1. Subinvolution, breast engorgement, mastitis, breast abscess, and thrombophlebitis are common postpartum complications that can occur. 2. Subinvolution occurs when the involution of the uterus after delivery is impaired or delayed. Breast engorgement is swelling of the breasts due to increased blood and lymph supply before lactation begins. 3. Mastitis is an inflammation of the breast tissue that is usually caused by bacterial infection during breastfeeding. Left untreated it can develop into a breast abscess, which is a localized collection of pus in the breast that requires drainage.

1. SUBINVOLUTION
BREAST COMPLICATIONS &
THROMBOPHELEBITIS
Mrs.Jagadeeswari
.J
M.Sc Nursing

2. SUBINVOLUTION
DEFINITION:
When the involution is
impaired or retarded it is called
Subinvolution.
D.C.DUTTA

3. CAUSES OF SUBINVOLUTION
PREDISPOSING FACTORS
• Grand multiparty
• Over distension of uterus as in twins and
hydramnios
• Maternal ill health
• Caesarean section
• Prolapse of the uterus
• Retroversion after the uterus become pelvic
organ
• Uterine fibroid.

4. AGGRAVATING FACTORS
• Retained products of
conception
• Uterine sepsis(Endometritis)

5. CLINICAL FEATURES
SYMPTOMS
• Abnormal lochial discharge either excessive
or prolonged
• Irregular or at times excessive uterine
bleeding
• Irregular cramp like pain in cases of retained
products or rise of temperature in sepsis

6. SIGNS
• The uterine height is greater than the normal
for the particular day of puerperium. It feels
boggy and softer.
• Presence of features responsible for
Subinvolution may be evident.

7. MANAGEMENT
• Appropriate therapy is to be instituted only
when Subinvolution is found to be a mere sign
of some local pathology:
• Antibiotics in Endometritis
• Exploration of the uterus in retained products
• Pessary in prolapse or retroversion.
• Ergometrine Is prescribed to enhance the
involution process by reducing the blood flow to
the uterus

8. BREAST ENGORGEMENT
DEFINITION
Swelling of the breast due to
an increase in blood and lymph
supply as a precursor to lactation.
D.C.DUTTA

9. CAUSES OF BREAST ENGORGEMENT
• Due to exaggerated normal venous and
lymphatic engorgement.
• Prevent the escape of milk from lacteal
system.
• Primiparas patients and patients with
inelastic breast are likely to be involved
• Engorgement is an indication that the baby is
not in step with the stage of lactation

10. ONSET
Usually manifests after
the milk secretion starts 3rd or 4th
postpartum

11. SYMPTOMS
• Pain and feeling of tenderness or
Heaviness in both breast
• Generalised Malaise
• Transient Rise of temperature
• Painful breast feeding

12. PREVENTIVE MEASURES
• Avoid prelacteal feeding
• Initiate breast feeding early and
unrestricted
• Exclusive breast feeding on demand
• Feeding in correct position

13. TREATMENT-NURSING CARE
• To support breast with a binder or brassiere.
• Frequent suckling and manual expression of any
remaining milk after each feed.
• To administer analgesics for pain.
• The baby should be put to the breast regularly at
frequent intervals.
• In a severe case gentle use of a breast pump this will
reduce the tension in the breast without causing
excess milk production.
• Gentle hand expression of milk to make the breast
soft so that the infant can latch on.
• Provide moist heat and cold compress to relieve
oedema.

14. MASTITIS
DEFINITION
Mastitis is inflammation of
tissue in one or both mammary
glands inside the breast.

15. ONSET AND CAUSATIVE ORGANISMS
The incidence of mastitis is 2.5% in
lactating and less than 1% in non lactating
women. The common organisms involved are
Staphylococcus Aureus , S.Epidermidis and
Streptococci.
Acute mastitis usually occurs during
late first week or by end of second week or
even after several week after the delivery

16. RISK FACTORS
The risk factors for
mastitis are poor nursing
and cracked nipples.

17. CLINICAL FEATURES
SYMPTOMS:
• Generalized malaise and headache
• Fever (102 F or more ) with chills
• Severe pain and tender swelling in one quadrant of
the breast
SIGN:
• Presence of toxic features
• Presence of a wedge shaped swelling on the breast
with its apex at the nipple
• The overlying skin is red, hot and flushed and feels
tense and tender.

18. MODE OF INFECTIONS
There are two different types of
mastitis depending upon the site of infection
1. Infection that involves the breast
parenchymal tissues leading to cellutitis.The
lacteal system remains unaffected.
2. Infection gains access through the
lactiferous duct leading to development of
primary mammary adenitis.

19. PREVENTION
1. Through hand washing before
each feed
2. Cleaning the nipples before
and after each feed
3. Keeping them dry

20. TREATMENT-NURSING CARE
1. Breast support
2. Consuming plenty of oral fluids
3. Continuous breast feeding with good attachment
4. Unaffected side is nursed first to establish let
down
5. Infected side is emptied manually with each feed
6. Flucloxacillin is the drug of choice or Erythromycin
is alternative drug for patients with allergy to
Penicillin
7. Antibiotic therapy is continued for 7days
8. Analgesics(ibuprofen) are given for pain

21. BREAST ABSCESS
DEFINITION
Localized collection of pus
that forms in the breast is
called breast abscess.

22. CAUSES
Most breast abscesses occur
as a complication of mastitis,
which is a bacterial infection that
causes the breast to become red
and inflamed

23. CLINICAL FEATURES
• Flushed breast not responding to
antibiotics promptly
• Brawny edema of the overlying skin
• Marked tenderness with fluctuation
• Swinging temperature

24. TREATMENT
Abscess is drained by radical incision done under
general anesthesia
Abscess can be also drained by using needle and
syringe
Breast feeding is continued in the uninvolved side
The infected breast is mechanical pumped every
two hours and with every let down
Antibiotics given depending upon the culture and
sensitivity report of pus
Antibiotic therapy is given for 7 days

25. THROMBOPHELEBITIS
DEFINITION
Thrombhophelebitis is the
inflammation of a vein with
blood clot formed inside the
vein at the side of the
inflammation.

26. ETIOPATHOGENESIS
• In normal pregnancy there is rise in concentration
of coagulation factors I,II,VII,VIII,IX.X,XII. Plasma
fibrinolytic inhibitors produced by placenta and
the level of protein S is marked decreased.
• Alteration in blood constituents- increased number
of platelet & their adhesiveness.
• Venous stasis is increased due to compression of
gravid uterus to IVC & iliac veins. This stasis cause
damage to endothelial cells.

27. Cont…
• Thrombophilias are hypercoagulable states in
pregnancy that increase the risk of venous
thrombosis
• Other acquired risk factors for thrombosis are
advanced age and parity, operative
delivery(10 times more),obesity , anemia,
heart disease, infection of pelvic cellulitis and
trauma to the venous wall.

28. SIGNS AND SYMPTOMS
• Fever
• Abdominal pain, usually localized and restricted
to the Side of the affected vein but may spread
into the groin, Upper abdomen, or flank
• Abdominal bloating and tenderness
• A tender, sausage-shaped mass near the
umbilicus
• Decreased or absent bowel sounds
• Nausea, vomiting and increased pulse rate
• HOMANS signs –Pain in the calf region

29. INVESTIGATIONS
• Doppler ultrasound
• Venography
• Fibrinogen scanning
• CT scan or MRI

30. PROPHYLACTIC MEASURES
• Avoid pressure behind the knees
• Avoid prolonged sitting
• Avoid constructive clothing
• Avoid crossing the legs
• Elevate legs including foot of the bed
• Never massage the leg
• Ambulate as soon possible
• Apply compression stockings
• Prophylactic anticoagulants therapy should be
started

31. MANAGEMENT
• Complete bed rest with foot end raised above
heart level
• Analgesics for pain
• Antibiotics therapy
• Anti coagulants Heparin 15000IU /IV 4to 6
hourly for 7-10days should be given
• Apply elastic stockings are fitted on the affected
leg before mobilization
• Venous Thrombectomy