushed breasts not responding to antibiotics promptly,

(2) Brawny edema of the overlying skin,
(3) Marked tenderness
(4) Swinging temperature.

Question 18

treatment of breast abcess ?

Answer 18

drained under general anesthesia

antibiotics

breastfeeding continues in the uninvolved site

Question 19

cause of lactation failure?

Answer 19

infrequent suckling,

Depression or anxiety state in the puerperium

Painful breast lesion,

Endogenous suppression of prolactin by retained placental bits

Prolactin inhibition by ergot preparations, diuretics, pyridoxine, dopamine agonist bromocriptine

Question 20

which drugs can increase lactation ?

Answer 20

Metoclopramide, intranasal oxytocin , and sulpiride (selective dopamine antagonist) . They act by stimulating prolactin secretion