postnatal complications, breast disorders

1. BREAST
COMPLICATIONS
R. Kavitha
Asso. Prof, KCN

2. BREAST COMPLICATIONS
The common breast complications in puerperium
are:
(1) breast engorgement,
(2) cracked and retracted nipple leading to
difficulty in breastfeeding,
(3) mastitis and breast abscess,
(4) lactation failure.
• Breast engorgement and infection are
responsible for puerperal pyrexia.

3. Definition
Breast engorgement occurs in the mammary
glands due to expansion and pressure exerted by
the synthesis and storage of breast milk. It is also
a main factor in altering the ability of the infant to
latch-on. The nipples on an engorged breast are
flat or inverted.

4. Cause:
• Breast engorgement is due to exaggerated
normal venous and lymphatic engorgement of
the breasts which precedes lactation.
• prevents escape of milk from the lacteal system.
• The primiparous & inelastic breasts are likely to
be involved.
• Engorgement is an indication that the baby is not
in step with the stage of lactation.

5. Signs & Symptoms
• Considerable pain
• feeling of tenseness
• heaviness in both the breasts,
• Generalized malaise
• even transient rise of temperature
• Painful breastfeeding.

6. Prevention
(i) To avoid prelacteal feeds
(ii) To initiate breastfeeding early and
unrestricted,
(iii) exclusive breastfeeding on demand,
(iv) Feeding in correct position,
(v) Correct latch on breast.

7. Treatment:
(1) To support the breasts with a binder or brassiere,
(2) Frequent suckling,
(3) Manual expression of any remaining milk after each
feed,
(4) To administer analgesics for pain,
(5) The baby should be put to the breast regularly at
frequent intervals,
(6) In a severe case, gentle use of a breast pump may be
helpful. This will reduce the tension in the breast without
causing excess milk production.

8. CRACKED AND RETRACTED
NIPPLE
• Cracked nipple (nipple trauma
or nipple fissure) is a condition that can
occur in breastfeeding women.
• A retracted nipple is a nipple that
turns inward instead of outward, except
when stimulated.

9. causes
a) unclean hygiene resulting in formation of
a crust over the nipple,
b) retracted nipple,
c) Trauma from baby’s mouth due to
incorrect attachment to the breast,
d) infection with Candida albicans and S.
aureus is often present.

10. Signs & symptom
• redness.
• soreness.
• chafed, dry appearance.
• crustiness or scabbing.
• oozing.
• bleeding.
• open cracks or sores.
• pain or discomfort.

11. Management
Prophylaxis:
• local cleanliness during pregnancy and in
the puerperium before and after each
breastfeeding to prevent crust formation
over the nipple.

12. Treatment:
• Correct attachment (latch on) will provide immediate
relief from pain and rapid healing.
• Fresh human milk and saliva have got healing
properties.
• 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 the infant is fed
with the expressed milk.
• Inflamed nipple and areola may be due to thrush also.

13. Cont…
• Miconazole lotion is applied over the nipple as
well as in the baby’s mouth if there is oral thrush.
• If it fails to heal up, rest is given to the affected
nipple using a breast pump while the nipples
heal.
• Nipple shields (thin latex) can be used. The
persistence of a nipple ulcer, inspite of therapy
mentioned, needs biopsy to exclude malignancy.

14. Retracted and flat nipple:
• It is commonly met in primigravidae. It is
usually acquired.
• Babies are able to attach to the breast
correctly and are able to suck adequately.
• In difficult cases, manual expression of
milk can initiate lactation.
• Gradually breast tissue becomes soft and
more protractile, so that feeding is
possible

15. Acute Mastitis
Acute mastitis is usually
a bacterial infection and is seen most
commonly in the postpartum period.
Bacteria invade the breast through the small
erosions in the nipple of a lactating woman,
and an abscess can result.
Chronic mastitis can be a sequela of acute
mastitis, or more commonly, associated
with duct ectasia.

16. incidence
• mastitis is 2–5% in lactating and less than
1% in non-lactating women.

17. Clinical features:
• Generalized malaise
• headache,
• nausea,
• vomiting,
• Fever (102°F or more) with chills,
• Severe pain
• tender swelling in one quadrant of the breast.
• The overlying skin is red,
• hot and flushed

18. Diagnosis:
• Microscopic examination of breast milk,
showing leucocytes more than 106/mL
and bacterial count more than 103/mL,
supports the diagnosis of mastitis.

19. Complications:
• Due to variable destruction of breast
tissues, it leads to the formation of a
breast abscess.

20. PROPHYLAXIS :
• Thorough hand washing before each feed,
cleaning the nipples before and after each
feed, and keeping them dry, reduce the
nosocomial infection rates.

21. Management
a) Breast support,
b) Plenty of oral fluids,
c) Breastfeeding is continued with good attachment. Nursing is
initiated on the uninfected side first to establish let down, The
infected side is emptied manually with each feed,
d) Dicloxacillin (penicillinase-resistant penicillin) is the drug of choice.
A dose of 500 mg every 6 hours orally is started till the sensitivity
report available. Erythromycin is an alternative to patients who are
allergic to penicillin. Antibiotic therapy is continued for at least 7
days,
e) Analgesics (ibuprofen) are given for pain,
f) Milk flow is maintained by breastfeeding the infant. This prevents
proliferation of Staphylococcus in the stagnant milk.

22. BREAST ABSCESS:
Clinical Features are:—
a)Flushed breasts not responding to
antibiotics promptly
b)Brawny edema of the overlying skin
c)Marked tenderness with fluctuation,
d)Swinging temperature.

23. prophylaxis
• Breastfeeding is continued in the uninvolved
side. The infected breast is mechanically
pumped every 2 hours and with every let down.
Recurrence risk is about 10%. Once cellulitis
has resolved, breastfeeding from the involved
side may be resumed.
• Antibiotics to be continued depending upon the
culture report of pus.

24. Management:
• Appropriate nursing technique, positioning
and breast care can reduce pain
significantly, when it is due to nipple
trauma, engorgement or mastitis.
• Use of miconazole oral lotion or gel into
both the nipples and into infant’s mouth
thrice daily for 2 weeks is helpful.

25. Lactation failure
Causes are:
1)Infrequent suckling,
2)Depression or anxiety state in the puerperium,
3)Reluctance or apprehension to nursing,
4)Painful breast lesion,
5)Endogenous suppression of prolactin (retained
placental bits),
6) Prolactin inhibition

26. Treatment:
• For maintenance of effective lactation in an
otherwise healthy individual, the following
guidelines are helpful.
• Antenatal:
(1)To counsel the mother regarding the
advantages of nursing her baby with breast milk,
(2)To take care of any breast abnormality
especially a retracted nipple and to maintain
adequate breast hygiene especially in the last 2
months of pregnancy.

27. Puerperium:
• To encourage adequate fluid intake,
• To nurse the baby regularly,
• Painful local lesion is to be treated to prevent
development of nursing phobia,
• Metoclopramide, oxytocin and sulpiride (selective
dopamine antagonist) have been found to increase milk
production.
• They act by stimulating prolactin secretion.
Metoclopramide given in a dose of 10 mg thrice daily is
found helpful.