Mastitis in mothers and nulliparous women. Mastitis - acute and chronic

Mastitis- this is inflammation of the mammary gland due to stagnation of milk and infection during the lactation period.

Most often it is a staph infection.

Mastitis may develop during the mother's stay in the maternity hospital, but more often there is a later onset - usually 2-3 weeks after discharge.

source of staphylococcus there may be another mother or medical personnel who transmit the infection to the newborn. That, in turn, infects the mother's nipples. The likelihood of mastitis in nulliparous women and women in age category from 20 to 29 years is higher than the rest - 70% and 60%, respectively.

The inflammatory process begins with inflammation of the milk ducts and blockage of the lumen of the ducts. Further, the inflammatory process passes to neighboring areas of the gland. Then there is a merger of small abscesses into a large abscess. Through the lymphatic pathways located in the interlobular space, the inflammation spreads to the surrounding tissues.

According to observations, the cause of the disease in women can be:

An increase in the number of women in labor with diseases of the cardiovascular, respiratory and endocrine systems after hormonal or surgical correction miscarriage;
- a significant increase in frequency caesarean section;
- the lack of unified approaches and a coherent system of teaching breastfeeding techniques and mastitis prevention in antenatal clinics of the country, and in maternity hospitals- behavior after childbirth;
- decrease in immunity and antimicrobial resistance after pregnancy in residents of cities with disturbed ecology.

Preventive measures in the history of medicine to reduce this disease were quite simple and logical:

1) early attachment of the baby to the breast (to avoid stagnation of milk);

2) pumping after feeding (earlier, some advised to express, while others - not to express), if the puerperal has a lot of milk;

3) hypothermia of the mammary glands (applying a heating pad with ice);

4) early discharge of women from maternity hospital(the child is protected from getting a nosocomial infection for 3-4 days);

5) opening of chambers cohabitation mother and child (this is a certain isolation of women from each other);

6) the use of modern disinfectants, the strictest implementation of sanitary standards;

7) the strictest control over bacteria carriers (all employees undergo special microbiological examinations once a quarter).

The results of this work exceeded all expectations. Mastitis has become much less - 0.3-0.5% of cases from the number of all puerperas. Almost disappeared severe forms mastitis, gangrenous and necrotic forms, as well as phlegmonous forms diseases. The ratio of initial and purulent forms(the latter became much less).

It is important, not at the first signs of the disease, not to take advice that can aggravate the situation - strain milk by mouth, apply cabbage leaves with honey, carry out rough massaging and decanting milk under a hot shower, use various suction jars.

Do not listen to such advice!

All these activities, as a rule, contribute to a powerful swelling of the breast tissue, an even greater blockade of milk output. And most often, further events unfold incredibly quickly and dramatically.

So, infection of the mammary gland by the mouth (all doctors know that the mouth is the dirtiest place in a person) leads to severe, aggressive infection of the whole organism. In such women, mastitis develops incredibly rapidly - literally within a few hours from the initial stage it passes into a gangrenous-necrotic form with an outcome in bacterial toxic shock. In such cases, the only measure that can save the patient's life is surgery.

Mastitis- this is perhaps the most formidable disease of the postpartum period. External and internal changes in the mammary gland at the stages of execution by a woman reproductive function begin to occur immediately after the onset of pregnancy. All these transformations come down to one thing - to the formation of a long-term ability to produce milk and provide the baby with breastfeeding.

The restructuring and preparation of the mammary glands for lactation begins as a result of complex interaction ovarian, placental, pituitary, thyroid gland, adrenal. Under the influence of estrogen, an increase in the mass of the mammary glands occurs - deposition large quantities adipose tissue, development vascular system, differentiation and growth of the lactiferous ducts. In the pituitary gland, the number and size of specific cells that synthesize prolactin, the hormone responsible for the production of milk in lactophore cells, increase.

As pregnancy progresses, the activity of glucocorticoids (hormones of the adrenal cortex) increases, stimulating the growth and development of breast tissue, as well as the onset of milk secretion. The role of progesterone in preparing the mammary glands for lactation is great.

Thanks to its influence, the mammary glands are transformed into producing milk secret. Progesterone not only promotes milk production, but together with estrogens regulates lactation (both of these hormones have the ability not only to stimulate lactation, but also to suppress the secretion of too much milk).

However, the main role during this period is played by prolactin, which stimulates the production of mammary gland secretions in the lactotrophors mentioned above. Control over the production of prolactin is carried out by the hypothalamic-pituitary system according to the feedback principle.

The development of mastitis in a pregnant woman

In a pregnant woman, prolactin levels begin to rise in the first trimester of pregnancy and continue to increase progressively until the end of pregnancy, reaching levels 10 times higher than those in non-pregnant women.

The fetal pituitary gland is able to synthesize, store and secrete prolactin from 12 weeks of gestation, rapidly increasing its production in the last weeks of fetal life. Although the role of fetal prolactin has not yet been studied.

The first signs of the onset of pregnancy are the growing discomfort in the mammary glands, their subsequent engorgement and increase in volume. The skin of the mammary glands, especially the zone nipple-areolar complex (NAC), becomes very sensitive, sometimes touching the mammary gland and wearing a bra cause pain.

By the end of the 3-4th month of pregnancy, these phenomena become barely perceptible or disappear altogether. During this period, there is an increased formation of the vascular system of the gland, on the skin appear superficial veins. SAH itself becomes more pigmented, darkens in some cases up to dark brown, its area increases.

The nipples hypertrophy, become juicy, embossed, covered with a special lubricant, on their top you can see how the excretory milk ducts of the gland gradually form and open. At the 5-6th month of pregnancy, a fluid such as colostrum can be released from the ducts, sometimes with an admixture of blood. This is a consequence of the rapid development of intraductal blood vessels, their spontaneous damage, which corresponds to the variant of the norm.

Proper breast care during pregnancy

Proper care of the mammary glands during pregnancy is the key to a healthy breastfeeding. Recommendations on these issues are quite simple and do not require excessive efforts and skills.

Considering all the features of the physiology of pregnancy and the development of the mammary glands, in the first and last trimester (1-3rd and 6-9th months of pregnancy) it is absolutely impossible to carry out any measures to prepare the mammary glands for lactation and breastfeeding, since any significant effect on the mammary glands during these periods of pregnancy can initiate a miscarriage or cause premature birth.

During these periods, it remains only to strictly follow the rules of personal hygiene of a pregnant woman - a daily hygienic shower of the mammary glands, delicately wiping them with a towel, and when dryness of the nipple-areolar complex is formed, skin treatment with softening and moisturizing nourishing creams.

In the middle trimester (4th-6th months of pregnancy) it is advisable to perform a contrast shower, and then massage the mammary glands and SAH with a hard towel for 2-3 minutes twice a day. The movements should be stroking in the direction from the nipple-areolar complex to the base of the mammary gland. After that, you should start circular motion. At the final stage, the chest with both hands moderate force it is necessary to press it against the chest wall 3-4 times.

All these exercises help to improve microcirculation in the mammary gland, improve the outflow of lymph and tissue fluid, which generally creates favorable conditions for milk production and the breastfeeding process, and also lays the foundation for maintaining beautiful breasts after lactation is completed.

With flattened and inverted nipples, to increase the erectile excitability of their neuromuscular apparatus, NAC gymnastics (stretching the nipple and imitating sucking movements with fingers) is recommended, performed 3-4 times a day for 5 minutes.

To increase the resistance of the nipple-areolar complex to mechanical damage baby's mouth while sucking, you can wear coarse canvas pads in a bra. To increase the resistance of the skin of the mammary glands to the effects of infection and the prevention of pustular lesions, ultraviolet irradiation of the skin (quartz treatment) is recommended.

Besides, during the entire pregnancy, a woman must wear special bras for pregnant women. The bra must meet the following requirements: it is made only of cotton fabric, does not have coarse and traumatic seams along the inner surface (especially in the SAH zone), does not tighten or squeeze the mammary glands, does not violate them normal development and growth, necessarily supports the glands in an elevated position, while preventing sagging.

The fixing straps should be wide, not cut into the shoulder girdle, not squeeze the side surfaces of the chest. This position of the breast during pregnancy provides it with the necessary good blood supply and proper innervation, is primary prevention osteochondrosis of the spine and intercostal neuralgia, developing after pregnancy and breastfeeding.

After childbirth, the amount of milk produced is determined by the concentration of the hormone prolactin, the secretion of which increases under the influence of the sucking movements of the child. But the level of sex hormones that have an inhibitory effect on lactation decreases.

The level of lactation in each woman is strictly determined genetically and directly depends on the concentration of prolactin produced by the pituitary gland (the amount of milk does not depend on the volume of the mammary glands). It also depends on the frequency of attachment of the infant to the breast and does not depend on the duration of feeding. If the baby is applied to the breast less often than expected, or if the attachment is not accompanied by decanting milk from the mammary glands, then the level of prolactin secretion decreases.

In the process of milk secretion, two phases are distinguished. In the first, associated with irritation of the receptors of the mammary gland, the sphincters of the nipple-areolar apparatus are relaxed and the milk ducts are activated. So-called low-fat early milk comes out.

This phase lasts 30-60 seconds. As a result of mechanical action, an erection (swelling and hardening) of the nipple occurs, which facilitates its capture by the child. The tissue trophism also improves, preparation for the second phase begins. AT

in the second phase, the hormone oxytocin is released from the pituitary gland, causing the glands to contract, which ensures the removal of more fatty “late” milk from the mammary gland. energy value. Latent period the second phase lasts from 50 seconds to several minutes.

In this phase, in addition to oxytocin, other hormones are also involved: adrenaline and glucocorticoids. Activity is activated digestive tract, there is a wide range of reactions from all internal organs nursing mother.

It is important to completely empty one gland in one feeding, and only after this the baby can be applied to the other breast.

In the first days after childbirth (1-5th days) colostrum is secreted in the mammary gland in the amount of 10-100 ml. Colostrum is a thick liquid with increased energy capacity and contains a large amount of protein, vitamins A, E and immune bodies necessary for the newborn.

Over the next two or three weeks the so-called "transitional" milk is produced, which becomes mature by the end of the first month. The level of lactation reaches 200-250 ml. With an increase in the period of feeding, the protein content in milk decreases and the concentration of fat increases, which ensures the growing energy costs of the child. Due to the fat component mother's milk 50% of the energy needs of the child are provided.

After childbirth, as a result of significant hormonal changes in the body of a woman, the hormone prolactin begins to dominate. He is responsible for the production of milk and determines its quantity. There are three states of the body depending on the production of milk by the mammary glands.

At low concentrations of prolactin, hypogalactia is formed - a small amount of milk is produced, usually within 50 ml, insufficient for one feeding from one mammary gland.

Normogalactia- the amount of milk produced in one breast is enough for a single feeding, which is 100-150 ml. Hypergalactia - increased production milk, more than 200 ml.

Breastfeeding has its natural periods decrease in lactation. This phenomenon is observed during increased speed growth and weight gain of the child. Usually this is the third, sixth and ninth months of a baby's life. It seems to the mother that there is less milk, but this condition lasts no more than two or three days, after which lactation is restored.

Breastfeeding has another important advantage.- it plays a protective role for mother and child. The protective effect of natural feeding on an infant is associated with the stimulation of growth in the intestines of lactobacilli bifidum in children during the first months of life, which prevent the growth of pathogenic bacteria.

The protective effect of breastfeeding on the mother is also significant. Sucking by a child of the mother's breast is a strong stimulating factor in the production of oxytocin in the body, which causes uterine contraction (a kind of gynecological massage).

This helps stop postpartum hemorrhage. Also, rolactin actively counteracts the process of maturation of follicles in the ovaries, becoming a reliable means of contraception for the period of breastfeeding. In breastfeeding mothers, breast and ovarian cancer practically does not occur, which is associated with a sharp decrease in the activity of steroid hormones.

The hormones produced endocrine system women during breastfeeding, soothe the mother, contribute to her relaxation. It also burns those excess fat that was accumulated during pregnancy.

The development of lactation is a very complex physiological process, which proceeds gradually and in stages. The final level of milk produced is formed only by the end of the first month after childbirth. This period is the most difficult and responsible.

As a rule, all the troubles associated with breastfeeding occur at this time. Milk production during the day in different parts of the glands occurs unevenly, which is especially noticeable and creates problems during the formation of lactation. In addition, during this period, there is a functional discrepancy between the work of the glandular apparatus - the part of the gland where milk is produced, and the ductal system that ensures the excretion of milk.

Milk arrives every day, with each feeding - it increases in volume, and due to the still poor contractility of the ducts, it is difficult to exit when sucking. It should also be said about the inability of many nursing women to properly carry out the process of breastfeeding, especially among nulliparous women.

In such difficult physiological conditions correct technique breastfeeding and subsequent care of the mammary glands play the most important role in the prevention of complications and diseases of the activating mammary glands. All these circumstances in the first weeks after childbirth create real threat milk stasis and mastitis. Only by the end of the first month after birth, the level of lactation reaches its final values.

Uneven filling of the mammary glands with milk and uneven exit of milk from different departments glands leads first to the fact that there is a so-called lactostasis - stagnation of milk, in which there is no microbial inflammation.

In nulliparous women, mastitis often develops - a purulent inflammation of the mammary gland, in which pathological processes cause unpleasant and sometimes very painful symptoms. Symptoms of mastitis most often occur during breastfeeding, but can appear even before childbirth, when expectant mother breasts begin to swell, preparing for the upcoming lactation.

In some cases, mastitis develops without being associated with pregnancy or breastfeeding (so-called non-lactating mastitis), and this occurs in women aged 20-60 years. In isolated cases, mastitis is diagnosed in girls who have just been born, which is associated with excessive intake of mother's hormones into the blood.

Inflammation of the mammary gland in women and its treatment is within the competence of mammologists. Among lactating women, the incidence of mastitis is 5-15%, and medical prevention of the disease is often ineffective. The vast majority of patients (85%) are primiparous, since they always have a higher risk stagnant processes in the chest due to lack of proper feeding and pumping skills. In non-nursing women, the incidence of mastitis is not high (no more than 1% of all mammological pathologies).

Mastitis, or, in the old way, the chest, has a tendency to spread rapidly over vast areas of the mammary gland. Lactational mastitis is always more severe than non-lactational mastitis. This is due to the penetration of pus into the ducts with the flow of milk and the coverage of purulent processes throughout the loose structure of the gland. As a rule, the disease affects only one gland, mainly the right one, but in last years doctors identify many cases of bilateral mastitis. Without treatment, this pathology can cause serious complications, the most formidable of which is sepsis, or blood poisoning.

Why mastitis develops

The causative agents of the disease in the vast majority of cases - staphylococcus aureus, streptococcus often - are not susceptible to antibiotics of the first generations. Occasionally, even E. coli affects the tissues of the organ, which can happen after poisoning, intoxication. Inflammation of the mammary gland occurs after the introduction of infection into the tissues, which can occur in various ways:

• through cracked nipples;
• through chafing, sores of the nipples, which were formed due to improper attachment of the child;
• with lymph flow from adjacent foci of infection;
• by hematogenous route from any infectious foci (with reduced immunity).

Mastitis during breastfeeding does not occur in every young mother. There are factors that provoke its development:

• complicated childbirth;
• purulent-septic complications after childbirth from other organs;
• mastopathy;
• large size of the mammary glands;
• flat, inverted nipples;
• scars on the mammary gland;
• decrease in general, local immunity;
• lactostasis (stagnation of milk, impaired venous and lymphatic outflow);
• insufficient emptying of the breast during breastfeeding;
• mechanical injuries of the nipples;
• improper attachment of the child to the breast;
• poor hygiene of the mammary glands;
• use of soiled underwear.

Prenatal mastitis is often associated with pathologies during pregnancy. After childbirth, if the mother's immunity is greatly reduced, the infection can easily spread from the tonsils, urinary tract, lungs, boils, carbuncles, get into the chest and cause inflammation of the mammary gland. Since the gland of lactating women has all the conditions for the existence and active reproduction of the infection, symptoms of mastitis appear after a couple of days.

Of all the above factors, the most common cause of mastitis is lactostasis - stagnation of milk due to its abundant production and insufficient or improper pumping. In the lobule of the gland where the most milk has accumulated, the ducts are clogged with milk "plugs". A woman has seals in her breasts, which, however, can resolve after a thorough massage. If you do not pay attention to the problem, there is purulent mastitis with all characteristic features.

Non-lactational mastitis develops without a woman having a breastfed baby. The disease is infrequent, and its main causes are associated with hormonal disorders, abortion, trauma, gland compression, complications fibrocystic disease, a sharp decrease in immunity, severe hypothermia. Sometimes such mastitis is a complication of small abscesses or boils in the chest.

Mastitis classification

The division of mastitis, depending on the functioning of the mammary glands, is as follows:

1. Non-lactational mastitis, including fibrocystic mastitis.
2. Lactational (postpartum) mastitis (more than 95% of cases).

The second type of pathology develops only in lactating women. Non-lactating mastitis is associated with other causes and occurs in non-lactating women or in pregnant women.

Type inflammatory process pathology can exist in several forms. They also represent the stages of mastitis:

1. Serous (acute) mastitis. initial stage pathology in which inflammation of the breast tissue occurs, the appearance of characteristic signs ( heat, pain, etc.). It proceeds similarly to normal lactostasis.
2. Infiltrative mastitis. In one of the lobules of the gland, a seal is formed, causing significant pain.
3. Purulent mastitis. If the first two stages of the pathology are not treated, purulent mastitis causes suppuration of the inflamed area of ​​the mammary gland.
4. Abscessing mastitis. A large purulent focus is localized in the chest.
5. Phlegmonous mastitis. At this stage, there is a spread of purulent phenomena throughout the gland or their transition to a healthy gland.
6. Gangrenous mastitis. There is necrotization of the tissues of the organ, the formation of blood clots in the vessels of the gland.

Usually, purulent mastitis causes localization of abscesses in the following areas:

• near the nipples, or subalveolar mastitis;
• inside the gland, or intramammary mastitis;
• behind the mammary gland, or retromammary mastitis;
• under the skin of the chest.

In addition, acute mastitis and chronic (recurrent) mastitis are distinguished.

How the disease manifests itself

The symptoms of mastitis vary depending on whether acute type pathology develops or chronic. Symptoms of mastitis of a nursing mother often occur against the background of lactostasis and as its complication, but sometimes they appear suddenly, without prior stagnation of milk. In some cases, mastitis begins only with inflammation of the milk ducts, then it is referred to as galactophoritis. The main symptoms of acute mastitis:

• breast engorgement;
• swelling of the gland;
• appearance painful hardening without clear contours;
• redness, hyperthermia of the skin in the affected area;
• inflammation of the nipple and the circle around it;
• increase in body temperature;
• general intoxication (weakness, sweating, headache);
• severe pain in the gland;
• an increase in the size of the entire organ;
• soreness of feeding, pumping;
• sometimes - the appearance of blood in the milk.

With the development of infiltrative mastitis, which occurs in the absence of therapy after 2-3 days, the clinic of the disease intensifies, general state continues to get worse. As a result of palpation of the breast, it is possible to accurately identify the focus of inflammation (infiltration). Gradually, the pathology acquires purulent character. Symptoms of mastitis in nursing in this case:

• secretion of milk with pus;
• increased signs of intoxication;
• fever up to 40 degrees;
• growth of infiltrate;
• the appearance of fluctuations (fluctuations of the skin due to the presence of liquid pus);
• the presence of extensive cavities with pus (phlegmonous mastitis);
• shine, hyperemia of the skin;
• the appearance of bluish spots;
• enlarged axillary lymph nodes.

If gangrenous mastitis develops, in addition to purulent fusion and extensive tissue necrosis, inflammation spreads to chest. In this case, the pathology may be complicated by sepsis.

Signs of mastitis chronic form arise as a result improper treatment acute mastitis. Gradually, small abscesses form in the mammary gland, the tissues around them thicken and become hard. Slow inflammation causes the formation of fibrous ridges around purulent cavities (encapsulation). The body temperature of a woman is subfebrile or normal, the lymph nodes are often enlarged. The gland itself is moderately painful, the skin is slightly reddened, a serous fluid is released from the nipple, sometimes with blood. At non-lactational mastitis the symptoms are similar to those of chronic mastitis, proceeding with mild severity.

Mastitis: is the danger great?

The danger of pathology exists already at the stage of purulent processes, when a cavity filled with pus forms in the chest. It is impossible to cure her with the methods of conservative medicine, so the woman has to undergo an operation to remove pus, stopping feeding the baby. Gangrenous mastitis is very difficult, irrevocably spoiling the shape of the breast and often complicated by general blood poisoning.

The consequences of mastitis are possible even after a successful operation. Some time after discharge, the woman develops milk fistula, which can resolve or fester again. Also, against the background of reduced immunity, suppuration often occurs. postoperative suture, or a new exacerbation of mastitis. In addition, any operation causes aesthetic damage to the mammary gland, sometimes significant. Long-term complications mastitis can become fibrocystic or nodular mastopathy and even breast cancer.

Examination for mastitis

Usually, acute mastitis does not raise doubts in the diagnosis already when examined by a mammologist and palpation of the affected area of ​​\u200b\u200bthe chest, lymph nodes. To clarify the diagnosis and differentiate it from some forms of cancer, an ultrasound is prescribed, reflecting inflammatory phenomena in iron:

• expansion of the ducts;
• increasing the thickness of the skin, a layer of fiber;
• decreased tissue echogenicity;
• the presence of a zone with greatly reduced echogenicity (inflammatory infiltrate);
• the presence of abscesses, necrotic tissues.

Sometimes, if the ultrasound picture does not give an accurate picture of the nature of the disease, an x-ray examination (mammography) may be required. A biopsy of the abscess or infiltrate is possible using fine needle aspiration. If treatment is ineffective, antibiotics for mastitis are selected after bakposev discharge from the mammary gland and determine the sensitivity of the pathogen to drugs. Additionally, the doctor may prescribe the following examinations:

• clinical analysis of urine, blood;
• cytology of milk from a diseased gland.

If it is not possible to visit a mammologist, you should contact the clinic for a surgeon or gynecologist.

Features of the treatment of mastitis

If the prevention of mastitis was ineffective, treatment of the pathology should be started as early as possible. This will help prevent purulent processes, cancel the need for surgery. An important non-drug measure of therapy is the correct expression of milk every 3 hours. Since this manipulation is very painful, it is often performed after a novocaine blockade. If within a day the desired effect does not occur, appoint antibiotic therapy. Antibiotics for mastitis are administered intramuscularly, and sometimes additionally - in the area of ​​inflammation. Use penicillins, more often - cephalosporins. If the purulent focus continues to grow, do surgical operation.
Other treatments that are used for mastitis (duration 7-15 days):

1. Desensitizing and antihistamine therapy.
2. Drug suppression of lactation (drugs are used to inhibit the production of prolactin). Such treatment will be required for phlegmonous mastitis and necrosis, as well as for severe disease in combination with various complications.
3. Taking vitamins (especially with mastitis is indicated vitamin C, group of vitamins B).
4. Reception of antispasmodics, painkillers.
5. Treatment of intoxication (infusion of glucose, electrolytes).
6. Physiotherapeutic methods.
7. Application of Vishnevsky ointment (bandages, compresses).

Feeding for the period of therapy will have to be stopped due to the presence of infection in the milk, as well as decay products of bacteria and leukocytes. The intake of such milk can provoke digestive disorders in the baby and the development of intestinal dysbiosis.

Operation for mastitis

Within two days, the doctor decides on surgical intervention. Indications for surgery:

• lack of positive dynamics;
• symptom progression.

Breast surgery for mastitis is performed under general anesthesia. An important task of the doctor is not only the complete extraction of the purulent focus, but also the maximum preservation of the aesthetic appeal of the gland. The abscess is opened, bridges, pockets, all necrotic areas are removed, the cavity is drained. If there is an infiltrate, it is also removed completely. With abscessing mastitis, it is important to excise each purulent focus, so several incisions in the mammary gland are performed.

After the operation, the woman expresses her milk to prevent it from stagnation. Wounds are drained, washed with antiseptics, which will help them heal faster and with less cosmetic consequences. The sutures are removed 7-10 days after the operation. In the early rehabilitation period treatment with antibiotics, taking general tonic drugs, vitamins, immunomodulators, UV, UHF, microcurrents, magnetotherapy is indicated.

Treatment of mastitis at home is allowed only at the stage of the serous type of pathology, before the formation of abscesses. Since it is quite difficult to determine the type of disease on your own, folk methods treat mastitis after consulting a doctor. Such popular recipes are popular:

1. Compresses with mint leaves. For resorption of edema and seals with mastitis, they take fresh leaves mint, crushed a little and crushed until the juice is released, applied to the chest. From above, the mammary gland is wrapped with gauze, a cloth. The compress is kept for 2 hours, after which it is removed, at least 2 procedures are performed per day. If there were no fresh leaves available, you can steam the dried ones and repeat the procedure in the same way. In addition to mint, leaves of cabbage, alder, coltsfoot have an excellent resolving effect.
2. Compresses with chaga. A piece of chaga mushroom should be well steamed in boiling water, cool. Wrap it with a bandage, attach it to the mammary gland, cover it with parchment on top (without cellophane). Leave the compress on all night, thus being treated for 7 days.
3. Honey onion compresses. Bake an onion in the oven. Grind the onion into gruel, add a spoonful of honey. Run a compress on the chest from this mass, secure with a rag, leave overnight. The course of treatment is 5 days.

Prevention of mastitis

Every woman after childbirth, especially a primipara, should remember that only properly organized prevention will protect her from such unpleasant disease like mastitis. Of course, not everyone can learn how to correctly attach the baby to the breast and optimally set the feeding regimen. But nowadays in any maternity hospital and antenatal clinic there are breastfeeding specialists who will gladly initiate a woman into all the mysteries of lactation. Prevention measures for mastitis are as follows:

• feeding on demand;
• pumping milk if the child for some reason "delays" the feeding process;
• no restrictions on the duration of feeding;
• timely treatment of cracks, wounds on the chest and nipples;
• observance of hygiene of a breast, all body;
• wiping the mammary glands only with a soft towel;
• do not wash your breasts with cold water;
• treatment of nipples between feedings with Bepanten ointments, sea buckthorn oil;
• preventing the baby from seizing the nipple without the areola;
• conducting light massage with the formation of seals in the chest;
• implementation of special exercise for the postpartum period.

Usually, even in the maternity hospital, a woman is told how to deal with lactostasis and take care of the mammary glands during lactation. Compliance with all these rules will help prevent inflammation of the glands and, possibly, severe surgery.

It seems that everything is already behind: the long way of bearing the fetus is over, the child was born, but, unfortunately, complications occur in the near future after childbirth. In particular, mastitis during pregnancy and in postpartum period may be the reason for serious problems in mother and unpleasant diseases in the baby. Inflammation inside the mammary gland leads to the formation of purulent foci. And the saddest thing is that you can not feed the baby breast milk.

Mastitis: what are the causes

Considering that there is no inflammation without the presence of an infection, it should be understood that it is the microbes that cause a purulent process in the breast tissue. Most often causal factor- a widespread microorganism staphylococcus, which is found on the human skin.

2. Lactostasis

The mammary gland is made up of many lobules, each of which produces milk. Nutrient fluid from the lobules through excretory ducts enters the nipple area, and from there outward to the child. If the exit from the milk lobules closes, then lactostasis develops (milk retention in certain areas of the mammary gland). It is this condition that creates the conditions for the occurrence of inflammation.

3. Nipple crack

If a woman violates the technique of feeding a child, then she may experience injuries in the nipple area. Cracks are not only painful, but also become the entrance gate for infection.

4. Reduced immunity

Quite often in a woman after childbirth, the body's defenses are very pronounced. This may occur due to postpartum trauma, bleeding, anemia, and malnutrition. In this case, the inflammatory process occurs much easier and faster.

5. Violation of hygiene

A woman should be very strict about the rules of hygiene, constantly treating the mammary glands and nipples before feeding in order to prevent possible infection and reduce the risk of inflammation in the breast.

Mastitis during pregnancy and in the postpartum period develops in stages. And this creates conditions for a woman to notice the complication in time and consult a doctor in a timely manner. Most often, the disease begins with stagnation of milk in the breast or against the background of a crack in the nipple. When microbes get inside, an inflammatory seal occurs. Then suppuration begins in this place, which requires immediate medical attention.

Mastitis: what are the symptoms

2. Temperature rise

On the background purulent inflammation there will be a pronounced and persistent increase in body temperature. Usually the temperature reaction is up to 38-39 degrees, and this increase persists for a long time, and attempts to reduce it do not give a good result.

3. Changes in the mammary gland

Outside, you can see that the breast has increased in size - on the side where the inflammation is, the mammary gland will be larger. In the place of suppuration there will be not only a seal, but also a patch of redness. There will definitely be swelling of the tissues. At the very worst case there will be a purplish or purple patch on the skin.

4. General complaints

The woman will have severe weakness, drowsiness, apathy, her appetite decreases and she does not want to do anything.

In the tests that the doctor will prescribe, there will be characteristic changes in the blood. AT bacterial culture milk, it is possible to identify the microbe-causative agent, with the determination of sensitivity to drugs.

Mastitis: how to treat

1. Antibiotics

Unfortunately, without using antibacterial drugs not enough. For the entire time of taking the medicine, you must stop feeding the baby, because the antibiotic will pass into breast milk. Doses of the drug should be sufficient to ensure that inflammation is eliminated.

2. Breast emptying

If the problem in the gland is still at the level of lactostasis, then you should try to completely express the milk. A woman who can cope with the stagnation of milk will be able to avoid mastitis.

3. Stop feeding

In cases where it is necessary to stop lactation and it will not be possible to feed the baby, the doctor will prescribe special tablets. Having clearly followed these recommendations, a woman will stop lactating within 1-2 days.

4. Operation

In the worst case, when a purulent focus has formed, it is necessary to perform an operation (an incision of the gland and removal of pus from the chest). This manipulation will be done by the surgeon in a hospital setting. After this, a long-term anti-inflammatory and antibacterial treatment against the background of which, of course, it is impossible to feed the baby with breast milk. In some situations postpartum woman can preserve the ability of the mammary glands to produce milk, so that after treatment, continue to provide the baby with natural feeding.

The inflammatory process in the mammary gland is more common in women who give birth for the first time and do not have experience in proper feeding child. If lactostasis occurs, then it is necessary to drain the breast as soon as possible. If this does not help and the microbes have penetrated inside, you should consult a doctor in a timely manner in order to prevent dangerous complications for mother and baby.

The preparation of the mammary glands and nipples during pregnancy for their future function should begin in the antenatal clinic at the first visit of the pregnant woman. The preparation is based on general hygienic measures: keeping the body, linen, hands clean. Hygiene measures increase the tone of the body and the functional activity of its individual organs and systems, in particular the mammary glands. It should be recommended to pregnant women daily (in the morning) washing of the mammary glands with water room temperature with soap, followed by wiping the skin of the glands and nipples with a hard towel. Particular attention should be paid to the cut of underwear, in particular bras. The mammary glands should be raised, because. their sagging predisposes to the formation of milk stagnation. As the mammary glands increase with the development of pregnancy, the size of the bras should change. Underwear should be light and free and not squeeze the body anywhere. Starting from the 5-6th month of pregnancy, daily air baths are desirable. To this end, the pregnant woman should be advised to lie on the bed with an open chest for 10-15 minutes. In order to increase the general tone of the pregnant woman's body and its resistance to infection, it is recommended that starting from the 7th-8th month of pregnancy, general irradiation with ultraviolet rays (every other day, 15-20 sessions).

Irradiation begins with a fractional part of the found average biodose, which then increases to 1 biodose. The duration of each exposure, depending on individual conditions, is not the same. The distance from the burner (along the plumb line) is at least 50 cm. The entire course of irradiation of each woman must be carried out with the same burner.

Particular attention should be paid to pregnant women with flat and inverted nipples. In such women, drawing out the nipples with cleanly washed hands should be tested. This manipulation is first carried out by midwives in a consultation, then the pregnant woman, after her training, pulls the nipples on her own (when visiting a pregnant consultation, the doctor checks whether the woman pulls the nipples correctly).

Regardless of the shape of the nipple, 2-3 weeks before the birth, they should be specially trained for the upcoming feeding by rhythmic squeezing of the nipples. These squeezes imitating the sucking movements of the baby are made with the thumb and forefinger, capturing the nipple at the base. Such manipulations become more frequent and their duration increases by the end of pregnancy from 2-3 to 25-30 minutes. This manipulation is contraindicated in case of a threat premature birth and untimely termination of pregnancy in history.

At oily skin nipples, it is recommended to wash the mammary glands with baby soap during the morning toilet, and in case of severe dry skin, lubricate the nipple with sterile vaseline oil. It is necessary to warn the pregnant woman that for all manipulations with the mammary glands and nipples, she must have a separate hand towel.

Especially strictly and persistently should be carried out preventive measures to prevent mastitis, from the moment the woman in labor enters the hospital and in the postpartum period. System preventive measures, carried out for the possible protection of puerperas from infection with hospital staphylococcus aureus, begins from the moment of admission to the emergency room and is of an organizational nature.

Acute inflammation of the parenchyma and connective tissue mammary gland in medical terminology called mastitis. More than 90% of all cases of this pathological process refers to the period of breastfeeding and is called lactational mastitis. It is caused by problems with breastfeeding and pumping in the first few months after childbirth. The remaining 10% are non-lactational mastitis, which includes mastitis during pregnancy.

Read in this article

Causes of mastitis during pregnancy

The main cause of mastitis during pregnancy is various extragenital pathologies, which tend to exacerbate during the period of bearing a child. Risk factors for the development of inflammatory problems in the breast during pregnancy include:

• diabetes;
• rheumatoid arthritis;
• long-term use of hormonal drugs by a woman;
• as a late manifestation of the consequences radiotherapy mammary gland;
• various operations on the female breast, including plastic ones.

Similar problems occur in pregnant women due to a decrease in the body's immune defenses, since significant hormonal changes occur during this period.

The occurrence of non-lactational mastitis in pregnant women is usually facilitated by those transferred during the period of gestation infectious diseases, general or local hypothermia of the body, leading to a decrease in immunity and the absence of antimicrobial resistance.

What are mastitis in pregnant women

The main causative agent of the inflammatory process in the mammary gland in 80% of cases is Staphylococcus aureus. Its impact on female body most often accompanied by the addition of Pseudomonas aeruginosa and coli, Proteus and Streptococcus. Sometimes, after antibiotic treatment, a pregnant woman may develop candidal mastitis, which is one of the signs of immunodeficiency in a future mother.

Mastitis in pregnant women is divided mainly according to the severity of the course of the inflammation process and its localization in the mammary gland. With inadequate treatment of mastitis in a pregnant woman, the disease goes through the following stages:

1. Acute mastitis. This consistently includes serous, infiltration, abscessing, phlegmonous and gangrenous inflammatory processes.
2. After the transition of mastitis to chronic, infiltrative and processes are isolated.

The classification of the localization of mastitis in pregnant women depends on the location of the main location of the process. Mastitis can be subareolar, that is, it covers only the nipple and areola. If the inflammation has affected the upper or lower halves of the mammary gland, experts speak of the presence of intramammary and retromammary mastitis. And if the entire breast tissue is affected by inflammation, often with the capture of the area axillary lymph nodes, it can be argued that a pregnant woman has diffuse mastitis.

Origin mechanism

As mentioned above, pregnant women have significantly reduced immunity, so any inflammatory agents easily penetrate the body of the expectant mother. The mammary gland is no exception. Microbes and bacteria can enter the tissues of the female breast through nipple cracks, abrasions and areas of inflammation on the skin of the breast, that is, exogenously. There is another way of damage, when microorganisms enter the mammary gland with blood flow from the areas available to a pregnant woman chronic inflammation. Such foci of infection include everything from carious teeth to chronic inflammatory processes of the female genital area.

Microbes destroy the cells of the breast tissue, which leads to a change in the balance of microelements, an increase in the amount of lysomal enzymes and autolysis. The decay products of some cells and the infectious agents that have grown as a result of this begin to damage healthy cells.

Against this background, an increase in permeability develops. vascular wall, increases the growth of macrophages, which provokes the release of a large amount of fluid in the breast tissue. After a massive release of exudate begins. Edema increases pressure on the vessels of the gland and on the milk ducts, their lumen narrows, the amount of exudate increases, a vicious circle is formed.

The mammary gland is a glandular organ, so its tissues do little to limit the spread of the inflammatory process to the entire breast, and mastitis easily captures more and more new areas. If, with the help of the ongoing treatment, the inflammatory process can be limited, then an abscess of the mammary gland is formed. With the further development of inflammation, it is possible to develop diffuse form acute mastitis in pregnancy.

We recommend reading. Why pathology occurs in the first days of breastfeeding, how to prevent the development of lactostasis and its subsequent transition to acute mastitis, what treatment is taken for lactostasis - you can read about everything in more detail in this article.

Clinic of the disease

The clinical picture of inflammation of the mammary gland in a pregnant woman differs from a similar process in other patients with a more pronounced severity of the course. This is explained by the weak immune protection body of the expectant mother and hormonal changes occurring during this period.

Usually, mastitis in a pregnant woman begins acutely: with sharp pains and hyperemia of the mammary gland, edema and signs general intoxication organism. Before that, usually for 1-2 days, a woman noted in her chest, there was no pain and redness of the tissues.

Since few women at the time of expecting a child will pay attention to areas of compaction in the chest, and if they do, they will associate their appearance directly with pregnancy, in most cases the process goes into acute stage. If a woman has swelling and soreness in the region of the lymph nodes, this indicates the transition of the process to infiltration mastitis.

Further development of the inflammatory process leads to the formation of liquid areas in the places of compaction, which indicates the formation of an abscess of the mammary gland. But if the inflammation goes through a period of limitation and spreads to the entire mammary gland, phlegmonous mastitis of pregnant women occurs. This is the most dangerous stage of the disease, threatening a woman with the occurrence general infection blood, the development of multiple organ failure, and for the expectant mother - the threat of premature birth and loss of the child.

Treatment and prevention of mastitis in a pregnant woman

If the expectant mother managed to seek help in time in case of small foci of inflammation in the mammary gland, then it is often possible to do without the use of specific antibacterial drugs.

For such cases, it is recommended that the woman drink large volumes of liquid, consisting of medicinal teas with calming and anti-inflammatory effects. You can use decoctions and infusions of mint, lemon balm, linden, licorice.

Of the physiotherapy procedures, we recommend stopping at ultrasound for 5-7 days, contrasting soul to improve microcirculation in the mammary gland. Pregnant women with incipient mastitis are shown wiping the nipples with a solution of potassium permanganate, lubricating them with synthomycin liniment or calendula ointment.

If mastitis in a pregnant woman has turned into more severe stage, then medical treatment is indispensable. Nursing women in the treatment of the disease will have to temporarily stop breastfeeding, while pregnant doctors will select the least toxic drugs for the unborn child.

Rational and efficient drug treatment mastitis in pregnant women requires the fulfillment of two mandatory conditions:

• it is necessary to use medicines only with proven safety of use during pregnancy, with known metabolic pathways;
• when prescribing drugs, the duration of pregnancy (early or late) should be taken into account. Usually obstetricians-gynecologists recommend to refrain from any drug therapy up to 12 weeks of pregnancy.

Medicines used by a woman during pregnancy cause the following effects on the fetus: embryotoxic, teratogenic and fetotoxic. They are most typical for the first 3 months of pregnancy and have the most Negative influence for the future child.

Treatment of mastitis in pregnant women should be carried out exclusively by specialists, and surgeons and obstetrician-gynecologists should act in tandem. For any expectant mother, the rule remains important: if any abnormalities appear in her body, especially in the mammary gland, immediately seek help from a antenatal clinic.

Pregnancy leads to sharp decline defensive forces body, so any self-medication in most cases leads to sad consequences for a young woman and her unborn child.