puerperal mastitis
Introduction
Introduction to puerperal mastitis Mastitis is an acute suppurative infection of the breast. It is a common disease in the puerperium and one of the causes of postpartum fever. It is most common in breastfeeding women, especially primipara. It can occur at any time during lactation, and the beginning of breastfeeding is most common. Mastitis is a common condition in primiparas. Light can not be used for normal feeding of infants, and severe cases require surgical treatment. However, early prevention or timely treatment can prevent or alleviate the symptoms. Rub the peanut oil on the nipple and areola every month before delivery. Wash the nipple and areola daily with alcohol or warm water after 8 months of pregnancy, so that the nipple skin becomes tough and wearable, preventing the baby from sucking and chapping in the postpartum. basic knowledge The proportion of illness: 0.002% Susceptible people: good for postpartum women Mode of infection: non-infectious Complications: bacteremia, sepsis
Cause
Causes of mastitis during puerperium
Milk deposition (45%):
Milk siltation is conducive to the invasion and growth of bacteria. The reasons for siltation are: 1 nipple dysplasia (too small or invagination) hinders breastfeeding; 2 too much milk or baby sucking less, so that milk can not be completely empty; 3 milk duct No, it affects milking.
Infection (40%):
Bacterial invasion of the nipple breaks the bacteria along the lymphatic vessels is the main way of infection, baby mouth nipples sleep or baby suffering from stomatitis is also beneficial to the bacteria directly into the milk duct, the pathogen is mainly Staphylococcus aureus.
Prevention
Maternal mastitis prevention
1. Keep the nipple clean: prevent nipple damage. If the nipple is damaged, the bacteria can be invaded by this. During pregnancy, warm water should be used frequently. Soap should be washed on both sides of the nipple. The nipple can be retracted. It can be corrected by pinching and pulling the nipple. To do baby oral hygiene, infants should not contain nipples to sleep, to avoid direct intrusion of bacteria into the milk duct, wash the nipples with warm water after breastfeeding, once the nipples are damaged, they should be treated promptly, and externally applied tin-like or scutellaria.
2. Avoid milk hoarding: Milk hoarding is beneficial to the reproduction of bacteria. It is an important cause of the disease. It should be developed into the habit of regular feeding. Each breastfeeding should let the milk suck. If there is hoarding, you can use a breast pump or massage. Help the milk to empty, early in the disease, when the abscess has not yet formed, you can take a breast massage, so that the stagnation of milk can be dredged, before using the massage, apply the external breast to the affected side for 10 to 15 minutes, then apply a small amount on the affected side of the breast. Lubricating oil, you can use five fingers to massage gently from the breast to the nipple direction, gradually apply pressure, gradually push out the stagnant milk. If there is serious infection or abscess after drainage, you can consider terminating breastfeeding, often terminating milk secretion. The method is: fried malt 60 grams, Shuijianbi, divided into multiple servings, one dose per day, and even served 2 to 3 days.
3. Pay attention to diet adjustment: Eat light and nutritious foods, eat more fresh fruits and vegetables, such as tomatoes, loofah, cucumber, fresh clams, oranges, etc., eat spicy, irritating, greasy products.
Complication
Complications of puerperal mastitis Complications bacteremia sepsis
1, breast fistula: abscess formation period, abscess can be inward or outward ulceration, the formation of skin breach and breast fistula. If improperly treated, it can form long-term unhealed purulent sputum or chyle. It can be seen that milk and pus are discharged from the fistula.
2, sepsis and bacteremia: the course of the disease into the stage of acute suppurative mastitis, patients can be complicated by sepsis and bacteremia. At this time, the patient continued to have high fever, and the complexion was flushed and sputum. A metastatic abscess can occur.
Symptom
Symptoms of mastitis in the puerperium common symptoms high fever breast with menstrual pain, breast pain, chills, milk, stagnation, erysipelas
(a) hoarding mastitis
Occurred in the early stage of calving (usually about 1 week after childbirth), due to the lack of experience of feeding babies in primipara, it is easy to cause stagnation of milk, not caused by emptying on time, the patient feels pain in varying degrees of breast, and moderate Increased body temperature (about 38.5 °C), check the breasts full, the surface is reddish (congested), tenderness, but after the milk is sucked out, the symptoms can disappear, so it is generally not considered to be true mastitis, but if not treated in time , or the nipple is small, smashed by the newborn, the stagnant milk can be contaminated by purulent bacteria, therefore, the excess milk should be drained, and the nipple should be cleaned.
(two) suppurative mastitis
Mostly due to staphylococcal or streptococci infection through ruptured nipples, as mentioned above, postpartum milk hoarding, if not empty in time, prone to infection, bacteria invade the mammary gland, continue to invade the parenchyma, then can form Various types of suppurative mastitis.
1, inflammation spread to superficial lymphatic vessels, leading to erysipelas-like lymphangitis, patients with sudden high fever, often accompanied by chills, breast tenderness, local skin red spots or red lines, this type of characteristics.
2, inflammation is limited to the connective tissue of the areola, forming an abscess under the areola.
3, the infection spreads along the lymphatic vessels into the mammary gland, from the surface to the base, across the breast tissue, due to connective tissue suppuration to form interstitial abscess, such abscess can be limited to a single breast lobules, can also spread to large Mammary gland.
4, the infection spreads rapidly, deep into the breast between the base of the breast and the pectoralis major, loose connective tissue, forming a post-abdominal abscess.
Inflammation or abscesses are all red and swollen, and the abscess is fluctuating. If necessary, the test may be puncture. The pus is taken for bacteriological examination and tested for drug sensitivity for reference when selecting antibiotics.
Examine
Examination of mastitis during puerperium
Blood routine
The total number of white blood cells and the number of neutrophils increased. When sepsis is complicated, the total number of white blood cells is often 1.5×1010/L, and neutrophils often reach 0.8 or more.
2. Bacteriology examination
(1) Pus smear extract pus smear examination, generally Gram-positive cocci, can also be acid-fast staining to check acid-fast bacilli, to help determine the type of pathogenic bacteria.
(2) Pus culture and drug susceptibility test guide clinical use of antibiotics.
(3) Blood bacteria culture acute mastitis complicated with sepsis sepsis, usually should be taken every other day, blood is taken for bacterial culture until it is negative. The best time to draw blood is to increase the positive rate before the expected chills and high fever. For clinical manifestations of bacteremia and blood culture multiple negative, the possibility of anaerobic infection should be considered, and blood can be used for anaerobic culture.
3. Local puncture and pus
For deep abscesses in the breast, the inflammation is obvious and there is no fluctuation. It is feasible to puncture and pus to help determine the location of deep abscess in the breast.
4. X-ray molybdenum target film
Breast skin swelling and thickening, interstitial shadow hyperplasia, blood vessel shadows increased significantly, the changes in inflammation after application of antibiotics significantly changed.
5.B-ultrasound
The first choice for no damage inspection. Characteristics of sound image: 1 Inflammatory mass, the boundary is not clear, the internal echo thickens and the spot is uneven; 2 milk retention, is a small dark area without echo; 3 abscess formation, the sound image shows internal uneven liquid dark area The edge is blurred, the lumps are locally thickened, sometimes stratified, and the echo behind the abs is enhanced.
Diagnosis
Diagnosis and differentiation of mastitis in puerperium
diagnosis
Diagnosis can be performed based on clinical manifestations and examinations. Women who have breast-feeding after breast-feeding, such as breast pain and local redness, swelling, heat, pain, and painful masses, accompanied by varying degrees of systemic inflammatory toxicity, is not difficult to make a diagnosis.
Differential diagnosis
Should be differentiated from breast hyperplasia, breast cancer.
1. Breast emphysema abscess
Can be expressed as local pain and lumps, but often no local redness, swelling and pulsating pain, no fever and other systemic manifestations, can be identified.
2. Breast skin erysipelas
Less common, there are red, swollen, hot, painful skin, and there are clear boundaries. Local pain is mild, and systemic venom is particularly evident. The breast parenchyma is still soft and has no inflammatory mass and can be identified.
3.B-ultrasound
The diagnosis of mammary inflammatory mass and abscess formation is valuable and has a localization effect. A pulsating inflammatory mass can be diagnosed by acupuncture to obtain a purulent fluid.
