Lactation and lactation disorders.Puerperal mastitis Flashcards
what are the most common breast complications in puerperium ?
breast engorgemnet
cracked and retracted nipple
what causes breast engorgement ?
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
signs and symptoms of breast engorgement ?
pain and feeling of tenseness or heaviness in both the breasts
transient rise of temperature and
Painful breastfeeding
prevention of breast engorgement ?
To initiate breastfeeding early and unrestricted,
breastfeeding on demand
Feeding in correct position,
Correct latch on
treatment of breast engorgement ?
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,
what is cracked nipple ?
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
causes of cracked nipple ?
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
what are the signs and symptoms of cracked nipple ?
painful when the infant sucks.
When infected, infection may spread to the deeper tissue producing mastitis.
prophylaxis of cracked nipple
local cleanliness before and after each breastfeeding to prevent crust formation over the nipple
treatmnet of cracked nipple
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
what re the bacteria causes acute mastitis ?
S. aureus, Staphylococcus epidermidis and Streptococci viridans
The source of organisms is the infant’s nose and throat.
what are the risk factors for acute mastitis ?
poor nursing
cracked nipple
poor nipple hygiene
what are the two mode of infection acute mastitis ?
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.
clinical features of mastitis ?
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.
diagnosis of acute mastitis ?
Microscopic examination of breast milk, showing leucocytes
and high bacterial coolant
management of acute mastitis ?
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
what are the features of breast abcess ?
Flushed breasts not responding to antibiotics promptly,
(2) Brawny edema of the overlying skin,
(3) Marked tenderness
(4) Swinging temperature.
treatment of breast abcess ?
drained under general anesthesia
antibiotics
breastfeeding continues in the uninvolved site
cause of lactation failure?
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
which drugs can increase lactation ?
Metoclopramide, intranasal oxytocin , and sulpiride (selective dopamine antagonist) . They act by stimulating prolactin secretion
