China Japan Friendship Hospital Obstetrics and Gynecology
puerperiummastitisIt usually occurs after the first delivery, and can be divided into the following two types according to the development process of the disease: stasis mastitis andSuppurative mastitis。Puerperal mastitisAcute mastitisMammarySuppurative infectionAlmost all patients are primipara, and the onset is mainly 3 to 4 weeks after delivery. The clinical manifestations are redness, swelling, heat, pain, and localtumor、abscessFormation, temperature rise,White blood cell countincrease.Before the formation of the abscess, the main method is to resist infection and promote the discharge of milk. After the formation of the abscessIncision and drainageMainly.prognosisGood.
Usually due to the incorrect nursing position, the baby does not suck the nipple and most of the areola in the mouth and fix them on one sideLactation timeToo long.
2. Breast duct obstruction
Common insecondaryThe breast is not completely aspiratedRegularityFrequent breastfeeding and local pressure on the breast are the main reasons.Milk stasis is also common in patients with nipple dysplasia (such asNipple depression）, affecting the progress of lactation.In addition, the milk of primipara contains more sheddingepithelial cellsIt is more likely to cause breast duct obstruction and aggravate milk stasis.
(1) Bacteria can invade directly through the milk tube, because of milk stasisretention, easy to infect.Because the retained milk is easy to decompose, the decomposition product is acidic, which not only stimulates the mammary gland tube, but also has good bacterial reproductionculture medium。
(2) Bacteria can pass through small nipplesWoundOr crack entrylymph glandInvasion of milky leaf stromaCellulitis。
（3）puerperiumThe pathogenic bacteria infected in other parts of the maternal body can cause breast infection through blood circulation.
(4) Another route of infection is caused by pathogenic bacteria (such asoral cavityNasopharyngeal infection) directly invades retrogradely along the mammary duct during lactationLobule of mammary glandGrowth and reproduction in the accumulated milk may cause breast infection.
4. Milk stasis
(1) Newborns are inexperienced in lactation and have a lot of milk. Babies often cannot suck up the milk, which causes excess milk to accumulate in the glandular lobules, which is conducive to the growth and reproduction of bacteria.The milk of primipara contains more exfoliated epithelial cells, which is easy to cause breast duct blockage and aggravate milk stasis.Milk accretion promotesAcute inflammationhappen.
(2) If the first parturient does not scrub the nipple frequently during pregnancy, the epithelium is fragile, the sucking time of children is too long, and the nipple epidermis is soft, which is easy to occurChapAfter rhagades occur, infant sucking will cause severe pain to the mother, which will affect the full lactation. It is not easy to empty the breast, and the milk is easy to accumulate.In addition, nipple dysplasia, short flat, smallInvaginationThe milk is easier to accumulate.
It occurs in the early puerperium (usually about 1 week after delivery).Due to the lack of experience in feeding infants, primipara are prone to milk siltation and not emptying on time.Patients feel that their breasts are unequalDistention painAnd moderate temperature rise (about 38.5 ℃).The breast was checked for fullness, redness (congestion) on the surface, tenderness, but the symptoms mostly disappeared after sucking out the milk.However, if it is not handled in time or the nipple is small and is sucked by the newborn, the retained milk can bepyogenic bacterium Contaminated.Therefore, the excess milk must be drained and the nipples cleaned.
Multiple causestaphylococcusOr streptococcus infection through ruptured nipples.As mentioned above, postpartum milk stasis, if not emptied in time, is likely to cause infection.After the bacteria invade the breast duct and continue to invade the parenchyma, various types of suppurative mastitis can be formed.
(3) The infection spreads along lymphatic vessels tobreastIn the stroma, it can cross the breast tissue from the surface to the base.Formed due to purulent connective tissueInterstitial partabscess。ThisabscessIt can be confined to a single mammary gland lobule or spread to most mammary glands.
(4) The infection spreads rapidly, reaching as far as the base of the breast andPectoralis majorThe loose connective tissue behind the breast formsabscess。
(1) Early puerpera with only milk stasisThe general symptoms are mild, and you can continue to breastfeed. Take active measures to promote smooth milk discharge and reduce siltation.Use bandage or breast support to hold up the breast. Patients in the stage of milk stasis can continue to breastfeedIce compressTo reduce milk secretion.
(2) Local treatmentFor those with obvious breast swelling or mass formation, local hot compress is conducive to the dissipation of inflammation. Each hot compress is 20-30 minutes, three times a day, and 25% can be used for severe casesmagnesium sulphateWet compress。
(3) Antibiotic useSelect sensitive antibiotics against Staphylococcus aureus, and take orally orIntramuscular injectionOr intravenous drip.
2. Abscess has formed
The incision should be cut and drained in time, usually withpapilla、AreolaPresented as centerRadial, shallow abscess under areola can be done along areolaArc cutThe abscess is located behind the breast and should be located at the lower part of the breastSkin foldMake an arc incision of 1~2cm.
prevention
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1. Keep nipples clean and wash them with warm soapy water frequently, if anyInverted nipplePay more attention to cleaning, do not useethanolScrub.
2. Develop a good habit of regular breastfeeding, and suck up the milk every time. If you can't, squeeze out or prevent the baby from sleeping with nipples.
