Postpartum infections
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Lactation mastitis is a cellulitis of the interlobular connective tissue within the mammary gland that usually occurs within the first 6 weeks postpartum (96). Mastitis occurs in up to 9.5% of breastfeeding women (96,97), but may rarely occur in women who are not nursing. Most cases are sporadic, presenting commonly in the second or third week following delivery (98,99). The onset of symptoms is usually abrupt with chills, malaise, generalized achiness, and fever as high as 39 to 40°C. The affected breast is tender, hot, swollen, and erythematous in a wedge-shaped segment (96) with its apex at the nipple and its base toward the periphery, demarcated by the divisions between the lobes of the breast. Decreased milk secretion may be noted (100), but expression of pus from the ducts is uncommon (99). Poor breastfeeding technique with attachment difficulties, injury to the nipple, nipple fissuring, and milk stasis (101) is considered to be the primary etiologic factor, along with lowered immune status from stress or sleep deprivation (96), but the cause of most cases is unclear (97). One study found fewer than 10 feedings/day to beprotective(96), contrary to common belief. Mastitis is no more common among women who are nursing for the first time than among women who have previously nursed. Previous mastitis is a risk factor for recurrence in successive pregnancies (96), perhaps due to persistence of poor practices (102).
Postpartum Problems (The Puerperium), Including Neonatal Problems – Answers
Rekha Wuntakal, Madhavi Kalidindi, Tony Hollingworth in Get Through, 2014
Various minor breast conditions are common during the puerperium; these include sore nipples, milk stasis and mastitis. More serious examples include abscesses and neoplasms. Inflammatory changes are easily treated with frequent breast emptying; infectious conditions require antibiotics. The symptoms of mastitis are fever, malaise, erythema and pain. The patient is usually several weeks postpartum when this condition develops. Staphylococcus aureus and Staphylococcus epidermidis are the most common causative organisms. Breast abscesses typically develop in lactating women. Breast abscess need to be ruled out in patients who do not respond to antibiotic treatment. The standard treatment is surgical incision, breaking down of loculi and drainage of pus under antibiotic cover.
Risk factors and possible causes of perinatal mental illness
Elaine A Hanzak in Another Twinkle in the Eye, 2017
So what were their reasons? Physically I had a tough time. During the latter stages of pregnancy, I was ill with urinary tract infections and very exhausted. The birth was traumatic; I had a retained placenta, postpartum haemorrhage and needed surgery. At my six week check-up, I had to have more surgery for a D&C (dilation and curettage) as the neck of my womb had not closed. I developed mastitis several times, a condition that causes a woman’s breast tissue to become painful and inflamed, as a result of breastfeeding. I was extremely sleep-deprived. Not only was the birth traumatic, there was considerable stress when my baby was four months old as he was hospitalised for suspected meningitis. It was finally diagnosed as a viral septicaemia (another name for blood poisoning that refers to invasion of bacteria into the bloodstream, and this occurs as part of sepsis). Along with all of that was my personality – I like to be busy, efficient and organised. I like to be tidy and to please and impress others. As a school teacher, I was used to planning, writing and completing tasks from lists then evaluating them. I attempted to maintain all this with a fractious baby and diminishing sleep. I had high expectations of myself and motherhood. I had the financial pressure to return to work when neither I nor my child were well enough. In hindsight, it wasn’t surprising something had to give – that was my mental health.
Treatment of lactational breast abscesses with cavity diameter larger than 5 cm via combined ultrasonography-guided percutaneous catheter placement and hydrostatic pressure irrigation
Published in Journal of Obstetrics and Gynaecology, 2022
Zhihui Du, Lei Liu, Xing Qi, Peisen Gao, Shumin Wang
Breast infection is a common problem among lactating women presenting with mastitis to abscess formation. The incidence of lactational breast abscesses ranges from 4% to 11% (Benson 1989). Milk stasis provides a lactose-rich culture medium for bacteria, of which Staphylococcus aureus (S. aureus), Staphylococcus epidermidis, and streptococci are the major contributing organisms (Givens and Luszczak 2002). Traditional management of breast abscesses involves surgical incision and drainage and a resultant frequent need for general anaesthesia and daily dressing changes. In recent years, ultrasonography (US)-guided percutaneous drainage of breast abscesses using needle aspiration or catheter drainage under local anaesthesia has been used as an alternative to surgical incision and drainage (Berna-Serna et al. 2004; Christensen et al. 2005; Chandika et al. 2012). Compared with traditional drainage though surgical incision, US-guided interventional treatment has better cosmetic effects, a shorter healing time, and does not require general anaesthesia (Eryilmaz et al. 2005; Fahrni et al. 2012).
Origins of human milk microbiota: new evidence and arising questions
Published in Gut Microbes, 2020
Shirin Moossavi, Meghan B. Azad
The proposed “retrograde transfer” of external bacteria into the mammary gland is another relatively new area of research. In addition to the areola skin and the infant oral cavity, exogenously derived bacteria could also originate from breast pumps. This mechanism is less appreciated because historically the majority of milk microbiota studies were concerned with intramammary cow’s milk with the primary goal of understanding predisposition to mastitis, which is the most costly disease of dairy animals.17 However, specially in human studies, the focus is now shifting to the offspring and the milk that s/he receives, whether that milk is pumped or provided directly from the breast. Reverse flow of milk from the infant mouth back into the breast occurs during breastfeeding,18 and probably pumping as well, allowing for infant mouth- or pump-associated bacteria to enter the milk duct. Our finding that feeding mode (nursing directly from the breast vs. using a pump) was the most consistent factor associated with milk microbiota composition suggests the exogenously derived bacteria have a stronger role in milk inoculation than the entero-mammary pathway. Increased risk of lactational mastitis in women who pump is also consistent with this proposition.19 Further research is needed to confirm whether bacteria actually enter the mammary gland during nursing and/or pumping, or simply inoculate milk as it is expressed.
Bacteria Associated with Granulomatous Lobular Mastitis and the Potential for Personalized Therapy
Published in Journal of Investigative Surgery, 2022
Xin-Qian Li, Hong-Li Wu, Jing-Ping Yuan, Tian-gang Liu, Sheng-Rong Sun, Chuang Chen
The relationship between GLM and breast cancer is a key concern for doctors and patients. Six cases of non-puerperal mastitis concurrent with breast cancer were identified by PubMed search. Five of the patients involved were diagnosed with GLM. Notably, the stages of breast cancer were very early. The cases included three cases of ductal carcinoma in situ (DCIS) [78–80], two cases of invasive breast carcinoma [81,82] and one case of invasive breast carcinoma and DCIS [83]. Most of the cases involved the right breast [79–83], and over half of the patients were more than 40 years old [78,80,81,83]. However, in only one case was Corynebacterium infection identified, on the same breast as DCIS [78], indicating that further investigation of the association between GLM-associated bacteria and breast cancer is warranted. Nevertheless, patients with a history of non-puerperal mastitis might be at increased risk of breast cancer [84]. Peters et al. [85] found that the risk of breast cancer in patients with non-puerperal mastitis was significantly increased within twelve months after mastitis treatment. Furthermore, a recent study in a large population in China showed that patients with a history of non-lactation mastitis were at high risk for breast cancer, especially those under 50 years of age, of lower socioeconomic status or receiving hormone drugs [86]. However, the intrinsic relationships between non-puerperal mastitis and breast cancer need further investigation.
Related Knowledge Centers
- Abscess
- Breast
- Breast Pump
- Fever
- Inflammation
- Udder
- Breastfeeding
- Latch
- Cracked Nipple
- Weaning