Thrush In Women On The Breast And Nipples During Pregnancy And Lactation. How To Treat Thrush During Pregnancy?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Thrush during pregnancy and lactation

Thrush during pregnancy is a disease caused by the yeast-like fungus Candida spp. (spp - different types). In anonymous surveys of women, nine out of ten respondents confirm the presence of vaginal thrush at different periods of life.

Vaginal thrush is not a genital infection, but due to its specific localization, it is often considered in conjunction with STDs. A direct connection between vaginal yeast infection and the anatomical features of the female genital organs, regular cycles, and possible pregnancy has been proven. The pathogenesis of thrush during breastfeeding is somewhat different, it is a consequence of cracking of the nipples with abundant milk production. The importance of candidiasis during pregnancy and lactation, their danger and consequences is a discussed topic in the female environment.

Content:

• Is thrush dangerous during pregnancy?
• Signs and symptoms of thrush during pregnancy
• Causes of thrush during pregnancy
• Thrush on the breast and nipples during lactation
• How to treat thrush during pregnancy?

Is thrush dangerous during pregnancy?

From the clinical practice of obstetricians-gynecologists, descriptions of the most significant, for the body, consequences of thrush during pregnancy were taken, namely:

• PRPO (premature rupture of the membranes). The reasons are varied, not fully understood. In some sources, the root cause is inflammatory processes of the membranes caused by pathogenic microflora, in combination with candida. Mechanical and toxic irritation of the mucous membranes provokes inflammation of the uterus (cervicitis), violates the integrity of the membranes. As a result, water simultaneously or fractionally penetrates into the birth canal of a pregnant woman. Diagnosed before 37 weeks of pregnancy. PRPO is one of the causes of neonatal mortality due to sepsis, prematurity, and underdevelopment of the lungs.
• Candida infection of the fetus. Fungi Candida spp. do not penetrate the placental barrier, therefore intrauterine infection of the fetus is practically excluded. Infection occurs when the fetus moves in the birth canal. It is diagnosed in the first days of life. In severe cases, it causes sepsis and systemic damage to the organs of the newborn.
• Thrush complicates the examination of a pregnant woman. Candida fungi, in combination with chlamydia, mycoplasma, and other pathogens of genital infections, cause inflammation, erosion, ectopia (pseudo-erosion) of the uterus and cervix. On colposcopic examination, inflammation caused by thrush is falsely mistaken for dysplasia (the presence of atypical, precancerous cells) of the cervix.
• Thrush is an allergy provocateur. Fungal metabolites cause sensitization (hypersensitivity) of the organism weakened by pregnancy to various allergens.

Signs and symptoms of thrush during pregnancy

The first, subjective sensations that sick women pay attention to:

• Itching, burning, discomfort in a calm state, during intercourse, urination;
• Edema of the labia, scratching, rash, sleep disorder;
• Discharge (plaque) on the visible parts of the external genital organs;
• Without constant hygiene procedures, a faint smell of sour milk;
• Thrush combined with bacterial vaginosis has a putrid odor.

Some pregnant women indicate a combination of thrush with profuse vaginal discharge. During pregnancy, vaginal discharge may be the norm. Brightness, discomfort, depends on individual sensitivity. Hypersensitivity (allergy) of a pregnant woman to fungi, accompanied by debilitating itching. The presence of subjective signs is not a sufficient basis for a definitive diagnosis. The differential diagnosis of thrush is carried out according to the traditional scheme: taking anamnesis (survey), external and internal examination, instrumental and laboratory methods of examination.

Anamnesis. The diagnostic value of conversations with the patient can be high, for example, in determining the social behavior of a woman (frequent change of sexual partners, unprotected sex), identifying the living conditions of pregnancy. When interviewing, the doctor excludes symptoms characteristic of: sexually transmitted diseases, diabetes mellitus, allergies, non-infectious inflammation of the genital organs, other pathologies accompanied by itching and other similar symptoms.

External and internal gynecological examination. Symptoms are detected visually and with a vaginal speculum. With the naked eye, in the region of the cervical canal, a focal plaque of a cheesy appearance, white or its shades, is visible. On the mucous membranes, pink foci are possible - evidence of erosion. The mucous discharge is colorless or white. Yellow or green color of mucus, purulent discharge is a reason for differentiating thrush from genital infections, accompanied by purulent inflammation. Ulcers and cracks in the mucous membrane, not mandatory signs of thrush. They often indicate a strong effect of infectious, allergic agents.

Vaginal smear microscopy. Thrush is confirmed by microscopy, native (unstained) and / or stained smear. In the field of view of the microscope, a large number of Candida (pseudohyphae) colonies growing in a chain are visible. An indicator of a healthy vaginal microflora is the detection of at least 95% of Dederlein rods in the field of view of the microscope. Dederlein's stick is an association of lactobacilli: L. acidophilus, L. casei, L. Fermentum, L. Cellobiosus. The vaginal flora is also considered healthy if rods are found less than 95% against the background of a small amount of other optional flora, including candida, with single inclusions of erythrocytes and leukocytes. A dangerous symptom is the finding of a large number of leukocytes of pathogenic microflora and candida against the background of a minimum of Dederlein's bacillus.

Sowing of clinical material. The method has a high diagnostic value. Candida is sown on simple and selective nutrient media. 30-37 is cultured at a temperature ^of C and pH 6,0-68. Using various laboratory techniques, one can differentiate:

• candida from bacteria, protozoa;
• the species composition of the fungi inhabiting the vagina;
• pathogenic and saprophytic forms of candida;

Another important sign of the pathogenicity of thrush is the determination, in the field of view of the microscope, the number of colony-forming cells in a milliliter of clinical material (CFU / ml). The method is used to differentiate the pathological development of thrush from harmless carriers of fungi. It is considered to be:

• asymptomatic candidiasis carriage, the value is less than 10 ⁴ CFU / ml;
• clinical course of thrush, the value is more than 10 ⁴ CFU / ml

To detail the pathogenesis, the interdependence of thrush to other damage to the body, immunological, allergic studies, biological tests on laboratory animals are used.

Find out more: List of the best home remedies for thrush

Causes of thrush during pregnancy

Yeast-like fungi can, harmlessly, coexist for a long time in association with beneficial bacteria in the body. The growth of fungi is inhibited mainly by natural antagonists, lactobacilli. Under certain conditions, candida begins to grow rapidly, causing mechanical and toxic effects on the body.

For the pathogenic development of thrush, it is necessary that a state occurs in the body:

• depression of lactobacilli, other beneficial microflora, intestines, vagina;
• hormonal disorder of the body under the influence of internal (diseases of the organs of internal secretion or physiological hormonal changes in the female body) or external causes (long-term use of hormonal drugs);
• damage to natural barriers (cracks, erosion of waterlogged mucous membranes), impaired immune cooperation (infections, taking medications - immunomodulators);
• hypersensitivity of the body to fungal metabolites.

Thrush in pregnant women occurs against the background of hormonal changes, accompanied by morphophysiological changes in the body. Highlighted the most significant changes in the body of pregnant women, indicating their increased predisposition to vaginal thrush:

• Under the influence of progesterone, the friability of the mucous membranes of the birth canal increases. In combination with other factors, this greatly facilitates the adhesion (adhesion) of fungal colonies on the mucous membranes of the birth canal;
• An increase in the total volume of circulating blood up to 40%, a drop in the amount of blood proteins up to 7 g / l provokes a tendency of pregnant women to edema. The increased humidity of the mucous membranes, with edema, in combination with other factors, is a favorable factor for the growth of candida;
• An increase in the erythrocyte sedimentation rate (ESR) from 50 mm / hour and above, is accompanied by anemia of pregnant women and a deficiency of vitamin B ₁₂ (cyanocobalamin). Vitamins are important metabolic regulators. In particular, vitamin B _{12 is} necessary to maintain the beneficial microflora of the vagina and intestines.
• An increase in the level of female sex hormones involved in the synthesis of glycogen reduces the renal filtration threshold, provokes glucosuria (sugar in the urine) of pregnant women. Sugar in urine is one of the most important private causes of thrush.
• Metabolic acidosis. Even with a normal pregnancy, under the influence of increased chest breathing, the phenomena of weak metabolic acidosis are possible. Some sources describe the stimulating effect of metabolic acidosis on candida.
• During pregnancy, the sebaceous and sweat glands function in an enhanced mode. The increased moisture in the folds of the body stimulates the growth of candida.

Thrush on the breast and nipples during lactation

Breastfeeding is an important factor in proper feeding, emotional interaction between mother and child. It is sad if there are problems with the lactating gland. One of them is breast thrush. It manifests itself as a consequence of vaginal yeast infection, the result of diaper rash on the breast skin. It is treated with traditional methods (drying) and drugs (antimycotics). The doctor in charge of the postpartum period may prescribe drugs of other pharmacological groups. A more formidable pathology is mastitis or inflammation of the mammary gland. Causes of mastitis (milk stasis, non-infectious and infectious agents). Sometimes thrush on the nipples is called a mastitis provocateur.

Signs of breast thrush

Thrush of the breast occurs after the appearance of diaper rash and breast engorgement. The causes of diaper rash are tight, dense underwear, profuse sweating. Engorgement (breast induration) is a consequence of the gland overflowing with milk. Without expressing milk, the delicate skin of the nipples cracks, the skin of the breast becomes shiny, the nipple stretches to a flat state. Candida colonization is possible on diaper rash or cracks. The lesions are painful at rest and while feeding. On the nipples and in the areas of diaper rash, white plaque. candida opens the gate of infection to the mammary gland. Soreness provokes a woman's refusal to breastfeed or express. As a result, stasis (stoppage) of milk flow occurs, then candida and other agents initiate the pathogenesis of mastitis.

Causes of thrush during lactation

The causes of thrush during lactation are similar to those of vaginal thrush. Disruption of the balance of normal intestinal microflora after antibiotic therapy, a decrease in general resistance in the postpartum period, a sharp cessation of the production of estrogen by the placenta, violation of the integrity of the natural integuments of the skin. A specific cause of lactational thrush is improper application of the baby during feeding, which provokes cracking of the nipple skin. Candida is the most likely cause of persistent mastitis after healing.

With thrush, can you breastfeed?

Neonatologists have noticed that thrush is not always transmitted to the baby. Cases of thrush are described only in the mother or child, especially with the latent course of the disease. However, the fungi found in the baby's mouth are identical to those that cause other candidiasis. Therefore, comprehensive recommendations for breastfeeding, for breast thrush, can be given by a doctor who monitors the health of the newborn and the mother. In case of acute pain, it is advisable to refuse feeding from the affected breast. Milk is expressed during treatment and is not used for feeding.

On the subject: 3 most effective remedies for thrush

Treatment of thrush during pregnancy

The most dangerous and difficult period for the treatment of thrush during pregnancy is 1 trimester. During this period, the fetus is actively growing and developing. When the organs and systems of the unborn child are being formed, taking medications for pregnant women is contraindicated.

In the first weeks of pregnancy, the occurrence of thrush is rare. As the term increases, the risk increases. For the treatment of pregnant women in the 2-3 trimester, there are a sufficient number of effective drugs. There are suppositories that can be taken with caution at any time, however, a complete cure for thrush is almost impossible. It is not uncommon for doctors to monitor the course of the disease throughout pregnancy.

Drugs for the treatment of thrush by trimester of pregnancy:

1 trimester	Betadine and Pimafucin - 6 times one candle at night;
2 trimester	Gino-Pevaril, Pimafucin, Betadin - 6 candles each; Clotrimazole - 7 suppositories; Gynofort - 1 applicator;
3 trimester	Gino-Pevaril, Pimafucin, Betadin - 6 candles each; Clotrimazole - 7 suppositories; Gynofort - 1 applicator;

Features of therapy for thrush during the period of bearing a child

• For the treatment of thrush during pregnancy, it is permissible to use topical treatments. In the 2nd and 3rd trimester, taking pills is possible only with the permission of a doctor.
• Douching during pregnancy is not recommended, especially if aggressive agents are planned. Douching with manganese, baking soda and chlorhexidine is strictly prohibited.
• Pimafucin candles are considered the safest. Application is permissible in the 1st trimester, after childbirth, during breastfeeding.
• It is important to complete the treatment course. Even if, after using 2-3 suppositories, the symptoms of thrush disappeared, the treatment continues.
• Burning sensation and discomfort at the beginning of the treatment course should not be a reason for refusing to use suppositories. This is a temporary discomfort.
• If at least a single symptom characterizing thrush was noticed during pregnancy, it is necessary to undergo a course of treatment before giving birth.
• The course of treatment is also recommended for the sexual partner, even if he has no symptoms or complaints.
• When treating with antibiotics during pregnancy, drugs for thrush are used as a prophylactic agent.
• After treatment, no later than two weeks, a sowing from the vagina is done, this is necessary to control the condition.

Ignoring medical recommendations and refusal (interruption) of therapy can lead to serious health problems for the child. Very often, untreated mother's thrush is transmitted to the baby and manifests itself already in the first weeks after his birth. The child's oral cavity is most often affected.

Candles from thrush during pregnancy

The appearance and development of thrush during pregnancy is most often associated with a weakened immune system. Many drugs are contraindicated for women in the position.

There are those whose safety has not yet been proven, and this is always a risk to the health of the unborn baby and the mother herself.

Today, the pharmacy assortment offers a fairly large selection of antifungal drugs that are actively used in gynecology.

During pregnancy, the choice of funds must be entrusted to the doctor, since from the available variety of suppositories from thrush allowed for pregnant women there are few:

• Candles Primafungin and Pimafucin.
• Macmiror complex (active ingredients Nystatin and Nifuratel).

From 14-15 weeks of pregnancy, the following are prescribed:

• Nystatin
• Clotrimazole
• Gino-Pevaril
• Borax remedy
• Pimafucin
• Gynofort (cream).

These medicines require careful use, they are used in cases where the risk to the health of the mother is higher than for the unborn child.

Sometimes Terzhinan is prescribed for pregnant women. Possible side effects are indicated in the instructions for the drug. Terzhinan contains prednisone (hormonal drug). It can be used for treatment, but not earlier than the second trimester and only with potential benefit to a pregnant woman.

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.