Lactational Mastitis - Symptoms, Treatment And Causes

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Lactational mastitis

Lactational mastitis is an inflammation of the mammary gland that occurs during the postpartum period while breastfeeding. Statistics indicate that the disease develops in 0.5-6% of women who have given birth to a child.

In more than 57% of patients, the pathological process manifests itself in the first 3 weeks after delivery. Moreover, about 78% of all cases are primiparous mothers or women who apply a baby to the breast for the first time.

Lactational mastitis most often provokes Staphylococcus aureus, it is sown in 90.8% of patients. Only 2.5% of women associate the disease with other microorganisms.

Content:

• Causes of lactational mastitis
• Symptoms of mastitis
• Diagnosis of lactation mastitis
• Treatment of lactational mastitis
• Prevention of mastitis

Causes of lactational mastitis

Features of the anatomy of the mammary gland and a significant increase in its functional activity in the period after the birth of the child, as well as the deterioration of immune forces leads to the fact that the risk of developing mastitis increases.

The mammary gland consists of lobules, it contains adipose tissue, there are many cavities, ducts and lymphatic vessels. Therefore, the process of inflammation spreads rather quickly through the tissues of the breast, and the serous contents and accumulated infiltrate in the shortest possible time become purulent. In this case, the disease takes a protracted course, and the risk of developing sepsis also increases.

It was found that in 85.8% of cases, mastitis is preceded by lactostasis, and if a woman's inflammation has a purulent course, then milk stagnation before its development was always observed.

As it was said, the main microorganisms that provoke the development of mastitis are staphylococci. However, it is possible that bacteria enter the gland tissue with blood flow. In this case, mastitis can be caused, for example, by E. coli or beta-hemolytic streptococcus.

In addition to stagnant milk, lactational mastitis can be triggered by cracks in the nipples, through which the infection penetrates. Therefore, the prevention of such injuries is an important factor in the prevention of disease. The main reason for the appearance of cracks is improper attachment of the baby to the breast, when the baby does not completely capture the nipple with his lips. Poor-quality breast care, as well as forced expression of milk with incomplete emptying, can increase cracks.

Local anatomical defects in the mammary gland also contribute to the development of mastitis.

Among these defects are:

• Flat, inverted and lobed nipple.
• Mastopathy.
• The presence of gross cicatricial changes in the tissues of the nipple due to past surgical operations on the breast.

During the normal course of pregnancy, the woman's immunological system is suppressed, which is a completely natural process and is explained by the long coexistence of two organisms. A week after the transferred childbirth, all indicators of immunity should return to normal. However, in practice, 84.4% of women experience pregnancy or childbirth with some kind of complications. The more severe these complications, the more the immunity suffers, respectively, the more severe the course of inflammation will be.

Therefore, one should not exclude such risk factors for the development of lactational mastitis as:

• Late toxicosis.
• The threat of termination of pregnancy.
• Premature birth.
• Severe blood loss during childbirth.
• Manual removal of the placenta, trauma during labor.
• Postpartum complications (bleeding, fever, exacerbation of existing diseases).

All these conditions affect the functioning of the immune system and create favorable conditions for the development of inflammation.

If we consider possible carriers of Staphylococcus aureus, then they can be adults, for example, employees of a maternity hospital, roommates, relatives of a woman. Moreover, they may not have pronounced symptoms indicating the presence of staphylococcal infection in the body. As practice shows, from 20 to 30% of people are carriers of Staphylococcus aureus.

The newborn also sometimes acts as a source of infection. He may have inflammatory processes in the oral cavity, in the pharynx, in the nasopharynx, which is a danger to the health of the baby and mother.

Symptoms of mastitis

Since it is lactostasis that is the trigger that provokes mastitis, you should know its main symptoms. The following signs indicate it: breast enlargement in volume, thickening of the lobules, a slight increase in body temperature. If milk stagnation is not eliminated in three days, then the number of microbes in the mammary gland will increase to high values, which will ultimately lead to the development of mastitis.

Symptoms of the development of mastitis are as follows:

• Acute onset of the disease with the appearance of a feeling of heaviness in the mammary gland and pain. These symptoms occur in the first few hours after the onset of the disease.
• The woman's health worsens, the body temperature rises to 37.5-38 degrees.
• General weakness arises.
• The mammary gland increases in size, the skin on it turns red. Hyperemia can be mild or barely noticeable.
• When touching the breast, the woman feels pain.
• Feeding a baby is uncomfortable.
• Expression of milk does not bring relief, although milk volume is reduced. While expressing, the woman experiences pain.
• If a woman does not receive timely treatment, then a painful lump begins to form in the mammary gland - an infiltrate. On palpation, its clear boundaries are palpated. At the same time, the skin of the mammary gland does not become more hyperemic, swelling does not develop.
• After 3-4 days, purulent mastitis manifests.

It is characterized by the following symptoms:

• Significant deterioration in health;
• Increasing weakness;
• Decreased appetite;
• Sleep disturbance;
• Increase in body temperature to 39-40 ° C;
• The appearance of chills;
• Increased sweating;
• Pallor of the skin;
• The appearance of severe chest pain;
• Swelling of the gland;
• Severe redness of the breast skin;
• Increased infiltration in size;
• Difficulty expressing milk;
• The presence of pus in milk.

If purulent mastitis is left untreated, it will progress rapidly and lead to abscess and gangrene of the breast tissue.

Forms of lactational mastitis

Distinguish between acute postpartum mastitis, which develops against the background of the absence of symptoms of milk stagnation. If it has a non-infectious nature, then spontaneous recovery is possible. The lump dissolves, the pain subsides.

Non-purulent mastitis has two forms: serous and infiltrative. The serous stage is characterized by milk stagnation, the appearance of heaviness in the chest. At the same time, the general condition of the woman is not disturbed, the body temperature does not rise.

The infiltrative form is characterized by the appearance of a painful induration. If you do not get rid of mastitis at this stage, then the disease will turn into a purulent form (destructive phase).

There are the following forms of purulent mastitis:

• Absolute mastitis. Pus-filled cavities form in the breast tissue. On palpation of the infiltrate, fluid transfusion is felt.
• Phlegmonous. The chest swells a lot, increases in size, becomes painful. The skin of the mammary gland turns red, the nipple may be retracted.
• Infiltrative abscessing mastitis. A dense infiltrate with small zones of abscess of various sizes is formed in the chest. This form of mastitis has a severe course.
• Gangrenous mastitis. The woman's condition deteriorates sharply, the body temperature rises to high levels. The chest becomes painful, swelling, necrotic areas and vesicles filled with hemorrhagic exudate appear on the skin. The edema is not fixed in a limited area of the breast, but spreads over its entire surface.

Diagnosis of lactation mastitis

Diagnosis of lactational mastitis is straightforward. The focus of inflammation in the mammary gland, as a rule, is well palpable. The breast itself increases in size, becomes painful, and the regional lymph nodes may swell. Fluctuation is a symptom that a doctor will check if a purulent process is suspected. Fluctuation is also called a swelling symptom. With the help of pressure on the chest and jerky movements of the hand, the doctor determines the fluctuations in the fluid in the chest.

It should be borne in mind that the diagnosis of purulent mastitis against the background of excessive lactation can be difficult. Therefore, an ultrasound scan of the mammary glands is shown, with the help of which abscesses, necrosis zones, areas of inflammation with expansion of the milk ducts and thickening of the subcutaneous tissue are perfectly visualized. The infiltrate looks like a delineated area, and as it progresses, a “honeycomb” pattern appears.

In some cases, bacteriological analysis of milk from the affected gland helps to confirm the diagnosis. Infectious mastitis is indicated by the level of bacteria in milk, exceeding 10 to 3 degrees per ml of liquid.

Other tests that make it possible to clarify the diagnosis:

• General blood analysis;
• General urine analysis;
• Cytological examination of milk with counting the number of erythrocytes in it;
• Measuring the ph level of milk;
• Determination of the degree of activity of reductase, etc.

Questionable ultrasound findings require ultrasound-guided fine needle aspiration breast biopsy. As a rule, puncture is used for phlegmonous and abscessed forms of lactational mastitis.

Treatment of lactational mastitis

Conservative therapy is effective in the early stages of mastitis.

Conditions for its implementation:

• The duration of the disease is no more than 3 days;
• The satisfactory condition of the patient;
• Normal or slightly elevated body temperature;
• Infiltration sizes not exceeding one breast quadrant;
• No signs of suppuration;
• Unchanged blood and urine tests.

Treatment with conservative methods consists of the following points:

• Expressing milk regularly from a healthy and inflamed breast (every 3 hours).
• Intramuscular injection of Drotaverin (2 ml, 3 times a day) for 3 days. Injections are given a quarter of an hour before the start of expressing milk.
• Setting retromammary novocaine blockade once a day with the addition of antibiotics.
• Intramuscular administration of broad-spectrum antibiotics. The drugs of choice are: Amoxicillin, Augmentin, Cephalexin.
• Conducting desensitizing therapy with intramuscular injection of 1 ml of Diphenhydramine solution 3 times a day.
• Taking vitamins of group B, and vitamin C.
• The imposition of compresses on the mammary gland containing semi-alcohol impregnation.
• If the woman's condition improves after a day from the start of treatment, then she is prescribed such local procedures as ultrasound therapy or UHF therapy.
• With excessive lactation, drugs are prescribed to suppress it.

Warming ointment compresses and local application of cold compresses are prohibited. As a rule, serous mastitis resolves within 2-3 days from the start of treatment, and the infiltration resolves within a week.

If there is no positive dynamics from conservative therapy for 2 days, then surgical intervention is necessary. A purulent form of mastitis always requires surgical treatment. The focus is opened and drained.

The progressive form of the disease, the appointment of antibiotics, purulent mastitis - all this is a contraindication to further breastfeeding, since the milk is infected or spoiled by drugs. This can lead to dysbiosis in the baby, disruption of the organs of his digestive system.

However, if doctors consider it possible to continue breastfeeding the baby, then lactation should be maintained by all means.

Prevention of mastitis

The sooner a woman turns to a specialist for help, the lower the risk of complications of mastitis and the need for surgery.

The main measures for the prevention of lactational mastitis are:

• Wearing high quality and comfortable lingerie for nursing women.
• Establishing breastfeeding at the request of the baby.
• Expression of milk when it is in excess.
• Correct latching of the baby to the breast with full latch on the nipple.
• During the night's rest, you need to lie on your side or back.
• You should protect your chest from various kinds of injuries and hypothermia.
• Do not take long breaks in feeding.
• The slightest cracks in the nipples require quality treatment.

Hygiene measures designed to keep the breasts clean must be followed in full.

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.