Postpartum mastitis in women. Causes, symptoms and treatment

After the birth of a baby, a woman may develop an acute bacterial disease of the mammary gland, which is characterized by inflammation of its tissues - postpartum mastitis. During this period, lactational mastitis usually develops, associated with the process of lactation.

When can postpartum mastitis appear?

In the first weeks, this ailment can develop in the following periods:

• Milk crises (after 3 and 6 months after birth). During these periods, milk actively arrives after short breaks in lactation.
• Mastitis often appears after breastfeeding is stopped. This is due to the fact that often women incorrectly interrupt the feeding of the baby.
• The disease can appear at any time due to cracks in the nipples or as a result of injury to the chest.

Note. Very often, mastitis is diagnosed in women over thirty years of age who give birth for the first time and have no experience in establishing breastfeeding.

Almost all nursing mothers with mastitis after childbirth have only one of the mammary glands affected. Bilateral mastitis is less common.

Reasons for development

The following factors can also contribute to the appearance of mastitis after childbirth:

• Sores on the nipples.
• Purulent diseases of the skin of the breast.
• Milk stasis.
• Non-observance by the nursing mother of elementary hygiene rules.
• Weak immunity of a woman.
• Difficult childbirth.
• The presence of pathologies.
• Improper expression of milk.

These reasons can provoke the development of postpartum mastitis, the appearance of which is associated with lactostasis.

Stages and symptoms

Postpartum mastitis in women has several stages. Each has its own symptoms and treatment features:

1. The initial stage of the disease is called "serous mastitis". It begins abruptly with an increase in temperature (up to 39 degrees). A woman has a gradually increasing headache, chills appear. In the place where the focus of inflammation was localized, painful seals can be felt.

Remember. The transition to the next stage develops rapidly - over three days.

1. The next stage - infiltrative - is characterized by the appearance of pus. The woman's condition is gradually deteriorating: heat persists, appetite decreases. The sore chest swells and becomes hot.
2. The next stage of mastitis after childbirth in women is called abscessing. It has the following forms: furunculous or abscessing lesions of the areola, abscess in the thickness of the gland, retromammary abscessing process.
3. With the progression of the disease, a phlegmous and then a gangrenous stage may occur. This is a very dangerous condition, the treatment of such neglected forms is possible only by surgery.

Important. It is impossible to independently diagnose the stage of postpartum mastitis. Therefore, at the first suspicion of a disease, you should immediately consult a doctor.

Treatment

How to treat mastitis after childbirth? Treatment may be:

• non-drug;
• medication;
• surgical.

With non-drug treatment, a woman needs to stop breastfeeding. This is due to the fact that, firstly, infection of the child is possible, and secondly, it is necessary to free the diseased breast from milk.

Drug treatment involves the appointment of a nursing mother with powerful antibacterial drugs. The woman is prescribed medicines that inhibit or completely suppress lactation. Such drugs are prescribed only by a doctor, self-medication is unacceptable.

For the treatment of purulent forms of the disease, surgery is used, during which surgeons open and then drain the focus of inflammation.

Prevention

How to avoid mastitis after childbirth? After childbirth, the woman is in the ward, which is well ventilated and periodically treated with ultraviolet light. The nurse introduces women in labor to the technique of feeding, expressing milk and shows how to properly attach the baby to the breast.

Note. Prevention of postpartum mastitis should be started during pregnancy. To do this, a woman needs to fully eat, observe the rules of personal hygiene, and properly care for her nipples.

Prevention of mastitis in the postpartum period includes the following points:

• Compliance with personal hygiene.
• Proper attachment of the baby to the breast.
• Periodic pumping of milk to avoid stagnation.
• Prevention of nipple cracks during pregnancy.

This disease in the absence of timely treatment can have quite serious complications. Therefore, at the first signs of the appearance of mastitis, a nursing woman should consult her doctor.

In the postpartum period, this complication is not so rare - up to 10% of women experience this disease.

Postpartum mastitis is an inflammatory disease of the mammary gland of a bacterial nature, directly related to the process of lactation. And although the main pathogens are various microorganisms (Staphylococcus aureus more often than others), the development of the inflammatory process in most cases contributes to lactostasis. Therefore, the prevention of lactostasis is the most important method of preventing postpartum.

What is lactostasis

The breast is divided into several lobes (from 15 to 25) and each of them leaves the duct in the nipple. Lactostasis is a blockage of the milk duct, due to which milk can stagnate in it. This place swells, becomes painful. It is important to take timely measures to eliminate this blockage, otherwise the situation may become more complicated and lead to the occurrence of PM.

Most often, lactostasis occurs in primiparous women (up to 80%), two to three days after childbirth, when milk begins to actively arrive. But it is possible that lactostasis can develop during any period of breastfeeding up to the year of the baby. In order to prevent the development of the disease (and even more so not to bring it to its consequences), it is important for a woman to understand that the cause of this ailment is not complete emptying of the breast.

With lactostasis, uneven engorgement of the mammary glands is observed, pain is felt on palpation, body temperature rises to 38-39 degrees. Recall that this condition precedes the appearance of PM, which, if left untreated, will be diagnosed in 1-3 weeks.

Therefore, from the very beginning of the appearance of milk (already within the first day after the birth of a child), no matter how tired the woman who gave birth is, you cannot relax - you should decant the incoming milk on time and completely. In the event that there is a lot of it and the baby does not completely empty his mother's breast, after feeding him, be sure to express the rest. Because it is he who can cause blockage of the milk duct.

Mastitis. Disease stages.

However, do not forget about other reasons that can cause postpartum mastitis. Among them: nipple cracks, anomalies in the development of the nipples, structural changes in the mammary glands, plastic surgery on the mammary glands, violation of the rules of breastfeeding, decreased immunity female body. Any of these conditions makes a woman vulnerable to infection.

There are three stages of lactational postpartum mastitis:

Serous mastitis. This initial stage the disease is characterized by a deterioration in the general condition, headache, weakness, pain in the mammary gland increases, the temperature rises to 38-39 degrees. The diseased chest increases in volume, with palpation, compacted areas are palpated - oval areas.

Infiltrative mastitis. Very quickly (literally within 2-3 days) the serous form becomes infiltrative. The general condition worsens, the body temperature rises, a solid area (infiltrate) is felt under the altered area of ​​the mammary gland, at the same time, the lymph nodes in the armpits increase. The stage develops within 5-10 days, after which it turns into a purulent one.

Purulent mastitis. This advanced stage is characterized by the following condition: fever, body temperature above 39 degrees, lymph nodes in the armpits continue to increase, become painful (regional lymphadenitis). Depending on the localization of the process, the shape of the affected mammary gland changes, palpation is painful.

Purulent mastitis, in turn, has several forms:

• infiltrative-purulent (without the formation of an abscess on an isolated rounded infiltrate);
• abscessing (characterized by an extensive purulent lesion of the mammary gland and a severe course);
• gangrenous (the most severe form of the disease, it also has signs of general intoxication, such as dehydration, tachycardia , hyperthermia).

Treatment

Whatever the stage of the disease during the period of illness (and especially with purulent mastitis), breastfeeding of the child is prohibited. Whether the mother will return to him after a course of treatment always depends on the outcome of the disease in each specific case and only after an appropriate bacteriological examination of the milk. Therefore, an important component mastitis treatment- this is inhibition and suppression of the lactation process, for which special preparations are used.

The main course of treatment includes complex antibiotic therapy aimed at the destruction of the causative agent of the disease. To find out the pathogen, milk is cultured from the affected and healthy mammary glands on the flora. Based on the data obtained, one or another antibiotic is prescribed.

Measures are also taken to reduce lactostasis in the affected breast. Physiotherapy is also used: ultrasound, UV rays.

With purulent mastitis, surgical treatment is necessarily indicated: opening the purulent focus, followed by removal of pus and necrotic tissues.

The causative agent of mastitis The most common microbe is Staphylococcus aureus, which is characterized by high virulence and resistance to many antibacterial drugs. Much less often, the causative agents of the disease can also be some types of streptococci, E. coli, Proteus, fungi as part of a mixed infection.

postpartum mastitis- This is an inflammation of the breast tissue that occurred in the postpartum period against the background of lactation. Risk factors for postpartum mastitis are: poor personal hygiene; the presence of concomitant diseases (pyoderma of the skin, impaired fat metabolism, diabetes); reduced immunological reactivity of the organism; complicated course of childbirth; complicated course of the postpartum period (wound infection, delayed involution of the uterus, thrombophlebitis); insufficiency of the milk ducts in the mammary gland; anomalies in the development of the nipples; cracked nipples; improper expression of milk.

The source of infection is carriers of pathogens of infectious diseases and patients with erased forms of pathology of a purulent-inflammatory nature from among those around them, since the listed pathogens spread through care items, underwear, etc. An important role in the occurrence of mastitis belongs to nosocomial infection.

The entry gate for infection is most often cracked nipples. The spread of infectious agents occurs intracanalicularly during breastfeeding and decanting milk, as well as hematogenous and lymphogenous routes from endogenous foci of inflammation.

Features of the structure of the mammary gland, namely its lobulation, an abundance of fatty tissue, a large number of alveoli, sinuses, a wide network of milk ducts and lymphatic vessels create good conditions to spread the inflammatory process to neighboring areas.

In the vast majority of cases, mastitis is preceded by lactostasis (milk stasis), which is the main trigger in the development of the inflammatory process in the mammary gland. In the presence of infectious agents, the milk in the milk ducts coagulates, swelling of the walls of the ducts is observed, which further contributes to the stagnation of milk. At the same time, microorganisms, getting into the breast tissue, cause the development of mastitis.

According to the nature of the course, acute and chronic postpartum mastitis are distinguished. Depending on the characteristics of the inflammatory process, mastitis can be serous (beginning), infiltrative and purulent. Depending on the location of the focus of inflammation, mastitis can be subcutaneous, subareolar, intramammary, retromammary and total, when all parts of the mammary gland are affected.

Features clinical course mastitis are: late onset (up to 1 month after delivery or more); an increase in the number of patients with erased forms of mastitis, in which clinical manifestations diseases do not correspond to the true severity of the process; the predominance of the infiltrative-purulent form of mastitis; protracted and prolonged course of purulent forms of the disease.

lactostasis(milk stagnation), caused by blockage of the excretory ducts, primarily contributes to the development of the inflammatory process in the mammary gland. In this regard, mastitis in the vast majority of cases occurs in primiparas. With lactostasis, the mammary gland increases in volume, its dense enlarged lobules are determined. Body temperature can rise up to 38-40°C. This is due to damage to the milk ducts and the absorption of milk. There is no redness of the skin and swelling of the gland tissue, which usually appear with inflammation. After decanting the mammary gland with lactostasis, the pain disappears, are determined small size painless lobules with clear contours, body temperature decreases. In the case of mastitis that has already developed against the background of lactostasis, after decanting, a dense painful infiltrate continues to be determined in the mammary gland tissues, a high body temperature persists, and the patient's state of health does not improve. If lactostasis is not eliminated within 3–4 days, then mastitis occurs, since with lactostasis the number of microbial cells in the milk ducts increases several times and, as a result, there is a real threat of rapid progression of inflammation.

Serous mastitis. The disease begins acutely, at 2-3-4 weeks of the postpartum period and, as a rule, after the discharge of the puerperal from the maternity hospital. Body temperature rises to 38-390 C, accompanied by chills. Symptoms of intoxication appear (general weakness, fatigue, headache). The patient is disturbed first by a feeling of heaviness, and then by pain in the mammary gland, which is accompanied by stagnation of milk. The mammary gland slightly increases in volume, its skin is hyperemic. Expressing milk is painful and does not bring relief. In the affected mammary gland, soreness and moderate infiltration without clear boundaries are revealed. With inadequate treatment and progression of the inflammatory process, serous mastitis becomes infiltrative within 2-3 days.

Infiltrative mastitis. The patient is disturbed by severe chills, a feeling of tension and pain in the mammary gland, headache, insomnia, weakness, loss of appetite. In the mammary gland, a sharply painful infiltrate without softening foci is determined. The gland is enlarged, with reddened skin above it. There is an increase and soreness of the axillary lymph nodes. In a clinical blood test, an increase in the number of leukocytes and ESR is observed. With ineffective or untimely treatment, after 3-4 days from the onset of the disease, the inflammatory process becomes purulent.

Purulent mastitis. The condition of patients worsens significantly: weakness increases, appetite decreases, sleep is disturbed. Body temperature is often in the range of 38-40°C. Chills, sweating appear, pallor of the skin is noted. Increased pain in the mammary gland, which is tense, enlarged, marked swelling and redness of the skin of the mammary gland. A painful infiltrate is determined in the breast tissue. Milk is expressed with difficulty, in small portions, often pus is found in it.

Abscessing form of mastitis. The predominant options are furunculosis and halo abscess, less common are intramammary and retromammary abscesses, which are purulent cavities limited by a connective tissue capsule. In the clinical analysis of blood, there is an increase in the number of leukocytes and ESR, there is moderate anemia.

Phlegmonous form of mastitis. The process captures most of the gland with the melting of its tissue and the transition to the surrounding fiber and skin. General state puerperas in such cases severe. The temperature reaches 400 C. There are chills and severe intoxication. The mammary gland sharply increases in volume, its skin is edematous, reddened, with areas of cyanosis. There is a sharp expansion of the subcutaneous venous network. The mammary gland is pasty, sharply painful. In a clinical blood test, there is an increase in the number of leukocytes and ESR, increasing anemia, a stab shift in the leukocyte formula. Phlegmonous mastitis may be accompanied by septic shock.

Gangrenous form of mastitis. It proceeds especially hard with severe intoxication and necrosis of the mammary gland. The general condition of the patient is severe, the skin is pale, the mucous membranes are dry. The patient complains of lack of appetite, headache, insomnia. The body temperature reaches 40 C, the pulse is rapid (110-120 beats / min), weak filling. The mammary gland is enlarged, painful, swollen; the skin above it is from pale green to bluish-purple, in some places with areas of necrosis and blistering, the nipple is retracted, there is no milk. Regional lymph nodes are enlarged and painful on palpation. In a clinical blood test, there is a pronounced increase in leukocytes and ESR, toxic granularity of neutrophils and a decrease in hemoglobin are noted. With severe symptoms of inflammation, the diagnosis of mastitis does not cause difficulties and, first of all, is based on the characteristic complaints of the patient and the results of an objective examination with an assessment of the clinical picture. Underestimation of the symptoms characteristic of a purulent process leads to unreasonably long conservative treatment of this form of mastitis. As a result of irrational antibiotic therapy with abscessing or infiltrative-abscessing mastitis, there is a real danger of developing an erased form of the disease, when the clinical manifestations do not correspond to the true severity of the inflammatory process.

With infiltrative-abscess mastitis, which occurs in more than half of the cases, the infiltrate consists of many small purulent cavities. In this regard, with a diagnostic puncture of the infiltrate, it is rarely possible to obtain pus. The diagnostic value of the puncture increases significantly with the erased form of abscessing mastitis.

As additional studies, a clinical blood test, echography (ultrasound) of the mammary glands are carried out. Ultrasound usually reveals a homogeneous mass of infiltrate in a specific area of ​​the breast being examined. When forming purulent mastitis a rarefaction center appears, around which the shadow of the infiltrate intensifies. Subsequently, a cavity with jagged edges and bridges is revealed at this place.

Before the start of treatment, during and after the end of antibiotic therapy, it is necessary to carry out bacteriological examination milk and discharge from the mammary gland with the determination of the sensitivity of the isolated microflora to antibiotics. Treatment is carried out taking into account the form of mastitis. Holding only conservative therapy possible in the presence of lactostasis, serous and infiltrative mastitis.

If the duration of the disease is more than 3 days, conservative treatment is possible only under the following conditions: satisfactory condition of the patient; normal temperature body; the infiltrate occupies no more than one quadrant of the gland; local signs of purulent inflammation are absent; the results of the puncture of the infiltrate are negative; indicators of the general analysis of blood are not changed. In the absence of positive dynamics of the process for no more than 3 days from the start of treatment, an operation with excision of the infiltrate is indicated.

With lactostasis, pumping milk is mandatory (it is possible to use a breast pump). Before pumping, it is advisable to perform a retromammary novocaine blockade, followed by the introduction of 2 ml of noshpa (for 20 minutes) and 1 ml of oxytocin (for 1–2 minutes) intramuscularly. If there is only lactostasis, then after emptying the mammary gland, the condition of the patients improves significantly. In the presence of purulent mastitis, signs of severe inflammation and infiltration after pumping persist.

As part of the treatment of serous mastitis, it is mandatory to express the mammary glands every 3 hours. Noshpa and oxytocin injections are used to improve the outflow of milk and optimize the function of the mammary glands.

When serous mastitis passes into an infiltrative form, it is recommended suppression of lactation. Similar measures are also taken in cases where:

• a rapidly progressing process, despite ongoing intensive therapy;
• purulent mastitis with a tendency to form new lesions after surgery;
• sluggish, therapy-resistant purulent mastitis (after surgical treatment);
• multifocal infiltrative-purulent and abscessing mastitis;
• phlegmonous and gangrenous mastitis;
• mastitis against the background of serious extragenital and obstetric pathology (heart defects, severe forms of preeclampsia, hemorrhagic and septic shock);
• any form of mastitis with a recurrent course.

It is possible to stop lactation with mastitis only after the elimination of lactostasis. Termination of lactation by tight bandaging of the mammary glands is dangerous due to the fact that milk production continues for some time, which again leads to lactostasis, and impaired blood circulation in the mammary gland contributes to the development of severe forms of mastitis.

Currently, to suppress lactation, they use:

• parlodel (bromocriptine) 1 tablet (2.5 mg) 2 times a day for 14 days;
• dostinex 1/2 tablet (0.25 mg) 2 times a day for 2 days.

In addition, in the treatment of serous and infiltrative forms of lactation mastitis, oil-ointment compresses are also prescribed (with vaseline or camphor oil, butadione ointment, Vishnevsky ointment), half-alcohol compresses 1 time per day.

With positive dynamics of the disease, one day after the start of conservative therapy, physiotherapeutic procedures are prescribed (microwave therapy of the decimeter and centimeter range; ultrasound, ultraviolet radiation). The most important component of the complex therapy of lactational mastitis is the use of antibiotics, which are administered intramuscularly or intravenously. To increase the body's defenses, drugs that have an immunostimulating effect are used. The complex of therapeutic measures includes desensitizing antihistamine therapy.

In the treatment of purulent mastitis, the leading place is occupied by surgical intervention. Timely opening of the abscess prevents the spread of the process and its generalization. The operation for purulent lactational mastitis is performed under general anesthesia. When choosing access to a purulent focus, one should take into account the localization and prevalence of the process, anatomical and functional features of the mammary gland. The incisions are made in the radial direction along the course of the excretory ducts, without affecting the nipple and areola. With multiple abscesses, you have to resort to several incisions. During the operation, pus and damaged necrotic tissues are removed. The cavity is washed with antiseptic solutions. Next, a drainage-flushing system is applied for constant drip irrigation of the remaining purulent cavity with antiseptics and outflow of the flushing fluid. The lavage system is removed from the wound not earlier than 5 days after the operation when the inflammatory process disappears, there is no pus, fibrin and necrotic tissues in the lavage fluid, and the volume of the cavity decreases. The sutures are removed on the 8-9th day. An indispensable condition for treatment is the suppression of lactation.

Along with surgery, continue complex therapy, the intensity of which depends on the clinical form of mastitis, the nature of the infection and the condition of the patient. Due to the fact that with purulent mastitis, a mixed infection is most often detected (associations of gram-positive and gram-negative microorganisms, anaerobic flora), combinations of antibiotics are used for treatment.

In the complex of therapeutic measures, infusion-transfusion and detoxification therapy are necessarily used. Integral components of the treatment of purulent lactational mastitis are also desensitizing and antianemic therapy, the appointment of vitamins, and physiotherapy.

All mothers and grandmothers repeatedly warn their child to carefully monitor their breasts during lactation: do not walk with an open neckline, do not be in the wind, etc. In fact, the causes of the disease lie in slightly different things. And the main symptom is pain in the mammary gland and fever. How to protect yourself from pathology and how to prevent mastitis after childbirth in "critical periods"?

Read in this article

Reasons for the appearance

Mastitis is an inflammation of the breast tissue. In order for a disease to appear, a combination of two conditions is necessary:

• stasis of milk in the breast,
• the presence of the infectious agent in the tissues.

milk stasis

The main factor for provoking milk stasis is poor pumping or improper feeding.

Ideally, a woman should feed at the request of the baby, then the amount of milk produced will meet the needs, lactostasis does not occur. If a young mother practices pumping, then the likelihood of milk stagnation in some slice increases. Deep tissues are especially affected, where mastitis most often occurs.

Also, stagnation of milk can provoke the wearing of uncomfortable, oversized underwear. Therefore, the choice should be approached carefully, and it is better to spend a night's rest without it at all.

Previously transferred can lead to lactostasis inflammatory diseases mammary glands, including mastitis. As well as cases when any surgical interventions were performed on the organ, for example, for fibroids. Injuries and bruises of the mammary glands, both in history and during lactation, can cause duct obstruction.

Milk stagnation can be provoked by constant preferential feeding from one breast, while in the second it will accumulate.

It should be noted that often mastitis develops on the 3rd - 5th day, which is associated with the active arrival of milk. Therefore, it is extremely important to know how to properly feed the baby and monitor the breast.

Sometimes a clear provoking factor is difficult to find, but it can always be determined if you analyze the situation more carefully.

The presence of a pathogen in the tissues of the mammary glands

If there is no stagnation of milk, then pathogenic microorganisms will not have time to create the necessary conditions for their reproduction, the secret will simply come out of the ducts. Under conditions, bacteria begin to change the properties of surrounding tissues and fluids to suit their needs, thereby creating comfortable conditions for increasing their number.

Where do pathogens come from? breast milk? There are several options:

The fact is that a woman after childbirth always has reduced body defenses. This is due to psycho-emotional experiences, stress, night sleep deprivation, blood loss, etc. Therefore, even a minor infection, which under normal conditions would hardly have caused mastitis, begins to actively manifest itself.

Watch the video about mastitis after childbirth:

Symptoms of pathology

Almost always, a woman independently draws attention to the fact that some changes have occurred in her breasts, if she is attentive to herself. She will also detect the first symptoms of lactostasis, but she does not always know that it is dangerous.

Before the onset of mastitis, milk stagnation always appears, which also manifests itself clinically. The symptoms are as follows:

• feeling of pain and heaviness in the chest;
• a compacted lobule is clearly defined, sensitive to palpation;
• the skin above its surface is not changed, normal color and temperature to the touch;
• body temperature and general well-being is good.

Moreover, if a woman tries to give the baby exactly the breast with suspected lactostasis, after feeding she will notice a significant improvement in her condition. And soon it will pass.

If the stage of milk stagnation was not noticed, then clinical picture brighter, and corresponds to the stage of the disease. Short description can be presented in the following form:

Most often you have to deal with lactostasis, infiltrative, abscessing stages. This is only due to the fact that the treatment of mastitis after childbirth in most cases is timely and qualified.

Phlegmonous and gangrenous - the most severe, serious complications and deaths are not excluded

What is forbidden to do if mastitis is suspected

Often, women, having noticed signs of lactostasis and mastitis, begin to use all the methods they are familiar with to treat the condition, without delving into the essence of the methods. It is better to consult a doctor in time, who will prescribe the most effective and effective therapy in this situation. Self-medication sometimes leads to disastrous consequences. The main mistakes with milk stagnation and mastitis that should not be done:

• Excessive and painful pumping. This leads to additional trauma without solving the main problem.
• You should not limit the number of attachments to the breast because of fear of harming the baby or because of pain. On the contrary, the more often a woman will feed the baby (if he does not refuse, of course), the less likely the disease will progress. Adults should not try to suck milk either, this will only lead to injury to the nipple.
• Warming up or prolonged compresses, especially with various alcohol-containing solutions, can contribute to the rapid progression of the disease.
• Also, do not take milk-reducing pills or antibiotics on your own.

Mastitis treatment

The most reliable way to treat mastitis after childbirth in a particular situation can only be said by a doctor after examination and examination.

Therapy for lactostasis includes the following:

• It is necessary to apply the baby as often as possible so that he helps to eliminate the stagnation of milk. If possible, you can use the services of an experienced midwife for pumping.
• A warm (not hot) shower and antispasmodics the day before will help the ducts expand somewhat, this will improve the outflow.

If symptoms worsen or do not improve within one to two days, seek medical advice. medical care.

Medicines for treatment

To stop the progression of mastitis or promote healing after surgery, two conditions must be met - to eliminate milk stagnation and to reduce the number of microbes to a harmless concentration.

It should immediately be said that the stage of abscess, gangrene and phlegmon requires urgent surgical intervention. This creates conditions for the outflow of inflammatory exudate, as a rule, it is pus. Then the therapy regimen includes all those drugs that are initially used in the infiltrative stage. These include the following medications:

• Antibacterial drugs. They should be prescribed taking into account whether the woman is currently breastfeeding or not (possibly only in the infiltrative stage). Most often, these are cephalosporins, metronidazole and some other drugs.
• Analgesics, antispasmodics, non-steroidal anti-inflammatory drugs help to return the "perception of the world" - to relieve the symptoms of intoxication and pain.
• Drugs to suppress lactation are appointed only in the case when it is not possible to cope with the pathology in a different way. These are bromocriptine, parlodel and others.
• Oxytocin, it helps to reduce the ducts of the mammary gland. This greatly improves the overall well-being of women.

Folk methods

Alternative medicine methods should be used only as prescribed by a doctor. Only treatment folk ways is unlikely to help cope with the disease, but in combination with the main therapy - this is a useful help. The most effective include the following:

• Application of cold or after exposure to hot water cabbage leaf. Peculiar compresses should be done for several hours, optimally at night.
• The leaves of the coltsfoot, after treatment with boiling water, must be applied to the painful area of ​​\u200b\u200bthe chest for 20-30 minutes several times a day.
• You can also make a lotion from alder leaves and mint. Pre-dried and crushed leaves should be soaked in water and applied to the sore spot in gauze.

Prevention of mastitis

Like any other disease, mastitis is easier to prevent than to treat. Therefore, every woman should know the basic recommendations for breastfeeding. The rules for avoiding mastitis after childbirth include:

• You need to learn how to properly attach the baby to the chest. This will help to maximally and evenly free the lobules from milk, and will also prevent nipple cracks.
• In the event of the appearance of wounds on the areola, they should be carefully monitored and treated. Ointments with a healing effect, for example, "Bipanten" and the like, help.
• You should choose the right underwear for lactation, preferably special for comfortable and unhindered feeding.
• It is better to express milk only in case of emergency, and not constantly.
• Before feeding, it is useful to gently stroke the breast from the periphery to the center, facilitating the flow of milk from distant lobules.
• You should not squeeze the mammary glands, for example, while sleeping on your stomach. This will cause compression of the ducts and stagnation of milk.
• It is necessary to be protected from injuries, excessive hypothermia, drafts.
• Observe hygiene, including the mammary glands. To do this, it is quite enough to take a shower and change clothes once or twice a day.
• It is useful to take courses or consultation with an experienced midwife even before childbirth.

Mastitis is a serious pathology, which in 90% of cases is associated with the postpartum period and breastfeeding. In many ways, the development of the disease depends on the woman, so every mother should know the basic rules for the prevention of pathology. The most efficient and safe treatment a specialist can appoint, therefore, if complaints arise, you should immediately contact him. Self-medication can aggravate the disease and lead to the need for surgery.

Mastitis is an inflammatory process in the tissues and areas of the mammary gland, in which purulent contents may appear and there is a threat to breastfeeding. This disease is one of the most common complications in the postpartum period.

The frequent development of mastitis in lactating women contributes to an increase in the number of types of pathogens, as well as their resistance to the effects of antibacterial drugs.

Causes of mastitis:

The causative agents of the disease are always microorganisms or their complexes. Common causes of mastitis after childbirth are:

Staphylococci;

Streptococci;

E. Coli - Escherichia coli.

Microorganisms penetrate into all parts of the mammary gland in a variety of ways.

What is the source of infection?:

The causative agent of the disease enters the body of a nursing mother in various ways. The most common are the following:

Carriers of bacterial infections;

Patients with asymptomatic forms of various inflammatory infections;

Household items, including linen, with which infected people have come into contact;

infection in the hospital. This mastitis is a type of common nosocomial infection.

Ways of entry of pathogens:

The most common portals of entry for pathogens in breastfeeding women are:

Cracks in the nipples. Through them, microbes penetrate from the surface of the skin of the chest, as well as the baby's oral cavity;

Foci of infection inside the female body, from where pathogens are delivered through the blood and lymphatic vessels to the tissues of the mammary glands. These are the rarer routes of infection.

Manifestations of postpartum mastitis:

In almost all cases, the disease begins with milk stagnation - lactostasis, the causes of which are:

Underdeveloped milk ducts of women for whom childbirth was the first;

Violations of the formation of the nipples;

Deviations in the work of the mammary glands.

The picture of the disease depends on whether there is purulent content in the glands, and whether therapy is started in a timely manner.

Symptoms of serous mastitis

This is the most common and least dangerous form of mastitis. With proper assistance, the functioning of the mammary glands can be fully restored. The main manifestations are as follows:

Acute onset 2-3 weeks after birth;
The temperature rises sharply to 39⁰С;
Fever;
Apathy, loss of strength;
Pain in the affected mammary gland;
The gland is slightly enlarged;
Headaches.

Symptoms of infiltrative mastitis

If the wrong therapy was carried out, then the disease after a while passes into an infiltrative form. The main signs are as follows:

Severe chills;
The appearance of painful compacted areas in the affected gland;
A significant increase in painful breast size;
Redness of the skin over the inflamed gland;
A strong increase in ESR and the number of leukocytes in the blood;
Pain in the chest intensifies;
Headaches;
sleep disorders;
Strong apathy, loss of strength and energy;
Lack of appetite;
Lymph nodes located in the armpit are inflamed, enlarged and quite painful.

Symptoms of abscessing mastitis

With the ineffectiveness of therapy, the disease does not stop, but develops further and passes into the next form - abscessing. Main symptoms:

Further increase in ESR and the number of leukocytes;
Decreased hemoglobin level to 80 g/l;
Increased fever;
Redness of the skin over the affected gland;
The veins in the region of the gland are dilated;
Lymph nodes in the armpits are inflamed and quite painful;
There is the formation of purulent foci in the cavities and tissues of the chest.

Symptoms of phlegmonous mastitis

The next form of the disease according to the severity of the condition is phlegmonous (purulent). Characteristic features are:

The woman's condition becomes much worse;
severe fever;
Intoxication of the body;
Dry tongue and lips;
sleep disorders;
Headaches;
The affected gland is enlarged;
Probing seals in the gland;
Redness of the skin located above the inflamed gland;
Areas of cyanosis on the skin that have a bluish tint;
Strong expansion of the veins in the chest;
Inflammation of the lymph nodes outside the affected area - lymphadenitis;
In the mammary gland there are seals and purulent foci;
Increase in the number of leukocytes and ESR;
Decrease in hemoglobin to 70 g/l.

Symptoms of gangrenous mastitis

The last stage of the disease with the ineffectiveness of treatment at the previous stages - gangrenous - is characterized by such manifestations:

Extremely serious condition of a woman;
The temperature is raised to 40⁰С;
Pulse 120 beats per minute;
pale skin;
Very dry tongue and surface of the lips (severe cracks form);
Greatest apathy and prostration;
Headache;
sleep disorders;
There is no desire and strength to eat food;
The affected breast greatly increases in size;
Soreness and swelling on the side of the affected chest;
The surface of the chest is painted in shades from pale green to purple-cyanotic;
Foci of blisters and dead parts on the surface of the affected skin;
Nipple retracted;
Lack of lactation both in the diseased gland and in the healthy one;
Enlarged lymph nodes throughout the body, soreness;
Further increase in ESR and white blood cell count;
Decreased hemoglobin level to 40 g / l, which is accompanied by symptoms of severe anemia.

How is the disease diagnosed?

The main ways to diagnose the disease are as follows:

Analysis of complaints of a nursing woman;
General analysis blood;
Bacteriological analysis of purulent contents and milk;
Ultrasound procedure mammary glands;
Controlling a woman's body temperature.

Treatment of postpartum mastitis:

Methods of treatment of the disease completely depend on its form. Main rule: timely treatment is the only way to avoid complications and keep the baby breastfeeding!

Mastitis, which is not accompanied by the presence of a purulent infiltrate, is treated with medication and non-drug methods.

Non-drug methods of treating mastitis without purulent contents

Providing rest to the gland when milk stagnation is detected;
Wearing a quality supportive bra. It is important that it does not squeeze and deform the chest;
Use of a breast pump to improve the outflow of milk and empty the breast;
Temporary cessation of breastfeeding if necessary medicines or often putting the baby to the breast if there is no need for medicines;
Heat on the chest area. A warm shower on the breast area is very effective;
Breast massage;
Physical methods of treatment - ultraviolet irradiation and other thermal methods.

Medical methods for the treatment of mastitis without purulent contents

Oxytocin intramuscularly;
No-shpa intramuscularly 30 minutes before the introduction of Oxytocin;
Antibacterial drugs are the basis of the treatment of the disease. They are selected depending on the sensitivity of the pathogen;
The introduction of drugs that increase the body's immune response in response to exposure to pathogens - Antistaphylococcal γ-globulin, Antistaphylococcal plasma;
antiallergic agents;
Means that restore the intestinal microflora. They are used simultaneously with the use of antibiotics.

Treatment of a purulent form of mastitis

The main method of treatment is surgery. The operation is performed in the hospital department. It is carried out by opening purulent foci against the background of exclusion of damage to the milk ducts.

Effective compresses using Vaseline or camphor oils, liniment according to Vishnevsky.
For small suppurations, the suction of pus with a syringe is used, followed by the introduction of an antibiotic into the resulting cavity.

Cessation of lactation is an extreme measure!:

The development of the disease during breastfeeding threatens the normal production of milk. Therefore, it is very important to monitor the breasts of a nursing woman and not let the infection become an obstacle to a healthy diet for the crumbs!

Unfortunately, in severe advanced forms of mastitis, it is necessary not only to use surgical measures of assistance, but also to completely stop lactation without the possibility of its further recovery. Absolute indications for this are:

1. Transition within three days from serous mastitis to infiltrative on the background of normal therapy;
2. Resumption of the purulent form of the disease after surgery with the threat of the formation of new inflamed foci and suppuration;
3. Long-term mastitis;
4. A disease that is not amenable to therapy and recurring even after surgery;
5. Phlegmonous and gangrenous forms of the disease;
6. postpartum mastitis in combination with other serious diseases.

In order to suppress lactation, the following drugs are used:

Bromocriptine, Parlodel;
Dostinex;
Diuretic drugs that enhance the suppression of milk production - Hypothiazid, Uregit;
Camphor in the form of compresses on the chest.

Measures to prevent postpartum mastitis:

1. Compliance with all hygiene standards in the departments of the hospital where there are nursing women;
2. Taking a hygienic shower;
3. Daily change of underwear;
4. Physical exercise;
5. Rinsing with soap of the breast before each feeding of the baby;
6. Mandatory washing and disinfection of hands;
7. Air baths for the breast for 15 minutes after feeding the baby;
8. Using the right supportive bra;
9. Teaching women in labor the correct principles of breastfeeding;
10. Treatment and prevention of cracked nipples. If cracks have formed, it is recommended to use special silicone or latex pads for feeding, as well as the use of healing and softening creams and ointments (Weleda cream for nipple cracks);
11. Prevention and treatment of milk stagnation and lactostasis;
12. Carrying out preventive massage;
13. Exclusion of hypothermia of the mammary glands in lactating women;
14. Mastering the skills of self-control, self-massage and breast self-examination.

Every breastfeeding woman should know the most important measures to prevent mastitis, as well as seek medical help in a timely manner if at least a few symptoms are detected.

Remember, postpartum mastitis is a direct threat to breastfeeding!