BREAST COMPLICATIONS IN

PUERPERIUM
 It includes
Breast engorgement
Cracked and retracted nipple
Mastitis
Breast Abscess
BREAST ENGORGEMENT
 Breastengorgement
is due to exaggerated
normal venous and
lymphatic
engorgement of the
breast which precede
lactation. This in turn
prevents escape of
milk from the lacteal
system.
 SYMPTOMS
 Firm, tender or painful breasts
 The areola may be hard and the
nipple may be flattened-out.
 Swelling and tenderness may extend
up into the axillary area.
 The skin may be taut, shiny and feel
warm to the touch
 Generalized malaise
 Transient rise of temperature.
 PREVENTION
Initiate breast feeding early and
unrestricted
Exclusive breast feeding on
demand
Feeding in correct position
Avoid early use of prelacteal feeds,
bottles and pacifiers while baby is
learning to breastfeed
Allow baby to start and end the
Gently massage and compress the
breast when baby pauses between
sucks. This helps to drain the
breast, leaving less milk behind.
If a feeding is missed or if baby is
not nursing well, use hand
expression or a breast pump to
remove the milk.
Always wean gradually.
MANAGEMENT
 Before breastfeeding
 Ibuprofen 200 mg-1 tablet every 3
hours for pain.
 For comfort, the mother can apply
warmth or cold to her breasts
 Gentle breast massage may help
improve milk flow and reduce
engorgement
 Pumping once to completely soften
the breasts can resolve
engorgement for some women.
 While breastfeeding
• Gently massage and compress the
breast when baby pauses between
sucks. This can help drain the breast,
leaving less milk behind.
 Between feeds
• If breasts are uncomfortably full,
express a little milk. Avoid over-
stimulating. Use manual expression or
a quality breast pump on a low setting.
• A well-fitted, supportive nursing bra
 MASTITIS

Acute infection of
the breast.
Invasion of breast
tissue by an
infectious organism
 Infection
Infection involves breast
parenchymal tissues leading to
cellulitis.
Usually the infection gain
access through lactiferous duct
If not treated properly it can
lead to breast abscess
 SYMPTOMS
 Generalized malaise  Overlying skin become
and headache red, hot, flushed &
 Fever with chills tender
 Severe pain,  Commonly affects upper
tenderness and outer quadrant which
swelling on the breast may affect one or both
resembling shape of a breast. I t is almost
wedge with apex at always unilateral.
nipple
 MANAGEMENT
 Breast support and Plenty of fluids
 Continue Breast feeding with good
attachment as this prevents proliferation
of staphylococcus in the stagnant milk
 Manual emptying of infected breast
 Flucoxacillin 500mg 6th hourly or
erythromycin and this is continued for
atleast 7 days
 Analgesics for pain
PREVENTION
 Metriculous hand washing before each feed
 Cleaning the nipple before and after each feed
 Early and frequent feeding
 Proper positioning of baby on breast
 Good support of breast without constriction
 Cleansing with water only and no drying
agents
 Daily observation of baby for skin and cord
infection
 Avoid close contact with a known
staphylococcal infection
BREAST ABCESS SYMPTOMS
 Purulent nipple discharge
 Brawny edema of overlying skin

 Flushed breast not responding

to antibiotics properly
 Marked tenderness with
fluctuation
 Swinging temperature
 MANAGEMENT
 Incision and drainage under GA by a deep
radical incision extending from near the
areolar margin to prevent injury of the
lactiferous ducts.
 Serial percutaneous needle aspiration
under USG guidance.
 Continue breast feeding on the uninvolved
breast. Infected breast to be mechanically
pumped every 2 hrs and with every let
down
CRACKED NIPPLE
The nipple becomes
painful due to loss
of surface
epithelium or due
to a fissure situated
either at the tip or
base of the nipple.
 Causes
• Unclean hygiene resulting in
formation of crust over nipple
• Retracted nipple
• Trauma from baby’s mouth due to
incorrect attachment to breast
 TREATMENT
 Correct attachment to breast.
 Fresh human milk
 Purified lanonin with the mothers milk is
applied 3 to 4 times a day
 Use breast pump
 Miconazole lotion for oral thrush.
 Nipple shields
 The persistence of nipple ulcer in spite of
above therapy needs biopsy to exclude
malignancy.
RETRACTED AND FLAT
NIPPLE

Treatment
Oil massaging
Expressed
breast feeding
 Reference
 Dutta D C. text book of obstetrics. Sixth edition.
Kolkata: New central book agency; 2006
 Novak C J, Broom L B. Maternal and child health
nursing. Ninth edition. Missouri. Mosby; 1999
 Varney H, Kriebs JM , Gregor CL. Varneys
textbook of midwifery . 4th edition. New Delhi:
Elsevier; 2005
 Fraser DM, Cooper MA. Myles textbook for
midwives. 14th edition. London: Churchill
Livingstone; 2003