Lactational mastitis

Lactation mastitis is an inflammation of the mammary gland (mostly one-sided) during lactation in the postpartum period.

It develops more often after 2-3 weeks. After childbirth.

[1], [2], [3], [4], [5], [6], [7]

Causes of the lactational mastitis

Most often, the entrance gates of infection are nipple cracks, breast ducts of the gland during breastfeeding or decanting milk (intrakankulyarnoe penetration of the causative agent of the infection). Very rarely the pathogen spreads from endogenous foci.

Risk factors for lactation mastitis:

• cracked nipples;
• lactostasis.

Cracks of the nipples can occur due to malformations of the nipples, improper technique of breast feeding, rough expression of milk.

[8], [9], [10], [11], [12]

Symptoms of the lactational mastitis

With lactostasis, an increase in body temperature of up to 24 hours is possible. If more than 24 hours, then this condition should be considered as mastitis.

According to the nature of the inflammatory process, lactational mastitis is distinguished:

• serous;
• infiltrative;
• purulent;
• infiltrative-purulent, diffuse, nodular;
• Purulent (abscessing): furunculosis areola, abscess areola, abscess in the gland thick, abscess behind the gland;
• phlegmonous, purulent-necrotic;
• gangrenous.

By localization of the focus, lactational mastitis happens: subcutaneous, subareolar, intramammary, retromammary and total. The clinical picture of mastitis is characterized by: acute onset, severe intoxication (general weakness, headache), fever to 38-39 ° C, pain in the mammary gland, which is enhanced by feeding or decanting. The mammary gland increases in volume, hyperemia and infiltration of tissues without clear boundaries are noted. This picture is typical for serous mastitis. With ineffective treatment for 1-3 days, serous mastitis becomes infiltrative. At a palpation dense, sharply morbid infiltrate, a lymphadenitis are defined. The duration of this stage is 5-8 days. If the infiltrate does not resolve against the background of the treatment, its suppuration occurs - purulent mastitis (abscessing).

There is an increase in local symptoms of inflammation, a significant increase and deformation of the mammary gland. If the infiltrate is located shallow, then when suppuration is determined by fluctuations. Suppuration of the infiltrate occurs for 48-72 hours. In those cases when several infiltrates are inflamed in the mammary gland, the mastitis is called phlegmonous. Body temperature - 39-40 ° C, chills, pronounced general weakness, intoxication, mammary gland sharply increased, painful, pastose, well expressed superficial venous network, the infiltration occupies almost the entire gland, the skin over the affected area swollen, shiny, red, with cyanotic shade, often with lymphangitis. With phlegmonous lactation mastitis it is possible to generalize the infection with the transition to sepsis.

[13], [14], [15], [16]

Diagnostics of the lactational mastitis

Diagnosis of lactation mastitis is based on the following data:

• clinical: examination of the breast, evaluation of clinical symptoms, complaints, anamnesis;
• laboratory: general blood analysis (leukogram), general urine analysis, bacteriological and bacterioscopic examination of exudate, immunogram, coagulogram and blood biochemistry;
• instrumental: ultrasound (one of the important methods of diagnosing mastitis).

[17], [18], [19], [20], [21], [22]

Treatment of the lactational mastitis

Treatment of lactational mastitis can be conservative and surgical.

Antibiotic therapy should begin with the appearance of the first signs of the disease, which helps to prevent the development of purulent inflammation. With serous lactation mastitis, the question of breastfeeding is decided individually. It is necessary to take into account: the wishes of the mother, history (for example, purulent mastitis in the anamnesis, numerous scars on the mammary gland, mammary gland prosthetics), antibiotic therapy, bacteriological and bacterioscopic examination of exudate, presence and severity of nipple cracks. Since infiltrative mastitis, breastfeeding is contraindicated because of the real threat of infection of the baby and the cumulative accumulation of antibiotics in his body, but lactation can be preserved by pumping.

In the absence of the effect of conservative therapy of mastitis for 2-3 days and the development of signs of purulent mastitis, surgical treatment is indicated. Surgical treatment consists of a radical incision and adequate drainage. At the same time, they continue to carry out antibiotic therapy, detoxification and desensitizing therapy. Timely surgical treatment of lactational mastitis can prevent the progression of the process, the development of SIRS.

Prevention

Prevention of postpartum mastitis is the training of women in the rules of breastfeeding and the observance of rules of personal hygiene. Timely detection and treatment of nipple and lactostasis cracks is necessary.

[23], [24], [25], [26], [27], [28]