General preventive measures to avoid the development of mastitis. Treatment and prevention of postpartum mastitis Lactation mastitis and cracked nipples

Antipyretics for children are prescribed by a pediatrician. But there are emergency situations with fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you lower the temperature in older children? What medications are the safest?

Mastitis (a disease also called “breastfeeding”) most often develops in women during the lactation period. However, it happens that mastitis affects nulliparous women, and in rare cases, even men. This disease is characterized by an inflammatory process in the mammary gland. If treatment measures are not taken immediately, you may wait until surgery.

In 90% of cases, mastitis is diagnosed in nursing mothers. Statistics indicate that the disease occurs in 16% of new mothers and 74% of first-born mothers. To avoid falling into this number, you need to know about methods of preventing mastitis. Let's take a closer look at what this disease is and what needs to be done to avoid it.

Causes of mastitis

Lactation mastitis is more common. Every woman should know about the etiology, treatment, and prevention of this disease. The most common cause of breast inflammation is infection. In 90% of cases, the causative agent is Staphylococcus aureus; mastitis is also caused by streptococcus and Escherichia coli. The pathogen easily penetrates the mammary gland through cracks in the nipples, as well as through lesions that are present with tonsillitis chronic form or pyelonephritis. With healthy immune system The body easily copes with minor infections. However, with a decrease in immunity, there is no strength to fight pathogens. Childbirth is a great stress for the body; all efforts are aimed at recovery. It is no wonder that very often after childbirth, women develop mastitis, when even the slightest penetration of the pathogen causes inflammation. Prevention and treatment of mastitis is very important to carry out in a timely manner so that there are no complications.

An infection that has penetrated from the outside spreads throughout the mammary gland and through the lymphatic ducts. There is a possibility of pathogens entering with lymph and blood from distant infectious foci, for example those localized in the organs of the genitourinary system.

Favorable conditions are often created for the development of disease in the mammary gland, in particular, this happens when milk stagnation occurs - lactostasis. Stagnant milk in the breast ducts is an excellent breeding ground for bacteria because it contains so many nutrients.

In what cases does lactostasis occur? If the baby does not suck all the milk from the breast, and the mother does not express herself, it stagnates, as a result, over the course of 3-4 days, a favorable environment for the development of pathogenic microflora matures, and mastitis begins. The likelihood of the disease is high in women with irregularly shaped nipples, as well as in those who do not maintain hygiene and ignore mastitis prevention.

The disease we are considering is often accompanied by obesity, diabetes, infectious diseases, difficult recovery period after childbirth.

Lactation mastitis

Lactation mastitis, which occurs in nursing mothers, has several stages, and one can transform into another. To avoid this, you need to prevent and treat mastitis in a timely manner.

First stage - serous. A woman’s body temperature rises sharply, her breasts become significantly enlarged and swollen. When touched, pain occurs. If timely treatment is not started, the disease will develop into acute form. Then the temperature reaches 39 degrees, severe chills occur, and there are signs of intoxication ( headache, malaise). The breasts are heavy, the color of the integument turns red, and the woman suffers from constant pain. Expressing milk causes severe discomfort, and the procedure does not bring relief.

If the development of the disease is not stopped, it develops into infiltrative. At this stage, the patient has a fever, the chest swells even more, and the pain does not stop, even if you do not touch the chest. The condition of the body is very serious. The woman suffers from insomnia, lack of appetite, headaches intensify, and general weakness is even more pronounced. A blood test reveals increased level leukocytes. There is also pain in the armpits (lymph nodes). This is what awaits those who are not serious about preventing lactation mastitis. During the infiltrative stage, it is necessary to stop feeding the child, as pus may accumulate in the milk.

The third stage of mastitis - purulent. Temperatures can reach 40-41 degrees. Sweating appears, appetite is completely absent. The chest becomes even more swollen and painful. Expressing becomes very painful, and milk comes out in minimal portions mixed with pus.

The only thing worse than this situation is abscessing mastitis. Abscess, halos and furunculosis begin, purulent cavities form on the chest.

Mastitis can also develop into a phlegmonous stage, when the breast tissue literally melts and neighboring tissues are affected. Septic shock often occurs at this stage.

To avoid such manifestations, it is necessary to take the necessary measures in time. Diagnosis and prevention of mastitis play an important role in maintaining women's health.

Non-lactation mastitis

This type of disease is quite rare - only in 5% of cases. The cause of non-lactation mastitis can be injury, compression of the mammary glands, or any hormonal disruptions that have occurred in the body. The disease, in turn, is divided into fibrocystic, plasma cell, and acute non-lactational. Prevention of mastitis in these cases will differ from the measures taken during lactation.

Plasma cell Mastitis is diagnosed quite rarely. More often it can be observed in women who have given birth a lot. Symptoms resemble breast cancer, but there is no suppuration.

Fibrocellular Mastitis occurs in women between 30 and 60 years of age. The main cause of the disease is a malfunction endocrine system. Pain is felt in both mammary glands, and inflammation is rare.

Acute non-lactational Mastitis can be caused by damage to the fatty tissue of the breast. Sometimes the disease develops in women who have suddenly changed climatic conditions.

Urgent measures when mastitis is detected

Often, inflammatory processes in the breast occur due to stagnation of milk, so the first action in the prevention and treatment of mastitis is to express to the last drop. If you have lactostasis, you should not stop breastfeeding; it helps the outflow from the mammary glands, and also reduces the volume of stagnation. If there is no infection, the stagnation will resolve after pumping. The woman feels relief, the initial symptoms of mastitis disappear.

If infection occurs, the disease should be treated only under the supervision of a doctor; conventional mastitis prevention will not be enough. Only a surgeon is able to distinguish mastitis from lactostasis and determine the purulent form. Most often, a woman is prescribed antibiotics and a course of physiotherapy, but breastfeeding has to be interrupted. If a purulent form of mastitis is detected, physiotherapeutic procedures should be cancelled. Urgently required surgical intervention. The abscess is opened, cleaned and washed. It is subsequently treated as an open purulent wound. To avoid such troubles, it is much easier to find out what mastitis prevention measures exist and follow all the recommendations.

Drug treatment

Mastitis is a rather serious disease, but despite this, with timely intervention, treatment is very successful and quick. Preventing mastitis will help you avoid the disease, but if you still notice the first signs of the disease, immediately contact your doctor - he will decide on treatment methods.

Diagnosis includes milk culture to check sterility and a complete blood count. Treatment begins without waiting for test results (they will help in further activities). Until complete recovery, it is better to stop breastfeeding for a while, because infectious agents, as well as components of the medicinal drug, can enter the child’s body with milk.

The basis in the treatment of any mastitis is antibacterial therapy. The doctor must choose exactly the drug that has the most negative effect on the pathogen. Concentration active substance in tissues should be high, then the treatment will be most effective. Drugs can be administered intravenously, intramuscularly, or the use of tablets is acceptable. Depending on the stage and form of the disease, the course of treatment can last from 5 to 14 days. During this time, milk must be expressed every three hours. Drugs that reduce lactation will help. Treatment of mastitis and prevention of the disease very quickly bring positive results. If the symptoms disappear before completing the full course, do not stop taking the medicine, otherwise a relapse is possible. If therapy does not bring relief and mastitis progresses to a more complex stage, surgical intervention may be required.

Prevention of postpartum mastitis

Avoiding insidious mastitis is not such a difficult task. First of all, every woman during pregnancy and breastfeeding must observe basic hygiene rules. Preventive measures also include:

regular pumping during lactation (it is important not to let milk stagnate in the ducts);
immediate treatment of any injuries that appear on the chest, Special attention given to nipples;
urgently consult a doctor if you suspect mastitis;
adequate sleep and balanced nutrition;
avoiding stressful situations and worries that negatively affect the body’s defense reactions and immunity.

Prevention of mastitis in postpartum period- the basis of the health of a nursing mother.

At the first symptoms, remedies will help relieve the condition traditional medicine, but don’t delay going to the doctor. Depending on the stage of the disease, the fight against mastitis will take no more than 1-2 weeks.

Hygiene

The main measures to prevent postpartum lactation mastitis mainly come down to preventing the formation of various cracks in the nipples, timely treatment microtrauma It is very important to express milk completely on time and follow the rules of personal hygiene. It is necessary to wash your breasts properly every day, using warm water and soap. It is recommended to wipe the areola and nipples with a soda solution (1 teaspoon per glass of boiled water).

To prevent microorganisms from entering the baby’s body, the first drops of milk must be expressed.

Also, prevention of postpartum mastitis involves the use of various protective agents. Be sure to lubricate the nipples with them after each feeding - this will help prevent the development of wounds and cracks. Before feeding with baby soap and water, the protective agent must be carefully removed. You can use folk remedies that help quickly heal cracked nipples.

Proper feeding and pumping

When preventing mastitis, great emphasis is placed on the correct process of breastfeeding. To ensure that the feeding process lasts as long as the baby needs it, without causing discomfort, change the position of the baby. It is necessary to ensure that the pressure on the areola and nipple is distributed evenly, all areas are involved. Attach your baby correctly to the breast. If after feeding the baby does not release the breast and presses, you can lightly pinch his nose - he will push out the nipple.

Then, following the requirements for the prevention of mastitis after childbirth, you must express the remaining milk to the last drop. If the glands are hardened, it is recommended to use a breast pump.

How to properly express milk by hand

Hands must be washed with baby soap. Place on top of the areola thumb, below - ring and index, retreating approximately 3 cm from the nipple. With confident but careful movements, you need to squeeze the breast with your fingers, pressing it inward a little, then point your fingers forward, towards the nipple. At this moment milk should appear. Repeat these movements until complete relief in the mammary gland. No need to feel sorry for yourself, press your chest confidently. For the first time possible painful sensations. If the process occurs correctly, the milk splashes in streams rather than being released in drops. Follow the technique of movements; your fingers should not pinch the nipple - this will injure it. If the skin becomes very wet, wipe it with a dry diaper or napkin. The doctor should tell every young mother in the maternity hospital about the pumping technique. If you still have any questions, do not hesitate to ask your gynecologist.

Expressing with a breast pump

Modern breast pumps are excellent helpers for young mothers. With their help, you can easily and simply express excess milk from the breast. There are many models on the market; choosing the right one for you will not be difficult. Preparation for the procedure will be the same as for manual expression. The device must be sterile. Each breast pump always comes with instructions for use.

What will be the basic rules for pumping technique? The device's funnel should always be positioned so that the nipple is in the middle. The skin must be dry to ensure a vacuum is created while sealing tightly. Further actions depend on the model of the device: you need to press the piston handle, squeeze the bulb or pump (in manual breast pumps) or turn on the button (in an electrical device). When operating manual models, constant mechanical work is required - rhythmic pressing of a pump, pen or bulb. Electrical appliances pump out milk themselves, but here you need to control the process and adjust the device to suit you. The flow of milk should be active and uniform.

At the end of pumping, the stream gradually turns into droplets. The chest should become light and empty. The pumping process itself should not cause discomfort. This is only possible in the first minutes when using a mechanical bulb or pump. After expressing, be sure to immediately sterilize the breast pump.

Leave the breast open for a while and let the remaining milk air dry. Change your underwear daily and use nursing pads that fit into your bra. If you feel a tightness in your breasts, gently massage your breasts and “disperse” it.

Take care of your breasts!

To avoid becoming a victim of postpartum mastitis, prevention must be carried out and all rules must be strictly followed. Be sure to keep your chest warm. With mastitis and lactostasis, even slight hypothermia contributes to the development of various complications. It is not recommended to tighten or bandage the chest. With difficult blood circulation, congestion only increases. Modern doctors say that you don’t need to feed your baby by the hour, it’s better to do it on demand. This way, the risks of lactostasis and mastitis are significantly reduced. When feeding by the hour, milk stagnates in the ducts. Free feeding improves the quality of life for both mother and baby. Mom is healthy, and the baby is always calm and well-fed. By adhering to recommendations for the prevention of mastitis in women, you can avoid this insidious disease and enjoy motherhood and the opportunity to feed a healthy baby.

Traditional recipes for the treatment of mastitis

If mastitis or lactostasis does begin to manifest itself, folk remedies will help alleviate the symptoms of the disease. However, this does not exempt you from going to the doctor; grandma’s remedies alone cannot do this; the pathogen must be destroyed.

By what means and folk recipes for these pathologies our ancestors used: We list the most popular methods:

Eases the patient's condition with lactostasis and mastitis honey cakes. They are prepared from equal proportions of honey and flour. They help to dissolve seals.
A fresh leaf of cabbage, burdock or coltsfoot will reduce the heat and alleviate the condition. The leaves must first be doused with boiling water. You can apply honey or sour cream. After this, secure the compress on the chest with a tight bandage; it is not recommended to use film. The inflamed area must breathe.
It is recommended to apply kombucha to the sore spot and cover the top with paper. The compress should be done before bedtime for a week.
Baked onions with honey help against mastitis; it is also applied as a compress. You can use figs: steam them in milk before use.
To rub the chest, prepare a tincture of Japanese sophora: pour vodka into the plant’s beans in a ratio of ½. You need to insist for three days in a dark place. Strain the tincture, it is ready for use.
Rice starch gruel will ease the condition. Stirring vigorously, dilute the starch in water until it reaches the consistency of sour cream. The product is applied to gauze and applied to the affected area for three hours. You can also use a paste of potato starch and vegetable oil.
Grate the apple and add soft butter. Apply the mixture to your chest and cover with gauze.
Soak a regular gauze napkin, folded in several layers, with Kalanchoe juice and apply to the sore area.
An ointment made from dry celandine and ghee helps. Mix a teaspoon of chopped herbs with two tablespoons of oil.
You can use pumpkin pulp for a compress. It is boiled in milk. When the mixture thickens, make a compress out of it, sprinkle sugar on top and cover with a napkin.

“Grandma’s recipes” will only help alleviate the condition, but will not solve the problem, you need to remember this. At the slightest suspicion of mastitis, you should consult a doctor and begin drug treatment!

16. The system for the prevention of mastitis in cows consists of a complex of zootechnical, agrotechnical, veterinary, sanitary and economic measures.

Strict compliance with zootechnical, hygienic, veterinary and sanitary requirements is the main condition for reliable prevention of mastitis in cows.

The basis of general zootechnical measures for the prevention of mastitis is compliance with the rules of milking, zoohygienic standards for keeping and caring for cows, and sufficient and complete feeding of them. One-sided (highly concentrated or silage-pulp) feeding of cows, or feeding them spoiled, moldy, frozen feed, which can cause diseases of the gastrointestinal tract and contribute to the occurrence of mastitis, should not be allowed.

To prevent mastitis caused by diseases of the gastrointestinal tract, at the beginning of the grazing period,

It is recommended to feed cows 1-2 kg of hay or straw at night.

Active exercise is an important preventive measure not only for metabolic disorders, but also for mastitis in cows. Therefore, during the stall period, daily walks are organized for cows over a distance of at least 4-5 km.

Before and after calving, succulent feed is excluded from the cows’ diet and the supply of concentrates is reduced to 1-1.5 kg. It is better to feed cows with good hay at this time. From the 4-5th day after calving, succulent feed is introduced into the diet and by the 10-12th day the feeding level is brought to full normal.

In premises where lactating and dry animals are kept, it is necessary to maintain the required microclimate and sanitary order. Particular attention should be paid to the quality of litter and timely removal of manure. The litter should be moisture-absorbing, warm and soft. Dry straw and sawdust should be used as bedding material.

Ventilation in the barn should provide an air exchange of at least 70-85 m 3 / hour per cow.

To maintain sanitary order on farms, it is recommended to hold a sanitary day once a month. Twice a year in spring and autumn, preventive disinfection of barns should be done. The maternity ward undergoes thorough mechanical cleaning and disinfection every ten days. The passages in the maternity rooms are regularly sprinkled with powdered lime.

Cows are transferred to the maternity ward 10-15 days before calving and returned to the barn 10-14 days after calving. Before transferring cows to the maternity ward, they are cleaned, contaminated areas of skin are washed, and the external genitalia are disinfected with a solution of potassium permanganate 1:1000. When udder edema appears, 2-3 weeks before calving, the cows are limited in the provision of succulent feed and water, and long walks are prescribed.

Proper milking is the most important measure for the prevention of mastitis in cows.

Regardless of the milking method, a thorough pre-milking treatment of the udder is carried out. One minute before putting the teat cups on the nipples, the udder is washed with warm water (temperature 40-45°) from a spray bottle and wiped with a clean towel, and then the lower one is wiped with a clean napkin moistened in a disinfectant solution (0.5% solution of desmol, iodine monochloride). part of the udder and teats. It is advisable to change the napkin after each cow.

In the absence of special devices, it is allowed to wash the udder from a bucket with one of the disinfectant solutions (0.5% chloramine, 0.5% iodine monochloride, sodium hypochlorite or dezmol).

The first streams of milk are poured into a special mug. Coll

It is absolutely unacceptable to milk the first streams of milk on the floor, since secretions from sick cows can cause the spread of infection.

In the prevention of mastitis in cows, the hygiene of milkmaids is of great importance. Before milking, the milkmaid puts on a clean robe, washes her hands with soap and wipes them with a clean towel.

All farm workers involved in milk production must periodically undergo a medical examination and carefully comply with the requirements set out in the “Sanitary and Veterinary Rules for Dairy Farms of Collective and State Farms for the Care of Milking Plants, Equipment and Dairy Utensils and Determination of the Sanitary Quality of Milk”, approved by the Main Veterinary Directorate of the USSR Ministry of Agriculture on January 22, 1970.

In order to prevent mastitis during machine milking, special measures should be taken, which include:

a) preparing farms for machine milking;

b) monitoring the condition of the udder of cows;

c) monitoring the correct operation of milking machines;

d) control over the sanitary condition of dairy equipment.

PREPARING FARMS FOR MACHINE MILKING

17. Milkmaids, cattlemen, mechanics and other farm workers must undergo a theoretical course and practical training in the techniques of machine milking of cows and sanitary processing of milking equipment.

Healthy cows whose udder shape meets the relevant requirements are transferred to machine milking. The most desirable shape of the udder is bath-shaped, cup-shaped with medium-sized (5-9 cm) cylindrical teats located at right angles to the udder.

Herds in which about half of the cows have an udder shape that does not meet the requirements of machine milking, it is better to transfer to less dangerous milking with Volga three-stroke milking machines.

Herds in which two-thirds of the cows have an udder shape suitable for machine milking can be transferred to milking with two-stroke milking machines DA-2 “Maiga”, “Impulse”.

Farms with machine milking of cows must have equipped dairy, cold and hot water, detergents and disinfectants, as well as an uninterrupted supply of electricity.

Installation of the milking machine must be carried out in accordance with the technical specifications. The assembled milking machine is accepted by a commission consisting of representatives of the farm, V/O Soyuzselkhoztekhnika, the chief specialist in livestock mechanization of the district agricultural department, as well as the district veterinary service.

When accepting the installation of a milking machine, special attention should be paid to the compliance of the operating modes of the milking machine and individual milking machines in accordance with the requirements of the operating instructions.

CONTROL OF THE CONDITION OF THE COW'S UDDER

18. When machine milking cows, monitoring the condition of the udder is decisive in the prevention of mastitis.

When milking the first portions of milk onto the black strainer of the mug, the milkmaid pays attention to the color of the milk, the presence of flakes, blood clots, mucus and other inclusions in it.

During milking, the milkmaid must monitor the behavior of the cow. The animal's restlessness, stepping from foot to foot, an attempt to throw off the milking machine, and milk retention indicate an irritating effect of the machine or an udder disease.

After milk production stops, the apparatus is immediately removed so as not to overexpose the glasses to the milked udder. The milkmaid turns off the vacuum and only after that removes the glasses from the teats by lightly tugging on the manifold. You cannot remove the teat cups without turning off the vacuum, as this leads to ruptures of the mucous membrane and disruption of the integrity of the teat skin.

After finishing milking, the milkmaid must examine the cow's nipples and udder. Any deviations from the norm are immediately reported to the foreman, veterinarian or livestock specialist.

As planned, all dairy cows are regularly checked for hidden mastitis at least once a month using a 5% solution of dimastin or 2% mastidine.

Cows suffering from latent mastitis are milked by hand last, taking precautions to prevent the spread of infection to other cows, and milk from sick animals is not allowed to be mixed with general milk.

Boiled milk from cows with mastitis is used only for animal feed. If there is a significant change in the milk (presence of pus, fibrin, blood), it is destroyed.

If mastitis is widespread in cows, after milking it is necessary to immerse the tips of the teats in a 0.5% solution of iodine monochloride, desmol, or lubricate them with an antiseptic emulsion. A glass is filled with a disinfectant solution, into which the ends of the nipples are placed without subsequently wiping them.

CONTROL OF THE OPERATION OF MILKING MACHINES

19. Before starting milking, the milkmaid must check each milking machine for pulsation frequency. In three-stroke devices, the number of pulses should be 60 per minute, in two-stroke devices - 80 ± 5. More frequent pulsation may cause mastitis in cows.

The vacuum value in the vacuum line during milking should be in the range of 380-400 mm for three-stroke machines and 360-380 mm Hg for two-stroke machines. The vacuum value in the milk pipeline of the milking plant milk pipeline-100 (200) “Daugava” is 450-500 mm Hg.

The milkmaid must constantly monitor the position of the teat cups during milking. If the glasses are detected creeping onto the udder, they are pulled forward and down by the collector. A strong creep of teat cups onto the udder is observed in three-stroke machines converted to work using the push-pull method.

Milking with such machines causes a large number of cows to develop mastitis, so converting three-stroke machines to a two-stroke mode of operation is unacceptable.

When milking into the milk line, sometimes there is a strong fluctuation in the vacuum in the teat space, which leads to slow milking, the collapse of teat cups and the reverse flow of milk into the teat cups, causing the so-called “wet milking”. This contributes to the transfer of infection from sick to healthy lobes of the udder.

If the teat cups fall off during milking, you should pay special attention to the vacuum mode of the installation or to the condition of the vacuum wire, which may be clogged.

When the milking cups fall off, you must immediately turn off the milking machine, wash them thoroughly in a hot 0.5% solution of sodium hypochlorite, desmol, rinse with hot water and only then continue milking.

During the milking process, it is necessary to ensure that the cows are completely milked by the machine. As soon as the flow of milk has stopped, it is necessary to switch to machine milking. For this purpose, the milking cups are pulled forward by the collector for 25-30 seconds. If during this time the milk flow has not increased, then stop milking and remove the glasses.

When milking cows with an udder shape that does not meet the requirements of machine milking, hand milking is allowed in some cases (different times for milking quarters).

A very important preventive measure is to determine the end of milk production in order to avoid dry milking, which leads to mastitis in cows. If no more than 250 ml of milk remains in the udder after milking, then the cow has been milked well. With an increase in the amount of unmilked milk, self-starting of cows and an increase in mastitis are observed.

CONTROL OF THE SANITARY CONDITION OF DAIRY PRODUCTSEQUIPMENT

20. To prevent mastitis, it is necessary to strictly observe sanitary regimes for the care of milking machines and milk utensils.

Veterinary specialists must carry out systematic monitoring of the sanitary condition of milking installations, paying attention to contamination of teat rubber, collector, milk hose, lids and gaskets of milking buckets, viewing devices, milk pipes, filters, coolers and milk pumps, which are most contaminated during operation . When parts of the milking machine become dirty, they become covered with grayish mucus or even milk clots.

SANITARY TREATMENT OF MILKING MACHINESAND DAIRY DISHES

21. The following modes are recommended for sanitizing milking machines with a milk line, portable machines and milk utensils.

MODE I. After each milking, rinse with warm water to remove any remaining milk, then wash with a hot 1% sodium hypochlorite solution and rinse again with warm water.

MODE II. After each milking, rinse with warm water, wash with a 0.5% solution of washing powder A, B or C and disinfect once a day with a 0.1% solution of sodium or calcium hypochlorite or chlorine water. After disinfection, rinse with warm water.

MODE III. After each milking, rinse with warm water, treat with a 0.5% solution of desmol and rinse with warm water.

MODE IV. Rinse with warm water, treat with a hot 0.5% solution of powder A, B, C or soda ash. Once a day, disinfect with steam for 3 minutes.

MODE V. For sanitary treatment of milking equipment using a circulating washing stand, use 0.25% solutions of detergents and 0.1% solutions of disinfectants in the above sequence.

In each farm, based on specific conditions, a specialist can choose the most appropriate mode of sanitization of milking equipment, which are recommended by these rules.

An indicator of the effectiveness of sanitary measures carried out on farms is also the results of milk testing for mechanical and bacterial contamination, which is carried out every ten days by dairy laboratories.

PREVENTION OF MASTITES DURING THE DRY PERIOD

22. Cows are started l"/g-2 months before the expected calving. At the same time, the supply of succulent feed and concentrates is limited to 50% of the diet. From three times milking they switch to double milking, then to single milking, after which they milk every other day and stop milking. Cows that are difficult to start are, in some cases, completely succulent and concentrated feeds are excluded from the diet and watering is limited.

The disease of cows with mastitis with a subclinical course is observed quite often during the start-up and dry periods. If there is no control over the condition of the udder during this period, mastitis goes unnoticed and is discovered after calving. In many cases, postpartum mastitis is a consequence of infection of the udder during dry periods. Therefore, during the dry period, it is recommended to conduct a clinical examination of the udder with a test milking of secretions once every two weeks. In order to prevent mass postpartum mastitis, cows suffering from subclinical mastitis can be intrauterinely administered long-acting antibiotics (bicillin-3) at a dose of 300 thousand units in each quarter of the udder or preparations mastikur, masticide, according to current instructions. In this case, antibiotics are administered after testing cows for mastitis through a test milking, test with dimastin and settling.

Antibiotic therapy for subclinical mastitis during the dry period reduces the number of clinically significant postpartum mastitis in cows by 50%.

ANNEX 1	The secret of the sick quarter	Initially unchanged in appearance, and then liquid, often with flakes	The secretion is liquid, watery, grayish-white in color, mixed with yellowish or whitish flakes. Less commonly, a small amount of yellowish whey with flakes or a thick, creamy mass is released	Serum with fibrin crumbs; less often, the exudate is thick with a predominance of flakes. There may be blood impurities, blood clots, and tissue fragments
Differential diagnosis of acute mastitis in cows	Quarter condition	More often than not, half or all of the udder is affected. It is enlarged, unevenly compacted, and doughy in places. The nipple is often enlarged and swollen	One quarter is affected, it is enlarged or compacted in areas, especially at the base. The nipple is unchanged, less often edematous, with foci of fluctuation at the base	One quarter is affected. It is sharply enlarged, compacted with the presence of individual dense nodes and areas of softening. The nipple is swollen. Sometimes crepitus is noted
	Skin condition local temperature, udder soreness	The skin is tense, non-pigmented areas are hyperemic, the temperature is elevated, the pain is significant	The skin is unchanged, the temperature is rarely slightly increased, the pain is mild or not at all	The skin is tense, non-pigmented areas are hyperemic. Body temperature is increased. A quarter is painful
	General condition of the animal	Often no change, less often oppression; body temperature is normal or slightly elevated, sometimes lameness	No visible changes, sometimes slight depression; decreased appetite; increase in body temperature	Depression, decreased or lack of appetite; increased body temperature; lameness, emaciation
		Serous mastitis	Catarrhal mastitis	Fibrinous mastitis

The secret of the sick quarter	The exudate is mucopurulent, often thick with white or yellow flakes, can be liquid, yellow-red in color	At first, the milk does not change in appearance, but there is little of it. Then it becomes watery, grayish-white or yellowish in color, and contains an admixture of pus and casein. The type of secretion depends on the number of abscesses and the location of their opening (through the skin or into the lumen of the milk ducts)	There is little secretion, it is watery, grayish in color with an admixture of flakes, and often bloody	There is little secretion, it is watery, reddish in color, with flakes and blood clots
Quarter condition	The affected quarter of the udder is enlarged and in some places has compacted lesions. The nipple is sometimes swollen	The affected quarter is unevenly enlarged, fluctuating, tense foci of varying sizes are palpable. With deep location of abscesses, the quarter is enlarged, fluctuation is weakly expressed	The affected quarter is significantly enlarged; very swollen nipple	More often, half or all of the udder is affected. The affected part is uniformly enlarged and compacted. Swollen nipple
Skin condition, local temperature, udder soreness	The skin is tense, non-pigmented areas are hyperemic. body temperature is increased. Soreness is expressed	The skin at the site of the outbreak is tense, swollen, hyperemic, hot, painful	The skin is tense, swollen, uniformly hyperemic, temperature and pain are significant	The skin is swollen evenly, diffusely hyperemic, the temperature is elevated, the pain is significant
General condition of the animal	Depression, refusal to feed; increased body temperature; lameness	Depression, loss of appetite, significant increase in body temperature; with multiple abscesses, remitting fever; lameness	Severe depression, significant increase in body temperature; decreased or lack of appetite; lameness	Depression, significant increase in body temperature; decreased appetite
	Purulent catarrhal mastitis	Udder abscess	Phlegmon	Hemorrhagic mastitis

APPENDIX 2

LABORATORY RESEARCH METHODS

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INDIVIDUAL TASK

“Lactation mastitis. Tactics of a paramedic-obstetrician"

Prepared

4th year student of 402 LD group

Khoteikina Anastasia Nikolaevna

VITEBSK 2015

Introduction

mastitis lactation parenchyma inflammation

Lactation mastitis is an inflammation of the parenchyma and interstitium of the mammary gland that occurs in the postpartum period during lactation.

Lactation mastitis is a common pathology of the mammary glands in postpartum women. Their frequency currently amounts to 2-33% of the total number of births in the world. Violation of the basic principles of preventing the disease, untimely and improper treatment of its initial forms contribute to the development of severe purulent lesions of the mammary gland, complicated by sepsis. Therefore, the main prerequisite for the correct prevention of mastitis and improving the outcomes of their treatment is maximum attention to this issue on the part of medical workers in obstetric, gynecological and surgical institutions and the consistent implementation of a number of well-founded and practice-tested measures.

Mastitis occurs due to infection of the mammary glands by pathogenic microbes, mainly staphylococci. Predisposing factors to the development of inflammation in the gland are stagnation of milk, the appearance of cracked nipples, infectious diseases suffered during pregnancy, complicated labor, violation of hygienic principles of feeding the child, lack of proper sanitary and hygienic conditions in maternity wards and insufficient compliance with the principles of preventing mastitis at home. . Therefore, prevention of mastitis should begin during pregnancy, continue during the woman’s stay in the maternity hospital before childbirth, during the labor and postpartum periods and after discharge from the maternity hospital at home under the supervision of obstetric and gynecological service workers.

Many factors are considered to predispose to mastitis, but only two of them, in our opinion, are leading: milk stagnation and infection. Thomsen and others studied the causes of lactostasis and non-infectious inflammatory diseases breastfeeding and came to the conclusion about the need to continue breastfeeding with lactostasis and initial stages mastitis. Non-infectious mastitis progressed to infectious or abscess in only 4% of cases if regular breast emptying continued. Progression to infectious mastitis was seen in 79% of cases when breastfeeding was discontinued. Perhaps this effect of predisposition to lactostasis explains the high incidence of mastitis in the first weeks after childbirth, when the outflow of milk is especially difficult.

The entrance gates for microorganisms are most often cracks in the nipples; intracanalicular penetration of infection is also possible during breastfeeding or expressing milk; less often, the spread of infection through hematogenous and lymphogenous routes from endogenous foci of infection.

Extremely important factor the occurrence of LM, as mentioned above, is stagnation of milk with infection by pathogenic microorganisms. With stagnation, the number of bacteria in milk and milk passages increases. Curdled milk undergoes lactic acid fermentation, which leads to the destruction of the epithelium lining the milk ducts and alveoli. When the pressure in the breast increases, blood circulation is disrupted and venous stagnation occurs. With the development of edema of the interstitial tissue, its resistance to pathogenic microorganisms decreases, which creates good conditions for the development of infection.

Risk factors for lactation mastitis include:

Insufficient personal hygiene;

Low socio-economic level of the patient;

The presence of concomitant extragenital pathology (skin pyoderma, lipid metabolism disorder, diabetes mellitus);

Reduced immunoreactivity of the body;

Complicated childbirth;

Complicated course of the postpartum period (wound infection, delayed uterine involution, thrombophlebitis);

Insufficiency of the milk ducts in the mammary gland;

Anomalies in nipple development;

Cracked nipples;

Incorrect expression of milk.

Symptoms

Features of the clinical course of lactation mastitis in modern conditions are:

Late onset (1 month after birth);

An increase in the proportion of erased, subclinical forms of mastitis, in which clinical manifestations diseases do not correspond to the true severity of the process;

The predominance of infiltrative-purulent form of mastitis;

Protracted and prolonged course of purulent forms of the disease.

The development of the inflammatory process in the mammary gland is facilitated by lactostasis caused by occlusion of the excretory ducts. In this regard, mastitis in the vast majority of cases occurs in primiparas.

With lactostasis, the mammary gland increases in volume, dense enlarged lobules with a preserved fine-grained structure are palpated. Body temperature can rise to 38-40 °C. This is due to damage to the milk ducts, milk absorption and its pyrogenic effect. There is no hyperemia of the skin and swelling of the gland tissue, which appear during inflammation. After expressing the mammary gland during lactostasis, the pain disappears, small, painless lobules with clear contours and a fine-grained structure are palpated, and body temperature decreases. In the case of mastitis that has already developed against the background of lactostasis, after pumping, a dense painful infiltrate continues to be detected in the breast tissue and persists heat body, the patients’ well-being does not improve.

If lactostasis is not stopped within 3-4 days, then mastitis occurs, since with lactostasis the number of microbial cells in the milk ducts increases several times and, as a result, the threat of rapid progression of inflammation is real.

Serous mastitis

The disease begins acutely, in the 2-3-4 weeks of the postpartum period, usually after the postpartum mother is discharged from the obstetric hospital. Body temperature rises to 38-39 °C, accompanied by chills. Symptoms of intoxication appear (general weakness, weakness, headache). The patient is first worried about a feeling of heaviness, and then pain in the mammary gland, stagnation of milk. The mammary gland slightly increases in volume, its skin is hyperemic. Expressing milk is painful and does not bring relief. Palpation of the affected gland reveals diffuse pain and moderate infiltration of the gland without clear boundaries. With inadequate therapy and progression of the inflammatory process, serous mastitis turns into an infiltrative form within 2-3 days.

Infiltrative mastitis

The patient is worried about severe chills, a feeling of tension and pain in the mammary gland, headache, insomnia, weakness, loss of appetite. A sharply painful infiltrate without foci of softening and fluctuation is palpated in the mammary gland. The gland is enlarged in size, the skin over it is hyperemic. There is an increase and pain on palpation of the axillary lymph nodes. In a clinical blood test, moderate leukocytosis is observed, ESR rises to 30-40 mm/h. In case of ineffective or untimely treatment after 3-4 days from the onset of the disease inflammatory process becomes purulent in nature.

Purulent mastitis

The condition of patients worsens significantly: weakness increases, appetite decreases, and sleep is disturbed. Body temperature is often within the range of 38-49 °C. Chills, sweating, and pale skin appear. Pain in the mammary gland intensifies, which is tense, enlarged, hyperemia and swelling of the skin are expressed. On palpation, a painful infiltrate is determined. Milk is expressed with difficulty, in small portions, and pus is often found in it.

Abscess form of mastitis

The predominant variants are furunculosis and areola abscess; intramammary and retromammary abscesses, which are purulent cavities limited by a connective tissue capsule, are less common. When palpating the infiltrate, fluctuation is noted. In a clinical blood test, there is an increase in the number of leukocytes (15.0-16.0 * 109/l), ESR reaches 50-60 mm/h, moderate anemia (80-90 g/l) is diagnosed.

Phlegmonous form of mastitis

The process captures most of the gland with melting of its tissue and transfer to the surrounding tissue and skin. The general condition of the postpartum woman in such cases is serious. Body temperature reaches 40 °C. Chills and severe intoxication occur. The mammary gland sharply increases in volume, its skin is swollen, hyperemic, with areas of cyanosis. There is a sharp expansion of the subcutaneous venous network, lymphangitis and lymphadenitis. On palpation, the mammary gland is pasty and sharply painful. Areas of fluctuation are identified. A clinical blood test reveals leukocytosis up to 17.0-18.0 * 109/l, an increase in ESR - 60-70 mm/h, increasing anemia, a rod shift in the leukocyte formula, eosinophilia, leukopenia. Phlegmonous mastitis may be accompanied by septic shock.

Gangrenous form of mastitis

The course is especially severe with severe intoxication and necrosis of the mammary gland. The general condition of the patient is severe, the skin is pale, the mucous membranes are dry. A woman complains of lack of appetite, headache, and insomnia. Body temperature reaches 40 °C, pulse is rapid (110-120 beats/min), weak filling. The mammary gland is enlarged, painful, swollen; the skin over it is pale green to bluish-purple, in some places with areas of necrosis and blistering, the nipple is inverted, there is no milk. Regional The lymph nodes enlarged and painful on palpation. In a clinical blood test: leukocytosis reaches 20.0-25.0*109/l, there is a sharp shift in the leukocyte formula to the left, toxic granularity of neutrophils, ESR increases to 70 mm/h, hemoglobin level decreases to 40-60 g/l.

Paramedic tactics and treatment

With lactostasis, first of all, it is necessary to take measures aimed at eliminating its cause. It is necessary to find out the feeding regimen, consult the nursing mother to ensure feeding on demand, only breastfeeding without the additional use of formulas, nipples, bottles, etc., and monitor the correct attachment of the newborn to the breast. A woman is recommended to follow a certain diet that does not provoke fluid retention, swelling, i.e. exclude sweet, fatty, salty foods. If there is a clear excess of milk in the first days of lactation, you can express the excess milk before feeding the newborn.

Basic principles of mastitis treatment

Continuation of breastfeeding (feeding the baby from the diseased gland 6 times and expressing milk 3 times from the healthy gland).

Timely regular evacuation of milk.

Elimination of the pathogen (antibacterial therapy).

Treatment of cracked nipples.

Early start of treatment.

Treatment is carried out taking into account the form and phase of the process.

Once the diagnosis of postpartum mastitis is confirmed, antibiotic therapy should be initiated to ensure optimal outcome. Delaying treatment significantly increases the incidence of abscess formation.

Whatever therapeutic methods are used, it is necessary to observe the basic principle: treat mastitis taking into account the phases and stages of the process: in the initial stages, a comprehensive conservative therapy, in the destructive phase of the process - surgery followed by treatment of a purulent wound.

Treatment can be carried out either on an outpatient basis or in a hospital, depending on the severity of the patient's condition. Systemic signs should be limited to fever and mild malaise. In case of outpatient treatment, re-examination and assessment of the patient’s condition are required within 24-48 hours. If there is no positive dynamics in response to antibiotic therapy, the woman should be hospitalized.

Continued breastfeeding helps remove microorganisms and their metabolic products from the breast and reduce milk stagnation.

Treatment of postpartum mastitis should be etiotropic, complex, specific and active. It should include antibacterial drugs, detoxification and desensitizing agents, methods for increasing specific immunological reactivity and nonspecific defense of the body, for purulent mastitis - timely surgical intervention.

Treatment of mastitis in the stage of serous infiltration should be comprehensive and include the following measures:

Rest (bed rest).

Elevating the diseased gland using a bra.

Limiting fluid intake.

Feeding the baby from the diseased gland 6 times (and expressing milk 3 times from the healthy gland).

Applying cold (heating pads with ice) to the affected area of the breast for 20 minutes every 1-1.5 hours (for 2-3 days).

Injections of oxytocin 0.5 g subcutaneously 2-3 times a day, just before feeding.

Use of sulfa drugs 1.0 g 4-5 times a day.

Introduction (parenteral) of broad-spectrum antibiotics, first without taking into account sensitivity, then, after receiving the results of milk culture, taking into account the sensitivity of the microflora to them.

If the inflammatory process in the mammary gland, under the influence of systematically carried out conservative treatment for 3-5 days, cannot be reversed and continues to develop further, conservative treatment should be replaced by surgical treatment.

Success surgical treatment Lactation mastitis depends on the effectiveness and duration of conservative therapy and the period elapsed from the onset of the disease to surgery.

In severe general condition of patients with abscess mastitis, surgery should be performed immediately upon admission to the hospital under general anesthesia. An incision 7-10 cm long is made at the site of fluctuation or greatest pain in the radial direction, not reaching the isola or 2-3 cm away from the nipple. The skin and subcutaneous tissue are dissected and the abscess cavity is opened. A finger inserted into the cavity of the abscess separates all existing cords and bridges. If there is an abscess in both the upper and lower quadrants of the mammary gland, an incision should be made in the lower quadrant and through it the abscess located in the upper quadrant should be emptied. If it is difficult to empty the abscess from one incision, it is necessary to make a second radial incision through a counter-hole.

Antibiotics are the main component in complex therapy postpartum mastitis. Basic requirements for antibiotics used during lactation:

harmlessness for mother and newborn;

wide spectrum of action (primarily against gram-positive cocci and gram-negative rods);

sufficient concentration and affinity for breast tissue;

compliance (method and mode of application convenient for the patient).

Prevention of mastitis during pregnancy

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 hygiene measures: maintaining cleanliness of the body, linen, and hands. Hygienic measures increase the tone of the body and the functional activity of its individual organs and systems, in particular the mammary glands. Pregnant women should be recommended to wash the mammary glands daily (in the morning) with soap and water at room temperature, 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 elevated, because their drooping predisposes to the formation of milk stagnation. As the mammary glands enlarge with the progress of pregnancy, the sizes of bras should change. The underwear should be light and loose and not compress the body anywhere. Starting from the 5th-6th month of pregnancy, daily air baths are desirable. For this purpose, a pregnant woman should be recommended to lie on the bed with her chest open for 10-15 minutes.

At oily skin nipples, it is recommended to wash the mammary glands with baby soap during the morning toilet, and if the skin of the nipple is severely dry, lubricate it with sterile petroleum jelly. The pregnant woman must be warned that for all manipulations with the mammary glands and nipples, she must have a separate hand towel.

Preventive measures to prevent mastitis should be carried out especially strictly and persistently from the moment a woman in labor is admitted to the hospital and in the postpartum period. System preventive measures The procedures carried out to possibly protect postpartum women from infection with hospital-acquired staphylococcus begin from the moment of admission to the emergency room and are of an organizational nature.

Prevention of mastitis in the postpartum period

Parturient women should pay special attention to the preparation and technique of feeding the child. Having taken a comfortable position, they spread a baby diaper at the chest and protect the mammary gland from underwear and a robe. The department's dairy nurse explains and demonstrates the technique of expressing milk.

Proper attachment is one of the components that ensures pleasant and long-term breastfeeding for children. It is the correct attachment that allows young mothers to avoid injury to the nipples, blockage of the milk ducts, and as a result, the occurrence of lactostasis and mastitis.

The mother should give the breast to the child; there is no need to wait for him to show activity and cling to it himself. The breast should be supported with your hand - thumb over the nipple, palm under the breast. Move the nipple along the baby's lower lip and, after waiting for the baby to open his mouth as wide as possible, place the breast in the mouth as deeply as possible. Correct grip is ensured by the deep insertion of the nipple and areola into the child’s mouth, while the nipple should be in the area soft palate. The baby's lower lip should be turned outward and the tongue should be down.

Externally, correct attachment looks like this: the baby rests his nose and chin on his mother’s chest. Thus, he feels his mother with almost his entire face, which has a calming effect on him. There is no need to worry that the child will not be able to breathe and hold the “dimple” near his nose with your finger. This innocent action can lead to blockage of the milk duct, and, in addition, the child will “slide” onto the end of the nipple and injure it. The hard wings of the baby's nose will prevent him from suffocating. If the grip is correct, the mother should not feel pain. There should be no sounds such as smacking or clicking while sucking. These sounds indicate an incorrect grip. During the entire period of breastfeeding, the mother should ensure that the baby grasps the breast correctly.

Among other hygienic measures that protect nipples from infection, the most important are the daily washing of each postpartum mother’s hands with a sterile brush, washing the body to the waist (especially the mammary glands and nipples thoroughly) with running water and soap and wiping them with a special diaper, changed every time.

For lying-in mothers, this measure should be replaced by wiping the mammary glands with a cotton ball (separate for each gland) moistened with a 2% solution of salicylic alcohol. The effectiveness of these measures is systematically tested by examining swabs from the skin of the nipples of the mammary glands for the presence of pathogenic microbes.

Prevention and treatment of cracked nipples

Nipple cracks, which are a reservoir of pathogenic staphylococcus and an entry point for infection, are of great importance in the occurrence of mastitis. The main predisposing factors leading to the appearance of cracks are:

poor nutrition of the pregnant woman and insufficient administration of vitamins, especially in the last months of pregnancy;

failure to comply with general hygiene measures;

improper care of nipples during pregnancy;

incorrect feeding method;

incorrect expression of milk by hand.

After the postpartum woman is discharged from the maternity hospital, further monitoring of the correct feeding and compliance with the hygienic principles of preventing cracked nipples and lactation mastitis should be carried out by children's and antenatal clinics, and when visiting postpartum women at home - by midwives and visiting nurses.

Nipples are treated in one of the following ways:

Before each feeding, the nipple and isola

wipe with a ball of clean cotton wool or gauze soaked in a solution of ammonia, and dry by applying (but not rubbing) dry cotton wool to them; After such preparation, the baby is given breastfeeding. After feeding, the nipple is wiped and dried again, as before feeding, after which the woman lies with her breasts open for 15-20 minutes (air bath).

The nipples are not treated before feeding. After each feeding

nipples are lubricated with a 1% solution of methylene blue in 60° alcohol: the woman lies with her breasts open for 15-20 minutes (air bath).

Apply 1-5% syntomycin emulsion to the nipple in the form of gauze pads.

The nipples are not treated before feeding. After each feeding

lubricate the cracks with prednisolone ointment.

For cracked nipples, wearing bras is one of the important treatment and preventive measures. Maintaining cleanliness of the entire body, frequent changes of underwear and bed linen, short cutting of nails, daily washing of the mammary glands are the most important hygienic measures for cracked nipples and threatening mastitis.

Bibliography

Lasachko S.A. Diagnosis and treatment of diffuse benign breast diseases / Modern trends in outpatient care in obstetrics and gynecology. - Donetsk: Lebed LLC, 2003. - P. 195-203.

Oskretkov V.I., Kokin E.F. Surgery patients with acute abscess and phlegmonous lactational mastitis // Bulletin of surgery. - 2001. - T. 160, No. 2. - P. 70-76.

Usov D.V. Selected lectures on general surgery. - Tyumen, 1995. 49-77s.

Chaika V.K., Lasachko S.A., Kvashenko V.P. The role of the obstetrician-gynecologist in the detection and prevention of breast diseases // News of medicine and pharmacy. - 2004. - No. 7 (May). - pp. 14-15.

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Causes of mastitis

Inflammation with mastitis is caused by a purulent infection, predominantly Staphylococcus aureus. This microorganism causes various suppurative processes in humans, from local skin lesions (acne, boils, carbuncles, etc.) to fatal injuries internal organs(osteomyelitis, pneumonia, meningitis, etc.).

Any suppurative process caused by Staphylococcus aureus can be complicated by generalization with the development of septic endocarditis, sepsis or infectious-toxic shock.

Recently, cases of mastitis caused by association of microorganisms have become more frequent. The most common combination of Staphylococcus aureus with gram-negative Escherichia coli (common in environment microorganism that normally inhabits the human intestine).
Lactation mastitis
In cases where we are talking about classic postpartum lactation mastitis, the source of infection most often becomes hidden bacteria carriers from medical personnel, relatives or roommates (according to some data, about 20-40% of people are carriers of Staphylococcus aureus). Infection occurs through contaminated care items, linen, etc.

In addition, a newborn infected with staphylococcus can become a source of infection for mastitis, for example, with pyoderma (pustular skin lesions) or in the case of umbilical sepsis.

However, it should be noted that contact with Staphylococcus aureus on the skin of the mammary gland does not always lead to the development of mastitis. For the occurrence of an infectious-inflammatory process, it is necessary to have favorable conditions - local anatomical and systemic functional ones.

Thus, local anatomical predisposing factors include:

gross scar changes in the gland left after severe forms of mastitis, operations for benign neoplasms, etc.;
congenital anatomical defects (retracted flat or lobulated nipple, etc.).

As for systemic functional factors contributing to the development of purulent mastitis, the following conditions should be noted first:

pregnancy pathology (late pregnancy, premature birth, threatened miscarriage, severe late toxicosis);
pathology of childbirth (trauma of the birth canal, first birth of a large fetus, manual separation of the placenta, severe blood loss during childbirth);
puerperal fever;
exacerbation of concomitant diseases;
insomnia and other psychological disorders after childbirth.

Primiparas are at risk of developing mastitis due to the fact that their milk-producing glandular tissue is poorly developed, there is a physiological imperfection of the gland ducts, and the nipple is underdeveloped. In addition, it is important that such mothers have no experience of feeding a child and have not developed the skills to express milk.
Non-lactation mastitis
Develops, as a rule, against the background of a decrease in general immunity (transferred viral infections, severe concomitant diseases, severe hypothermia, physical and mental stress, etc.), often after microtrauma of the mammary gland.

The causative agent of non-lactation mastitis, as well as mastitis associated with pregnancy and lactation, in most cases is Staphylococcus aureus.

To understand the features of the mechanism of development of lactational and non-lactational mastitis, it is necessary to have a general understanding of anatomy and physiology mammary glands.

Anatomy and physiology of the mammary glands

The mammary gland is an organ reproductive system, intended for the production of human milk during the postpartum period. This secretory organ is located inside a formation called the breast.

The mammary gland contains a glandular body surrounded by well-developed subcutaneous fatty tissue. It is the development of the fat capsule that determines the shape and size of the breast.

At the most protruding place of the breast, there is no fat layer - here is the nipple, which, as a rule, has a cone-shaped, less often cylindrical or pear-shaped.

The pigmented areola makes up the base of the nipple. In medicine, it is customary to divide the mammary gland into four areas - quadrants, bounded by conditional mutually perpendicular lines.

This division is widely used in surgery to indicate the localization of the pathological process in the mammary gland.

The glandular body consists of 15-20 radially located lobes, separated from each other by fibrous connective tissue and loose fatty tissue. The bulk of the glandular tissue itself, which produces milk, is located in the posterior parts of the gland, while ducts predominate in the central regions.

From the anterior surface of the gland body, through the superficial fascia that limits the fatty capsule of the gland, dense connective tissue strands are directed to the deep layers of the skin and to the collarbone, representing a continuation of the interlobar connective tissue stroma - the so-called Cooper ligaments.

The main structural unit of the mammary gland is the acinus, consisting of tiny formations of vesicles - alveoli, which open into the alveolar ducts. The inner epithelial lining of the acinus produces milk during lactation.

The acini are united into lobules, from which the milk ducts depart, merging radially towards the nipple, so that the individual lobules unite into one lobe with a common collecting duct. The collecting ducts open at the top of the nipple, forming an expansion - the milk sinus.

Lactation mastitis proceeds less favorably than any other purulent surgical infection, this is due to the following features of the anatomical and functional structure of the gland during lactation:

lobular structure;
a large number of natural cavities (alveoli and sinuses);
developed network of milk and lymphatic ducts;
abundance of loose fatty tissue.

The infectious-inflammatory process during mastitis is characterized by rapid development with a tendency to rapid spread of infection to neighboring areas of the gland, involvement of surrounding tissues in the process and a pronounced risk of generalization of the process.

So, without adequate treatment, the purulent process quickly engulfs the entire gland and often takes a protracted, chronically relapsing course. In severe cases, purulent melting of large areas of the gland and the development of septic complications (infectious-toxic shock, blood poisoning, septic endocarditis, etc.) are possible.

Mechanism of development of the infectious-inflammatory process

The mechanism of development of lactational and non-lactational mastitis has some differences. In 85% of cases lactation mastitis the disease develops against the background of milk stagnation. In this case, lactostasis, as a rule, does not exceed 3-4 days.

Acute lactation mastitis

With regular and complete expression of milk, bacteria that inevitably fall on the surface of the mammary gland are washed away and are not capable of causing inflammation.

In cases where adequate pumping does not occur, a large number of microorganisms accumulate in the ducts, which cause lactic fermentation and milk coagulation, as well as damage to the epithelium of the excretory ducts.

Curdled milk together with particles of desquamated epithelium clog the milk ducts, resulting in the development of lactostasis. Quite quickly, the amount of microflora that multiplies intensively in a confined space reaches a critical level, and infectious inflammation develops. At this stage, secondary stagnation of lymph and venous blood occurs, which further aggravates the condition.

The inflammatory process is accompanied by severe pain, which in turn makes it difficult to express milk and aggravates the state of lactostasis, so that a vicious circle is formed: lactostasis increases inflammation, inflammation increases lactostasis.

In 15% of women, purulent mastitis develops against the background of cracked nipples. Such damage occurs due to the inadequacy of a sufficiently strong negative pressure in oral cavity baby and poor elasticity of the nipple tissue. Purely hygienic factors can play a significant role in the formation of cracks, such as, for example, prolonged contact of the nipple with the damp fabric of the bra. In such cases, irritation and weeping of the skin often develops.

The occurrence of cracks often forces a woman to give up breastfeeding and careful pumping, which causes lactostasis and the development of purulent mastitis.

To avoid nipple damage when breastfeeding, it is very important to latch your baby to the breast at the same time every day. In such cases, the correct biorhythm of milk production is established, so that the mammary glands are, as it were, prepared for feeding in advance: milk production increases, the milk ducts expand, the lobules of the gland contract - all this contributes to the easy release of milk during feeding.

With irregular feeding, the functional activity of the glands increases already during feeding; as a result, individual lobules of the gland will not be completely emptied and lactostasis will occur in certain areas. In addition, with an “unready” breast, the baby has to expend more effort while sucking, which contributes to the formation of nipple cracks.

Non-lactation mastitis

At non-lactation mastitis the infection, as a rule, penetrates the gland through damaged skin due to an accidental injury, thermal injury (a heating pad, tissue burn in an accident), or mastitis develops as a complication of local pustular skin lesions. In such cases, the infection spreads through the subcutaneous fatty tissue and fatty capsule of the gland, and the glandular tissue itself is damaged again.

(Non-lactation mastitis, which arose as a complication of a breast boil).

Symptoms and signs of mastitis

Serous stage (form) of mastitis

The initial or serous stage of mastitis is often difficult to distinguish from banal lactostasis. When milk stagnation occurs, women complain of heaviness and tension in the affected breast; a mobile, moderately painful lump with clear segmental boundaries is palpated in one or more lobes.

Expressing with lactostasis is painful, but the milk comes out freely. The woman's general condition is not affected and her body temperature remains within normal limits.

As a rule, lactostasis is a temporary phenomenon, so if within 1-2 days the compaction does not decrease in volume and persistent low-grade fever appears (increase in body temperature to 37-38 degrees Celsius), then serous mastitis should be suspected.

In some cases, serous mastitis develops rapidly: the temperature suddenly rises to 38-39 degrees Celsius, and complaints of general weakness and pain in the affected part of the gland appear. Expressing milk is extremely painful and does not bring relief.

At this stage, the tissue of the affected part of the gland is saturated with serous fluid (hence the name of the form of inflammation), into which, a little later, leukocytes (cells that fight foreign agents) enter from the bloodstream.

At the stage of serous inflammation, spontaneous recovery is still possible, when pain in the gland gradually subsides and the lump completely resolves. However, much more often the process moves into the next - infiltrative phase.

Considering the seriousness of the disease, doctors advise that any significant engorgement of the mammary glands, accompanied by an increase in body temperature, should be considered the initial stage of mastitis.

Infiltrative stage (form) of mastitis

The infiltrative stage of mastitis is characterized by the formation of a painful compaction in the affected gland - an infiltrate that has no clear boundaries. The affected mammary gland is enlarged, but the skin above the infiltrate at this stage remains unchanged (redness, local increase in temperature and swelling are absent).

Elevated temperature during the serous and infiltrative stages of mastitis is associated with the entry of human milk from foci of lactostasis into the blood through damaged milk ducts. Therefore, when effective treatment lactostasis and desensitizing therapy, the temperature can be reduced to 37-37.5 degrees Celsius.

In the absence of adequate treatment, the infiltrative stage of mastitis passes into the destructive phase after 4-5 days. In this case, serous inflammation is replaced by purulent inflammation, so that the gland tissue resembles a sponge soaked in pus or a honeycomb.

Destructive forms of mastitis or purulent mastitis

Clinically, the onset of the destructive stage of mastitis is manifested by a sharp deterioration general condition patient, which is associated with the entry of toxins from the focus of purulent inflammation into the blood.

Body temperature rises significantly (38-40 degrees Celsius and above), weakness, headache appear, sleep worsens, and appetite decreases.

The affected breast is enlarged and tense. In this case, the skin over the affected area turns red, the skin veins dilate, and the regional (axillary) lymph nodes often become enlarged and painful.

Abscess mastitis characterized by the formation of cavities filled with pus (abscesses) in the affected gland. In such cases, softening is felt in the area of infiltration; in 99% of patients, the symptom of fluctuation is positive (a feeling of iridescent liquid when palpating the affected area).

(Localization of ulcers in abscess mastitis:
1. - subalveolar (near the nipple);
2. - intramammary (inside the gland);
3. - subcutaneous;
4. - retromammary (behind the gland)

Infiltrative abscess mastitis, as a rule, is more severe than an abscess. This form is characterized by the presence of a dense infiltrate, consisting of many small abscesses of various shapes and sizes. Since the ulcers inside the infiltrate do not reach large sizes, the painful compaction in the affected gland may appear homogeneous (the symptom of fluctuation is positive in only 5% of patients).

In approximately half of the patients, the infiltrate occupies at least two quadrants of the gland and is located intramammary.

Phlegmonous mastitis characterized by total enlargement and severe swelling of the mammary gland. In this case, the skin of the affected breast is tense, intensely red, in places with a cyanotic tint (bluish-red), the nipple is often retracted.

Palpation of the gland is sharply painful; most patients have a pronounced symptom of fluctuation. In 60% of cases, at least 3 quadrants of the gland are involved in the process.

As a rule, disturbances in laboratory blood parameters are more pronounced: in addition to an increase in the number of leukocytes, there is a significant decrease in hemoglobin levels. Indicators are significantly violated general analysis urine.

Gangrenous mastitis develops, as a rule, as a result of involvement in the process blood vessels and the formation of blood clots in them. In such cases, as a result of a gross disruption of the blood supply, necrosis of large areas of the mammary gland occurs.

Clinically, gangrenous mastitis is manifested by an enlargement of the gland and the appearance on its surface of areas of tissue necrosis and blisters filled with hemorrhagic fluid (ichor). All quadrants of the mammary gland are involved in the inflammatory process; the skin of the breast takes on a bluish-purple appearance.

The general condition of patients in such cases is severe; confusion is often observed, the pulse quickens, and blood pressure drops. Many laboratory parameters of blood and urine tests are disrupted.

Diagnosis of mastitis

If you suspect inflammation of the mammary gland, you should seek help from a surgeon. In relatively mild cases, nursing mothers can consult their attending physician at the antenatal clinic.

As a rule, making a diagnosis of mastitis does not cause any particular difficulties. The diagnosis is determined based on the patient’s characteristic complaints and examination of the affected mammary gland.
From laboratory research, as a rule, carry out:

bacteriological examination of milk from both glands (qualitative and quantitative determination of microbial bodies in 1 ml of milk);
cytological examination milk (counting the number of red blood cells in milk as markers of the inflammatory process);
determination of milk pH, reductase activity, etc.

For destructive forms of mastitis it is indicated ultrasonography mammary gland, allowing to determine the exact localization of areas of purulent melting of the gland and the condition of the surrounding tissues.
In case of abscess and phlegmonous forms of mastitis, puncture of the infiltrate is performed with a needle with a wide lumen, followed by bacteriological examination pus.

In controversial cases, which often arise in the case of a chronic process, an X-ray examination of the breast gland (mammography) is prescribed.

In addition, in case of chronic mastitis, differential diagnosis with breast cancer must be carried out, for this purpose a biopsy (sampling of suspicious material) and histological examination are performed.

Treatment of mastitis

Indications for surgery are destructive forms of infectious and inflammatory process in the mammary gland (abscess, infiltrative-abscess, phlegmonous and gangrenous mastitis).

The diagnosis of a destructive process can be unambiguously made in the presence of foci of softening in the mammary gland and/or a positive symptom of fluctuation. These signs are usually combined with a violation of the patient’s general condition.

However, erased forms of destructive processes in the mammary gland are often encountered, and, for example, with infiltrative abscess mastitis, it is difficult to detect the presence of foci of softening.

Diagnosis is complicated by the fact that banal lactostasis often occurs with a disturbance in the general condition of the patient and severe pain in the affected breast. Meanwhile, as practice shows, the issue of the need for surgical treatment should be resolved as soon as possible.

In controversial cases, to determine medical tactics, first of all, carefully express milk from the affected breast, and then after 3-4 hours, re-examine and palpate the infiltrate.

In cases where it was only a question of lactostasis, after expressing the pain subsides, the temperature drops and the general condition of the patient improves. Fine-grained, painless lobules begin to be palpated in the affected area.

If lactostasis was combined with mastitis, then even 4 hours after pumping, a dense painful infiltrate continues to be palpated, the body temperature remains high, and the condition does not improve.

Conservative treatment of mastitis is acceptable in cases where:

the patient's general condition is relatively satisfactory;
the duration of the disease does not exceed three days;
body temperature below 37.5 degrees Celsius;
there are no local symptoms of purulent inflammation;
pain in the area of infiltration is moderate, palpable infiltrate occupies no more than one quadrant of the gland;
General blood test results are normal.

If conservative treatment does not produce visible results for two days, this indicates the purulent nature of the inflammation and serves as an indication for surgical intervention.

Surgery for mastitis

Surgeries for mastitis are performed exclusively in a hospital setting, under general anesthesia (usually intravenous). At the same time, there are basic principles for the treatment of purulent lactation mastitis, such as:

when choosing an surgical approach (incision site), the need to preserve function and aesthetics is taken into account appearance mammary gland;
radical surgical treatment (thorough cleansing of the opened abscess, excision and removal of non-viable tissue);
postoperative drainage, including the use of a drainage-washing system (long-term drip irrigation of the wound in postoperative period).

(Incisions for operations for purulent mastitis. 1. - radial incisions, 2. - incision for lesions of the lower quadrants of the mammary gland, as well as for retromammary abscess, 3 - incision for subalveolar abscess)
Typically, incisions for purulent mastitis are made in a radial direction from the nipple through the area of fluctuation or greatest pain to the base of the gland.

In case of extensive destructive processes in the lower quadrants of the gland, as well as in case of retromammary abscess, the incision is made under the breast.

For subalveolar abscesses located under the nipple, the incision is made parallel to the edge of the nipple.
Radical surgical treatment includes not only removal of pus from the lesion cavity, but also excision of the formed abscess capsule and non-viable tissue. In the case of infiltrative-abscess mastitis, the entire inflammatory infiltrate within the boundaries of healthy tissue is removed.

Phlegmonous and gangrenous forms of mastitis require the maximum volume of surgery, so that in the future plastic surgery of the affected mammary gland may be necessary.

The installation of a drainage and lavage system in the postoperative period is carried out when more than one quadrant of the gland is affected and/or the patient’s general condition is severe.

As a rule, drip irrigation of the wound in the postoperative period is carried out for 5-12 days, until the patient’s general condition improves and components such as pus, fibrin, and necrotic particles disappear from the rinsing water.

In the postoperative period, drug therapy is carried out aimed at removing toxins from the body and correcting those caused by the purulent process general violations in organism.

Antibiotics are mandatory (most often intravenously or intramuscularly). In this case, as a rule, drugs from the group of 1st generation cephalosporins (cefazolin, cephalexin) are used, when staphylococcus is combined with E. coli - 2nd generation (cefoxitin), and in the case of a secondary infection - 3rd-4th generation (ceftriaxone, cefpirome). In extremely severe cases, thienam is prescribed.

With destructive forms of mastitis, as a rule, doctors advise stopping lactation, since feeding a child from an operated breast is impossible, and pumping in the presence of a wound causes pain and is not always effective.
Lactation is stopped with medication, that is, drugs are prescribed that stop the secretion of milk - bromocriptine, etc. Routine methods of stopping lactation (breast bandaging, etc.) are contraindicated.

Treatment of mastitis without surgery

Most often, patients seek medical care with symptoms of lactostasis or in the initial stages of mastitis (serous or infiltrative mastitis).

In such cases, women are prescribed conservative therapy.

First of all, you should provide rest to the affected gland. To do this, patients are advised to limit physical activity and wear a bra or bandage that would support but not compress the sore breast.

Since the trigger for the occurrence of mastitis and the most important link in the further development of the pathology is lactostasis, a number of measures are taken to effectively empty the mammary gland.

A woman should express milk every 3 hours (8 times a day) - first from a healthy gland, then from a sick one.
To improve milk flow, 20 minutes before expressing from the diseased gland, 2.0 ml of the antispasmodic drotaverine (No-shpa) is injected intramuscularly (3 times a day for 3 days at regular intervals), 5 minutes before expressing - 0.5 ml of oxytocin, which improves milk yield.
Since expressing milk is difficult due to pain in the affected gland, retromammary novocaine blockades are performed daily, with the anesthetic novocaine administered in combination with broad-spectrum antibiotics in half the daily dose.

To combat infection, antibiotics are used, which are usually administered intramuscularly in medium therapeutic doses.

Since many of the unpleasant symptoms of the initial stages of mastitis are associated with the penetration of milk into the blood, so-called desensitizing therapy with antihistamines is carried out. In this case, preference is given to drugs of a new generation (loratadine, cetirizine), since drugs of previous generations (suprastin, tavegil) can cause drowsiness in a child.

To increase the body's resistance, vitamin therapy (B vitamins and vitamin C) is prescribed.
If the dynamics are positive, ultrasound and UHF therapy are prescribed every other day, promoting rapid resorption of the inflammatory infiltrate and restoration of the functioning of the mammary gland.

Traditional methods of treating mastitis

It should immediately be noted that mastitis is surgical disease, therefore, at the first signs of an infectious-inflammatory process in the mammary gland, you should consult a doctor who will prescribe proper treatment.

In cases where conservative therapy is indicated, traditional medicine is often used in a complex of medical measures.

So, for example, in the initial stages of mastitis, especially in combination with cracked nipples, you can include procedures for washing the affected breast with an infusion of a mixture of chamomile flowers and yarrow herb (in a ratio of 1:4).
To do this, pour 2 tablespoons of raw material into 0.5 liters of boiling water and leave for 20 minutes. This infusion has a disinfectant, anti-inflammatory and mild analgesic effect.

It should be remembered that in the initial stages of mastitis, under no circumstances should you use warm compresses, baths, etc. Warming up can provoke a suppurative process.

Prevention of mastitis

Prevention of mastitis consists, first of all, in the prevention of lactostasis, as the main mechanism for the occurrence and development of an infectious-inflammatory process in the mammary gland.

Such prevention includes the following measures:

Early attachment of the baby to the breast (in the first half hour after birth).
Developing a physiological rhythm (it is advisable to feed the baby at the same time).
If there is a tendency to stagnation of milk, it may be advisable to perform a circular shower 20 minutes before feeding.
Compliance with the technology of correct milk expression (the manual method is the most effective, in this case special attention must be paid to the outer quadrants of the gland, where stagnation of milk is most often observed).

Since the infection often penetrates through microcracks in the nipples, the prevention of mastitis also includes the correct feeding technology to avoid damage to the nipples. Many experts believe that mastitis is more common in primiparous women precisely because of inexperience and violation of the rules for attaching a child to the breast.

In addition, wearing a cotton bra helps prevent cracked nipples. In this case, it is necessary that the fabric in contact with the nipples is dry and clean.

Predisposing factors for the occurrence of mastitis include nervous and physical stress, so a nursing woman should monitor her psychological health, get good sleep and eat well.
Prevention of mastitis not associated with breastfeeding consists of observing the rules of personal hygiene and timely adequate treatment of skin lesions of the breast.

Is it possible to breastfeed with mastitis?

According to the latest WHO data, breastfeeding during mastitis is possible and recommended: " ...a large number of studies have shown that continued breastfeeding is usually safe for the baby's health, even in the presence of Staph. aureus. Only if the mother is HIV positive is there a need to stop feeding the infant from the affected breast until she recovers."

There are the following indications for interrupting lactation:

severe destructive forms of the disease (phlegmonous or gangrenous mastitis, the presence of septic complications);
appointment antibacterial agents in the treatment of pathology (when taking which it is recommended to refrain from breastfeeding)
the presence of any reasons why the woman will not be able to return to breastfeeding in the future;
the patient's wish.

In such cases, special medications are prescribed in tablet form, which are used on the recommendation and under the supervision of a doctor. The use of “folk” remedies is contraindicated, since they can aggravate the course of the infectious-inflammatory process.

With serous and infiltrative forms of mastitis, doctors usually advise trying to maintain lactation. In such cases, a woman should express milk every three hours, first from the healthy breast and then from the diseased breast.

Milk expressed from a healthy breast is pasteurized and then fed to the baby from a bottle; such milk cannot be stored for a long time either before or after pasteurization. Milk from a sore breast, where there is a purulent-septic focus, is not recommended for the baby. The reason is that for this form of mastitis, antibiotics are prescribed, during which breastfeeding is prohibited or not recommended (the risks are assessed by the attending physician), and the infection contained in such mastitis can cause severe digestive disorders in infant and the need for treatment of the child.

Natural feeding can be resumed after all symptoms of inflammation have completely disappeared. To ensure the safety of restoring natural feeding for the child, a bacteriological analysis of the milk is first carried out.

What antibiotics are most often used for mastitis?

Mastitis is a purulent infection, so bactericidal antibiotics are used to treat it. Unlike bacteriostatic antibiotics, such drugs act much faster because they not only stop the proliferation of bacteria, but kill microorganisms.

Today it is customary to select antibiotics based on the microflora’s sensitivity to them. Material for analysis is obtained during puncture of the abscess or during surgery.

However, at the initial stages, taking material is difficult, and carrying out such an analysis takes time. Therefore, antibiotics are often prescribed before such testing is performed.

In this case, they are guided by the fact that mastitis in the vast majority of cases is caused by Staphylococcus aureus or the association of this microorganism with Escherichia coli.

These bacteria are sensitive to antibiotics from the penicillin and cephalosporin groups. Lactation mastitis is a typical hospital infection, and is therefore most often caused by staphylococcal strains resistant to many antibiotics that secrete penicillinase.

To achieve the effect of antibiotic therapy, penicillinase-resistant antibiotics such as oxacillin, dicloxacillin, etc. are prescribed for mastitis.

As for antibiotics from the cephalosporin group, for mastitis, preference is given to drugs of the first and second generations (cefazolin, cephalexin, cefoxitin), which are most effective against Staphylococcus aureus, including against penicillin-resistant strains.

Is it necessary to apply compresses for mastitis?

Compresses for mastitis are used only in the early stages of the disease in combination with other therapeutic measures. Official medicine advises using semi-alcohol dressings on the affected chest at night.

Among traditional methods you can use cabbage leaves with honey, grated potatoes, baked onions, burdock leaves. Such compresses can be applied both at night and between feedings.

After removing the compress, you should rinse your breasts with warm water.

However, it should be noted that the opinions of doctors themselves regarding compresses for mastitis are divided. Many surgeons indicate that warm compresses should be avoided as they can aggravate the disease.

Therefore, when the first symptoms of mastitis appear, you should consult a doctor to clarify the stage of the process and decide on treatment tactics for the disease.

What ointments can be used for mastitis?

Today, in the early stages of mastitis, some doctors advise using Vishnevsky ointment, which helps relieve pain syndrome, improving milk discharge and resorption of infiltrate.

Compresses with Vishnevsky ointment are used in many maternity hospitals. At the same time, a significant part of surgeons consider the therapeutic effect of ointments for mastitis to be extremely low and indicate the possibility of an adverse effect of the procedure: a more rapid development of the process due to stimulation of bacterial growth by elevated temperature.

Mastitis is a serious disease that can lead to serious consequences. It is untimely and inadequate treatment that leads to the fact that 6-23% of women with mastitis experience relapses of the disease, 5% of patients develop severe septic complications, and 1% of women die.

Inadequate therapy (insufficiently effective relief of lactostasis, irrational prescription of antibiotics, etc.) in the early stages of the disease often contributes to the transition of serous inflammation into a purulent form, when surgery and associated unpleasant moments (scars on the mammary gland, disruption of the lactation process) are already inevitable . Therefore, it is necessary to avoid self-medication and seek help from a specialist.

Which doctor treats mastitis?

If you suspect acute lactation mastitis, you should seek help from a mammologist, gynecologist or pediatrician. In severe forms of purulent forms of mastitis, you must consult a surgeon.

Often women confuse the infectious-inflammatory process in the mammary gland with lactostasis, which can also be accompanied by severe pain and increased body temperature.

Lactostasis and initial forms of mastitis are treated on an outpatient basis, while purulent mastitis requires hospitalization and surgery.

For mastitis that is not associated with childbirth and breastfeeding (non-lactation mastitis), contact a surgeon.

One of the most common breast diseases is mastitis. This disease is an inflammatory process of breast tissue. Mastitis can occur not only in women, but also in men and even children. In addition to a number of unpleasant symptoms, accompanying this disease, mastitis is dangerous due to complications that can lead to extremely negative consequences for the human body. Preventing mastitis will help avoid such problems.

Mastitis and its types

As already mentioned, mastitis is inflammation of the mammary gland. Most often, this disease occurs in young mothers, but women can also be susceptible to it during periods not associated with motherhood.

It is customary to distinguish several types of mastitis:

Postpartum (lactation). This form of the disease usually occurs in primiparous women and appears during breastfeeding. This mastitis occurs due to improper attachment of the baby to the breast. The cause of the disease is usually cracked nipples, stagnation of milk in the breast and poor emptying. In most cases, the causative agent of the disease is Staphylococcus aureus. Such mastitis usually develops after the appearance of lactostasis (stagnation of breast milk in the gland), if measures to combat this condition have not been taken in a timely manner.
Fibrocystic mastitis. This form of mastitis occurs in women suffering from fibrocystic mastopathy, and is an inflammatory process that develops against the background of existing fibrocystic changes in the gland. Its appearance is usually caused by the secondary penetration of any microorganisms into the breast tissue. It may be associated with injuries to the mammary gland (open or closed), hormonal imbalances, and the presence of chronic inflammatory foci in the body.
Mastitis of newborns. This disease is an inflammation of the mammary glands of an infant, which is usually caused by Staphylococcus aureus bacteria, which, for a number of reasons, have penetrated into the breast ducts.

Prevention of postpartum mastitis

It is known that the disease is easier to prevent than to treat, so all young mothers need to do everything possible to avoid this unpleasant disease.

Prevention of mastitis that occurs when breastfeeding, requires compliance with a number of rules:

If during breastfeeding there is a suspicion of lactostasis (enlargement of the mammary glands, engorgement of any parts of them, swelling and soreness of the breasts or nipples), the woman should immediately consult a doctor in the postpartum department or an antenatal clinic.
To prevent lactostasis and mastitis during breastfeeding, it is important to comply with a number of conditions that allow you to effectively empty the mammary glands:
- putting the baby to the breast in the first 2 hours after birth;
- cohabitation of the baby and mother;
- flexible feeding schedule;
- co-sleeping with the baby (it allows you to feed the baby in a timely manner and avoid stagnation of milk);
- refusal to quickly introduce complementary foods (with a rapid increase in the amount of complementary foods, the breasts do not have time to rebuild, which leads to problems);
- late weaning (you should stop breastfeeding when the baby is no longer suckling enough, switching to other foods).
Prevention of cracked nipples when breastfeeding a baby includes compliance with the following rules:
- rational feeding;
- limiting the baby's stay at the breast (especially at the beginning of breastfeeding);
- compliance with the correct feeding technique (the baby should grasp the entire isola);
- treatment of nipples with special prophylactic agents;
- treatment of nipples in case of injury during breastfeeding. For this purpose, after each feeding, you should lubricate the nipples with a small amount of expressed milk, allowing it to dry. Each time treat the affected areas with ointments “Purelan”, “Bepanten” and the like. Change your bra every day, and breast pads every 2 hours, excluding contact of the underwear with the damaged nipple;
- expressing the first drops of milk to remove possible microbes from the gland ducts;
- washing your breasts both before and after each feeding;
- changing the baby's position when feeding (this will ensure uniform pressure on the nipple);
- removing the nipple immediately after feeding;
- avoiding touching the nipple when expressing.
Maintaining healthy image life:
- adherence to daily routine;
- balanced diet;
- taking multivitamins;
- body hygiene (it is advisable that detergents do not dry out the skin and have a neutral pH level).

Prevention of fibrocystic mastitis

Any woman with a history of fibrocystic mastopathy, preventive measures should be taken to prevent the development of mastitis against its background. To do this, you need to follow several rules:

Do not advance fibrocystic disease by treating it in a timely manner.
Try to eliminate all foci of chronic infection.
Avoid injury to the breast.
Wear suitable underwear.
If you experience discomfort in the mammary gland, immediately consult a doctor.

Prevention of neonatal mastitis

Although this form of the disease is rare, it has an extremely negative impact on the baby’s health. Young mothers should pay attention to the child’s condition and take the necessary set of measures to prevent this disease from occurring:

Daily bathing of the baby.
Use only clean clothes.
Timely change of diapers.
Mandatory hand washing before interacting with the baby.
Protecting the baby from people with infectious diseases(acute respiratory infections, colds, flu, etc.), as well as with purulent inflammations on the body.
Timely contacting a pediatrician in case of enlargement of the child’s mammary glands (when a sexual crisis occurs) without attempting to treat it yourself.
Avoiding injury to the baby's skin and mammary glands, as well as dirt getting into them.

Mastitis is a rather unpleasant disease, but it can be easily avoided. Since the cause of the disease is a bacterial infection, following simple preventive measures will keep the mammary glands healthy.

Causes of mastitis

Lactation mastitis

Non-lactation mastitis

Urgent measures when mastitis is detected

Drug treatment

Prevention of postpartum mastitis

Hygiene

Proper feeding and pumping

Take care of your breasts!

Traditional recipes for the treatment of mastitis

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Causes of mastitis

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Symptoms and signs of mastitis

Serous stage (form) of mastitis

Infiltrative stage (form) of mastitis

Destructive forms of mastitis or purulent mastitis

Diagnosis of mastitis

Treatment of mastitis

Surgery for mastitis

Treatment of mastitis without surgery

Traditional methods of treating mastitis

Prevention of mastitis

Is it possible to breastfeed with mastitis?

What antibiotics are most often used for mastitis?

Is it necessary to apply compresses for mastitis?

What ointments can be used for mastitis?

Which doctor treats mastitis?

Mastitis and its types

Prevention of postpartum mastitis

Prevention of fibrocystic mastitis

Prevention of neonatal mastitis