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Puerpera F., 22 years old, was delivered through the natural birth canal by a live full-term male child weighing 3500 g. On the 4th day of the postpartum period, complaints of headache, weakness, pain in the right mammary gland, a sharp increase in body temperature to 39 ° C, chills .

Status praesens. The condition is satisfactory. The skin is pale, dry. Marked engorgement of the mammary glands is noted. In the region of the lower outer quadrant of the right mammary gland, a dense painful infiltrate is palpated, the skin above it is hyperemic, hot to the touch. Palpated enlarged painful lymph nodes in the right armpit. The respiration in the lungs is vesicular, no wheezing. Heart sounds are clear, rhythmic. HELL 120/70 mm RT. Art. Ps PO per minute. The abdomen is soft, painless. Stool, urination is normal. Discharges from the genital tract are bloodless, odorless.


Diagnosis Lactational mastitis, infiltrative form

Tactics, doctor obstetric hospital?

Transfer of the puerperal to the second obstetric department or specialized hospital for purulent-septic postpartum infections. Call for surgeon consultation.

Tactics of a doctor of antenatal care?

The doctor of the antenatal clinic should send the puerperas to the specialized department (for the treatment of mastitis) of the surgical hospital

Modern features of the course of mastitis?

- rapid progression of the process from serous mastitis to the stage of abscess formation;

- later (in terms of time after childbirth) development - a belated "delayed" mastitis that occurs after discharge from the maternity hospital;

- the difficulty of treatment due to the immunodeficiency state (anemia, blood loss in childbirth) of the puerpera.

Prevention of mastitis?

- Preparation of the mammary glands during pregnancy (with flat and inverted nipples, their stretching);

- Prevention of nipple cracks, proper attachment to the chest. It is necessary to put the child to the chest at the moment when his mouth is opened as wide as possible. This should be accompanied by a slight pressing of the baby to the chest, so as to enable him to capture as much tissue as possible about the halos of the mammary gland. The correct position of the baby during feeding plays a decisive role both in the prevention of nipple cracks and in the success of breastfeeding. When the baby is correctly attached to the breast, the woman should not experience any pain. The nipple, along with the surrounding tissues (areola), is deeply drawn into the baby’s mouth, creating a large “tissue nipple”. Gums should not come in contact with the nipple. Otherwise, the nipple will be damaged, due to friction, and a crack in the nipple will form;

- Timely diagnosis of nipple cracks and their treatment. If a woman has a crack (nipple injury), she should continue to breastfeed (correctly applied to the breast), express milk. Cessation of feeding and application of a variety of vitamin-oil and other means for nipples is not effective. To stimulate the regeneration of nipple cracks, irradiation of the nipples with a helium-neon laser is used, the laser also has an analgesic effect;

- Breast care - washing with water and baby soap before and especially after feeding in order to wash off the infection that got on the nipple from the baby's mouth;

- Proper breast pumping, lactostasis prophylaxis, radial massage.

An important condition for the prevention of lactostasis is thorough decantation, the application of the baby to the chest, and the use of a breast pump.
In the event that milk is not removed as it is formed, the volume of milk in the breast exceeds the ability of the alveoli to store it. Overstretching of the alveoli with milk causes the flattening of cells secreting milk, stretching them and even tears. Once the alveoli become distended, further milk production is reduced. The expansion of the alveoli can be felt as a soft tumor in the tissues of the mammary gland. If there is no outflow, then pressure can force the release of the constituents of milk substances through the cell membrane into the surrounding tissues, causing an inflammatory reaction. An edematous, red, painful area forms in the mammary gland, the body temperature rises, the pulse quickens, and there may be chills. At this stage, the process does not reach the state of infection and it can be cured if lactostasis is eliminated. If lactostasis is not eliminated, then what began as a non-infectious inflammatory process can quickly progress to the infectious process. In women with infectious mastitis (local tension and redness in the mammary gland, fever up to 39 ° C), antibiotics are necessary (for example: Ampioks), and expressing milk improves treatment results.

Breastfeeding is important for both the mother and the baby. Early contact between mother and baby has a beneficial effect on breastfeeding. It is difficult to separate the effects of early attachment to the breast from the effects of other early interactions between the mother and the baby, such as stroking, visual, and skin-to-skin contacts. The first postpartum feeding (as opposed to the first breastfeeding) follows

exercise in an intimate setting when the child is ready for this and when the young mother and child are in comfortable conditions.

Lactostasis Treatment

- bandage that fixes the mammary gland in an elevated position;

- restriction of fluid intake;

- semi-sitting position;

- physiotherapy: cold to the gland, ultrasound, microwave therapy;

- retro-mammary procaine blockade (possibly with antibiotics).

Is breastfeeding possible with mastitis?

The issue of feeding a child should be decided on the basis of the results of bacteriological examination of milk. Before receiving the result of milk sowing, breastfeeding is contraindicated in the purulent process (purulent mastitis, abscess, purulent wound after opening the abscess).

Indications for the suppression of lactation in mastitis

- repeated abscesses;

- bilateral mastitis;

- gangrenous mastitis;

- retro-mammary abscess;

- a combination of mastitis with severe extragenital pathology;

Lactation Suppression Methods

- restriction of fluid intake, semi-sitting position;

- tight bandaging of the mammary glands (after decantation);

- medications' estrogens or combined oral estrogen-progestogen contraceptives; prolactin inhibitors: bromo-cryptin - syn .: parlodel 2.5 mg (1 tablet) 2 times a day for 5-10 days, norprolak 25 μg per day (1 tablet) 3-5 days, dostinex 0.25 mg (1/2 tablet) after 12 hours for 2 days.

Are mastitis related to postpartum infections?

No, mastitis is not represented in the classification of postpartum infections of Sazonov-Bartels. Postpartum diseases are characterized by infection of the birth wound and staged development. Lactational mastitis is a postpartum disease.
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