Mastitis In A Nursing Mother - What To Do? Symptoms And Signs

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Video: Mastitis In A Nursing Mother - What To Do? Symptoms And Signs

Video: Mastitis In A Nursing Mother - What To Do? Symptoms And Signs
Video: Mastitis: Recognition and Treatment 2023, March
Mastitis In A Nursing Mother - What To Do? Symptoms And Signs
Mastitis In A Nursing Mother - What To Do? Symptoms And Signs

Mastitis in a nursing mother

Mastitis in a nursing mother
Mastitis in a nursing mother

Mastitis, or breastfeeding, is an inflammation of the breast tissue caused by the entry of infectious agents. Due to the spread of pathology, purulent destruction of the gland and surrounding tissues is formed, in severe cases, sepsis (blood poisoning) occurs.

The main category of patients suffering from mastitis is primiparous women. Their glandular tissue of the mammary gland is not as well developed as in experienced nursing mothers, the ducts have not yet been developed, and sometimes the nipple is problematic (inverted, flattened). In addition, primiparous women have no experience with breastfeeding and expressing milk.

The disease develops in 3-7% of the total number of women in labor, and this number, according to medical statistics, has remained unchanged for decades. Approximately 80-85% of mastitis cases occur in the first month after delivery. Mastitis can be either lactational or non-lactational. There are manifestations of this disease in newborn girls under the influence of the hormonal background of the mother. Non-lactational mastitis can develop in girls and women from 15 to 60 years old, accounting for 5% of all cases of the disease. It does not proceed as violently as lactation, with a minimum of complications, but more often it becomes chronic.


  • The causes of mastitis
  • The mechanism of development of inflammation
  • Symptoms of mastitis
  • Classification of mastitis
  • Can I breastfeed with mastitis?
  • Diagnosis of mastitis
  • Treatment methods for mastitis
  • Prevention of mastitis
  • Which doctor treats mastitis?

The causes of mastitis

The causes of mastitis
The causes of mastitis

The main causative agents of lactational mastitis:

  • Staphylococcus aureus (70% of all diseases);
  • Streptococcus;
  • Staphylococcus albus (white);
  • Beta-hemolytic staphylococcus;
  • E. coli;
  • Fecal enterococcus;
  • Mycobacterium tuberculosis;
  • Klebsiella.

Causes of lactational mastitis

Usually, a woman becomes infected through linen, hygienic care items, from hidden carriers of infection (visitors to the woman in labor, medical staff, roommates). Carriers of the infection may not even know about their status, as up to 30% of people do not know about it. Another source of infection can be a newborn who is a carrier of bacteria due to a disease of the pharynx, pharynx, or due to a pustular skin disease.

Contact with bacteria does not always cause illness. For the appearance of mastitis, provoking factors are required that make the development of inflammation inevitable.

Anatomical causes of mastitis:

  • History of mastopathy;
  • An inverted or flat nipple that is not prepared for feeding;
  • History of surgical intervention (mastitis, removal of tumors in the past), leaving rough scars.

Functional causes of mastitis:

  • Pathology of pregnancy - the threat of miscarriage, gestosis of late pregnancy, premature birth;
  • Pathological course of labor - trauma, blood loss, a large fetus in the first birth, manual separation of the placenta;
  • Postpartum pathologies - bleeding, complication of existing somatic diseases, fever;
  • Postpartum depression, sleep disorders and trauma.

All these factors create favorable conditions for reducing immunity, hypovitaminosis, and provoke the development of lactational mastitis.

Causes of non-lactational mastitis

Non-lactation mastitis develops against the background of insufficient immunity (after an infectious disease, psychological and physical overstrain, hypothermia), as well as after microtraumas of the breast.

Staphylococcus aureus in the vast majority of cases becomes the causative agent of non-lactational mastitis and mastitis during pregnancy and lactation.

The mechanism of development of inflammation

The mechanism of development of inflammation
The mechanism of development of inflammation

The disease develops against the background of milk stagnation - lactostasis. From the beginning of lactostasis until the first signs of mastitis appear, 3-4 days pass. If a woman expresses her breast milk regularly, bacteria on the surface of the breast are flushed out. This mechanism, provided by nature, reliably protects the breast from inflammation.

If pumping is performed irregularly, milk accumulates in the ducts of the gland, pathogenic bacteria cause lactic acid fermentation and damage to the epithelium. Particles of coagulated milk, together with exfoliated epithelium, clog the ducts, and stagnation occurs. The causative agents of infection are intensively divided in a confined space, and when their number reaches a critical level, inflammation develops, its course is accelerated due to stagnation of lymph and venous blood.

It is almost impossible to drain milk from an inflamed breast due to severe pain, the scale of lactostasis increases. A vicious circle arises - inflammation aggravates lactostasis, milk stagnation increases the symptoms of inflammation.

In about 15% of cases, the infection enters the breast through cracks in the nipples, resulting from the unpreparedness of the breast for feeding, as well as due to the pressure exerted by the baby's mouth. Cracks in the nipples can occur due to the fact that the skin of the areola becomes wet and irritated in a damp bra.

If you do not follow the feeding regime, the preparation of the glands for it does not take place in advance, but already in the process of attaching the baby to the breast.

What is the preparation:

  • Milk production is enhanced;
  • The ducts of the mammary glands expand;
  • Their segments are shrinking.

Because of the "unprepared" breast, the baby makes more effort, thus injuring the nipples. In addition, incomplete emptying in individual lobules provokes lactostasis and mastitis. The problem may arise due to the fact that a woman, due to cracks in the nipples, does not attach the baby to the breast, but expresses milk, not doing this to the fullest. Improper grip of the infant or an anatomically uncomfortable nipple further aggravate the cracks.

Symptoms of mastitis

Symptoms of mastitis
Symptoms of mastitis

The course of the disease and its symptoms differ depending on what form the disease took.

Symptoms of the serous stage

The symptoms of the initial stage of mastitis are very similar to normal breast milk stasis:

  • There is heaviness and tension in the chest;
  • On palpation, a painful seal is found in several lobes of the affected breast, it is mobile and has clear boundaries;
  • Expression is painful, but milk passes without delay;
  • The woman's temperature and general condition are normal.

If within 1-2 days the temperature becomes subfebrile (+ 37.5 + 38 ° C), the induration does not disappear after expressing, it can be assumed that the woman has developed serous mastitis.

There is another scenario for the development of the disease, when its onset is characterized by a rapid rise in temperature to + 38 + 39 ° C, a woman feels weak, severe chest pain when expressing. The tissues of the gland are saturated with serous fluid, which gives the name to this form of inflammation. Leukocytes from the circulatory system enter the site of infection.

With this form of mastitis, cases of spontaneous cessation of the disease are recorded, when the pain syndrome stops, and the seal dissolves. If this does not happen, the serous form of mastitis turns into a more severe - infiltrative form of the disease. In order to take effective measures in time, experts consider any breast engorgement during lactation to be the initial stage of mastitis.

Symptoms of the infiltrative stage

At this stage, an infiltrate is formed in the breast, which has an indistinct shape. The affected breast enlarges, although initially there may be no edema, skin redness, or hyperthermia. These symptoms increase with an increase in the volume of lactostasis and the ingestion of breast milk from the damaged ducts into the bloodstream.

If timely therapy is carried out, the temperature can be reduced to + 37 + 37.5 ° C. In the case of inadequate treatment, the infiltrative stage turns into a destructive form after 4-5 days, when the breast tissue resembles a sponge soaked in pus.

Symptoms of the purulent stage

Symptoms of the purulent stage
Symptoms of the purulent stage

Typical symptoms of destructive mastitis:

  • A general deterioration in well-being due to intoxication with bacteria waste products;
  • Weakness;
  • Hyperthermia up to + 38 + 40 ° c;
  • Headache;
  • Decreased appetite;
  • Sleep disturbance;
  • An increase in the size of the mammary glands;
  • Redness of the skin of the chest, expansion of the subcutaneous veins;
  • Swelling of regional lymph nodes.

There are the following types of purulent mastitis:

  • Absolute mastitis - an abscess filled with pus forms inside the gland or behind it;
  • Infiltrative-abscessing mastitis - in the tissues of the gland, a dense infiltrate is formed from many small abscesses, occupying at least 2 quadrants of the breast;
  • Phlegmonous mastitis - the breast is significantly enlarged and edematous, the skin acquires a bluish-red tint, the nipple is retracted, at least 3 quadrants of the gland are affected, the level of hemoglobin is reduced, the blood and urine tests are impaired;
  • Gangrenous mastitis - due to the formation of blood clots in the blood vessels, the blood supply to the gland is disrupted, which causes tissue necrosis, the breast is enlarged, there are areas of necrosis on its surface - blisters filled with ichor, the skin becomes bluish-purple, all quadrants of the gland are affected by gangrene.

With gangrenous mastitis, confusion, a sharp decrease in blood pressure, a rapid pulse, and a change in laboratory tests are noted.

Classification of mastitis

Classification of mastitis
Classification of mastitis

Depending on the clinical picture of the disease and on the indicators of laboratory tests, the following conditions are distinguished:

  • Lactostasis - can be eliminated while maintaining lactation;
  • Non-infectious mastitis - can be stopped with additional pumping;
  • Infectious mastitis - treatment with antibiotic therapy and breast milk expression.

The classification of types and forms of mastitis is formed on various grounds.

By the course and intensity of the infection:

  • Acute;
  • Chronic.

By functional state:

  • Lactation;
  • Non-lactation.

By the depth of tissue damage:

  • Deep;
  • Surface.

By the nature of the inflammatory process:

  • Serous (usually fixed in primiparous women under 30 years of age);
  • Purulent;
  • Gangrenous.

By the prevalence of the inflammatory process:

  • Diffuse;
  • Limited.

All forms of mastitis should be distinguished from abscesses, boils, phlegmons, carbuncles, erysipelas, and breast cancer. If an oncological lesion is suspected, a biopsy with a histological examination is mandatory.

Can I breastfeed with mastitis?

Is it possible to breastfeed
Is it possible to breastfeed

If earlier, at the first symptoms of mastitis, a woman was recommended to stop breastfeeding, now, on the recommendation of the World Health Organization, the preservation of lactation is encouraged. Research has shown that only an HIV-positive mother is a source of threat, and then only until she recovers from mastitis.

In what cases breastfeeding is prohibited:

  • Purulent forms of mastitis, sepsis;
  • Treatment with antibiotics, when taken, breast milk becomes a source of danger for the baby;
  • Objective barriers to breastfeeding.

To maintain lactation with serous and infiltrative mastitis, it is necessary to express milk every 3 hours, first from a healthy breast, and then from a breast affected by mastitis (how to express breast milk correctly, how much and how to store?). After pasteurization, breast milk from a healthy breast can be fed to your baby. Milk from the affected focus should not be consumed due to the danger to the health of the baby.

Before fully recovering lactation after treatment, it is recommended to test the milk for bacteria.

Diagnosis of mastitis

Diagnosis of mastitis
Diagnosis of mastitis

The symptoms of mastitis can be seen on visual inspection.

To clarify the diagnosis, laboratory tests are carried out:

  • General blood analysis;
  • General urine analysis;
  • Bacteriological culture of milk samples from both mammary glands - the concentration of pathogenic bacteria per 1 ml 3 is determined;

  • Study of milk for cytology (determination of the concentration of leukocytes, as indicators of inflammation);
  • Measurement of the acid balance of milk, normally the ph of breast milk is 6.8, with inflammation this number increases.

Informative instrumental research methods:

  • Ultrasound of the mammary gland - the localization of purulent fusion of tissues is analyzed;
  • Puncture of the infiltrate with phlegmonous and abscessing form to study its contents;
  • Mammography of the mammary glands - rarely performed when diagnosing a chronic process;
  • Biopsy and histological examination for differential diagnosis in case of suspected breast cancer.

Treatment methods for mastitis

Treatment methods
Treatment methods

There are indications for the use of conservative therapy. To analyze the situation, milk is pumped from the affected breast, and 3-4 hours later it is examined again. If the pain subsides, the temperature approaches normal values, and the induration becomes less, most likely normal lactostasis takes place.

If the condition does not improve, the temperature remains high, and the woman still feels bad, milk stagnation is combined with mastitis.

Indications for conservative treatment:

  • The disease lasts no more than 3 days;
  • The temperature does not exceed subfebrile values;
  • Blood tests are normal;
  • The general condition is satisfactory;
  • There are no symptoms of a purulent process.

In the absence of positive dynamics after a few days of conservative treatment and the transition of mastitis to a purulent or, especially, gangrenous form, a woman is shown surgical intervention.

The surgery is performed under general anesthesia in a surgical hospital. The doctor tries to preserve the aesthetic appearance and functionality of the breast to the maximum.

After removal of the affected tissues, the wound is washed for 5-12 days, intravenous or intramuscular administration of antibiotics. Breastfeeding after the operation is stopped artificially, with medication, since it is impossible to express milk from the operated breast

Antibiotics for mastitis

Antibiotics for mastitis
Antibiotics for mastitis

For conservative treatment and prevention of complications after surgery, antibacterial drugs of various groups are used. Staphylococcus aureus is most sensitive to drugs from the group of penicillins and cephalosporins. These are Oxacillin, Dicloxacillin, Cefazolin, Cefalexin.

How antibacterial drugs pass into breast milk:

  • Penicillins - penetrate into milk in a minimal dose;
  • Cephalosporins - a limited amount passes into milk, slightly more than that of penicillins;
  • Macrolides - almost half of the drug is found in milk, but it does not pose a danger to a child;
  • Aminoglycosides - a minimal amount is found in milk, but even this dose is toxic to the baby's kidneys;
  • Fluoroquinolones are highly toxic drugs and are not recommended for breastfeeding.

Additionally, antihistamines, vitamin complexes, physiotherapy (ultrasound, UHF therapy) are used.

What ointment to use for mastitis?

At the beginning of the disease, a good therapeutic effect can be recorded by applying Vishnevsky's ointment:

  • Infiltration resolves;
  • Reduced pain;
  • Milk secretion improves.

There is a different opinion of practicing surgeons about the use of this ointment - the increased temperature that occurs in the focus of application provokes the multiplication of bacteria and only stimulates the further development of mastitis.

Prevention of mastitis

Prevention of mastitis
Prevention of mastitis

In order not to meet the symptoms of mastitis, you need to take precautions, prepare in advance for breastfeeding.

Preventive measures:

  • Master the correct attachment of the baby to the breast, so that the baby grabs the nipple and part of the areola around it;
  • Feed the baby on demand, avoiding breast overflow - if the baby completely empties the breast, unnecessary pumping is not necessary;
  • Choose a comfortable bra;
  • Observe the hygienic rules for breast care, wash it with cool water, avoiding constant moisture;
  • If lactostasis develops, contact a doctor or breastfeeding consultant right away.

Even if the alarm is false, it is better to play it safe and not expose yourself to serious complications.

Which doctor treats mastitis?

It is most advisable to contact a surgeon for the treatment of mastitis. If the symptoms of the disease are not so pronounced, you can get advice from a gynecologist.


The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist

Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.

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