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Postpartum breast inflammation

24-08-2019,
doctor. Paulina Raczyńska

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Postpartum breast inflammation

PantherMedia

Mother breastfeeding a newborn baby

Postpartum breast inflammation, as the name suggests, is an inflammation of the breast gland that occurs during the postpartum period. It is rare, occurring in about 1% of postpartum women. Occasionally in those who are not breastfeeding.

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The causative agent in more than 90% of cases ishaemolytic staphylococcusaureus, less commonly streptococci and Escherichia coli. The route of infection is most often the nasopharyngeal cavity of the healthcare personnel and the mother, through the nasopharyngeal cavity of the newborn to the papilla of the mother's mammary gland. This means that the development of infection or colonisation of the breast with the pathogen occurs during breastfeeding. The development of inflammation is favoured by any damage to the gland (abrasions of the epidermis, fissures, cracks, wounds or striae). These are the gateways to infection, through which microorganisms enter via the lymphatic route, spreading along the connective tissue and between the glandular tissue. If the infection spreads under the skin of the wart, a subungual abscess will form. If, on the other hand, the infection spreads throughout the connective tissue of the breast, extending all the way to the fascia, a subpectoral or breast abscess will form. Initially, the infection usually affects one breast, usually the outer quadrant. It is important to remember that milk is a great breeding ground for microorganisms, so stagnant breast milk can also promote the development of infection.

Among the most common symptoms of mastitis are:

  • pain: initially slight, increasing as the infection develops, localised and limited,
  • fever: often the first and sometimes the only symptom, usually preceded by pain,
  • redness: very often associated with lymphadenitis, usually appears 12-14 hours after the onset of fever and pain, almost always accompanied by tissue warming and severe pain on palpation,
  • pyoderma: a complication of inadequate or late treatment, it is an organised, demarcated and chelated infiltration 2-3 cm in diameter, causing severe pain on palpation.

Treatment in the early phase begins with the administration of low doses of prolactin inhibiting drugs. This is to reduce the secretion of food, which, as we already know, is a breeding ground for bacteria. Within 24-48 hours of such treatment, the fever should disappear. It is not usually necessary to implement further treatment. However, it is important to ensure that the breasts are completely emptied during this period. This treatment guarantees that lactation is maintained and that breastfeeding can continue. If, on the other hand, there is no clinical improvement after the implemented treatment, a 3- to 4-day antibiotic treatment should be applied. In extreme cases, only if an organised, chelating abscess has already formed, can the abscess be surgically punctured or incised. Opinions are divided on feeding during postpartum breast inflammation. While it may be considered in milder cases, it should be contraindicated once an abscess has developed.