Puerperal mastitis is an inflammatory process of infectious origin, which affects the breast during lactation or following its suspension. Although it affects a significant percentage of nurses (up to 10%), mastitis can first be prevented, but also cured without the need to suspend breastfeeding.
Causes
Puerperal mastitis is caused by the entry of germs into the galactophore ducts, small ducts that drain the milk up to the nipple. In addition to their natural dilation due to breastfeeding, the entry of pathogens is favored by poor local hygiene and skin lesions caused by the newborn during an incorrect attachment to the breast (nipple fissures). Even the mammary engorgement can favor the onset of mastitis, since breast milk is an excellent breeding ground for bacteria.
The etiological agents most commonly implicated in the development of puerperal mastitis are staphylococci, in particular staphylococcus aureus.
Mastitis is more frequent in primiparae, probably due to inexperience in the management of the aforementioned risk factors, and in women who suspend breastfeeding.
Very rare are the puerperal mastitis of hematogenous or lymphatic origin.
Symptoms
To learn more: Mastitis symptoms
The mastitis symptomatology is very similar to that of the mammary engorgement. However, breast pain and general malaise, both of greater magnitude, are accompanied by a significant fever (> 1 ° C), which is instead absent in the simple obstruction of one or more ducts. Similar flu-like symptoms are also typical of mastitis, while on physical examination part of the breast appears swollen, reddened and rather painful on palpation and suction.
Prevention
To reduce the possibility of infecting the galactophore ducts, it is essential:
- pay particular attention to breast hygiene during pregnancy.
- The mother must wash her breast before and after each feeding; thorough hygiene with water is sufficient, whereas soaps, ointments, ointments and cleaning and antiseptic solutions are generally not recommended. These substances, in fact, could irritate the skin and give the nipple an unpleasant smell and taste. On sale there are special tissues for cleansing breasts during breastfeeding, obviously without surfactants, perfumes or substances that need rinsing. The hands, of course, will have to be washed carefully before starting breastfeeding, while the same care in compliance with the basic hygiene rules will also have to be placed in the replacement of the linen.
- Properly attach the baby to the breast, in order to prevent the appearance of fissures and irritations, while stimulating lactation (see dedicated article).
- Prevent breast engorgement (see dedicated article).
Treatment
To learn more: Medicines for the treatment of Mastitis
Mastitis is a complication that must be taken seriously, since the affected part of the breast could suppurate (abscess).
Normally, mastitis is not a reason to stop breastfeeding, since the pathogens involved are completely harmless to the health of the newborn. Rather, even in this case, it is important to breastfeed often (about every two hours). When this is not possible, due to pain or medical advice, it is advisable to empty the breast with the breast pump, nursing the baby to the other breast. As mentioned, in fact, milk represents an excellent breeding ground for bacteria, therefore any stagnation would facilitate the propagation of the infectious process.
If necessary, the doctor will prescribe anti-inflammatories and analgesics to attenuate the maternal painful symptoms. When the doctor deems it appropriate it is necessary to undertake an antibiotic therapy; in this sense avoid all those active ingredients that are secreted in milk (tetracyclines, sulfonamides and metronidazole). The needle aspiration of the area affected by mastitis allows cultural examinations to be set up with antibiograms, in order to use the most effective antibiotic in the fight against the pathogens involved. They promote healing, even bed rest and the use of hot and cold compresses, respectively applied to the inflamed part of the breast before and after breastfeeding.
When the inflammatory process associated with mastitis results in abscess, surgical drainage is required, via a small incision in the breast.
