The complications of breast during puerperium and its management

1. By:
MS. LAMNUNNEM HAOKIP
SENIOR TUTOR/LECTURER
OBG NURSING
SSNSR, SU

2. INTRODUCTION
The common breast complications in puerperium
are:
BREAST
ENGORGEMENT
CRACKED AND
RETRACTED NIPPLES
LACTATION FAILURE
MASTITIS AND
ABSCESS

3. BREAST ENGORGEMENT
Breast engorgement is breast swelling that
results in painful, tender breasts. It’s caused by
an increase in blood flow and milk supply in the
breasts, and it occurs in the first days after
childbirth.
It usually starts after milk secretion starts ( 3rd
to 4th day of PP)

4. Symptoms Include:
Pain/tenderness and feeling of
tenseness in both breast.
Generalized malaise or even transient
rise of Temperature
Painful breastfeeding

5. Treatment:
Breast Binder/Brassiere
Frequent suckling
Manual expression
Analgesics
BF at frequent interval
Breast pump

6. Prevention Includes:
Avoid prelacteal feeds
Initiate early breastfeeding and unrestricted
EBF on demand
Correct BF position
Correct latch on

7. CRACKED AND RETRACTED NIPPLES
Cracked Nipple:
Cracked nipples are characterized by red, irritated, and
scabbed skin on or around the nipple.
During breastfeeding, causes of cracked nipples include:
Problems with the baby’s latch
Not finding the optimal position and ideal technique
Not finding the using a breast pump, particularly if the
pump flange is too small

8. It is caused by:
Unclean hygiene resulting in formation of crust over the nipple
Retracted nipples
Trauma from baby’s mouth due to improper latching
Due to infection with Candida Albicans, S. aureus

9. Treatment:
Correct attachment
Purified Lanolin (3 to 4 times a day)
Breast bump
Miconazole over breast and baby’s mouth
Nipple shield

10. Retracted Nipples:
A retracted nipple is a nipple that turns inward
instead of outward, except when stimulated. This
type of nipple is sometimes referred to as an inverted
nipple.
It is caused by – aging, mammary duct ectasia,
paget’s disease of the breast and carcinoma.

13. Treatment:
Nipple corrector device
Warm compression in case of mammary duct ectasia.
Silicon Nipples Orthotics Pump

14. MASTITIS
• Mastitis is an inflammation of breast tissue
that sometimes involves an infection. The
inflammation results in breast pain, swelling,
warmth and redness, fever and chills.
• Mastitis most commonly affects women who
are breast-feeding (lactation mastitis). But
mastitis can occur in women who aren't
breast-feeding and in men.

15. Cause:
A blocked milk duct
Bacteria
Lymph nodes and ducts
Sore / cracked nipples
Improper nursing technique
Tight bra / brassiere
Poor nutrition

17. Treatment:
Warm compression and warm shower
Frequent breastfeeding if breast not infected
More oral fluids
Antibiotic- Tab. Dicloxacillin 500 mg every 6 hours and Tab.
Erythromycin 500 mg TD for 7 days for patient allergic to Penicillin.
Analgesic – Tab. Ibuprofen 200 mg per day.

18. LACTATION FAILURE
Inadequate milk production.
The causes are:
Infrequent suckling
Depression / anxiety in PP
Reluctance in nursing
Painful breast
Prolactin inhibition

21. Management
Antenatal counselling
Puerperium counselling
Tab. Metoclopramide