Breast complications in pregnancy and postpartum and its management

2. A Midwife
• Must ensure that the baby is adequately fed
at the breast.
• Must help the mother to develop necessary
skills to feed her baby by herself.
• Must know about the different breast
conditions which may effect on feeding and
many complications which can arise after
delivery.

3. Long Nipple
Inverted and
Flat Nipple
Short Nipple
Abnormally
Large Nipple

4. • It leads to poor feeding because the
baby is able to latch on to the nipple
without drawing the breast tissue into
his mouth.

5. • It doesn’t cause any problem as
the baby has to form a teat from
both the breast and nipple.

6. •In this case if the baby is small
then his/her mouth may not be
able to get beyond the nipple and
on to the breast.
•Lactation should be initiated by
expressing.

7. • If the nipple is deeply inverted it is
necessary to initiate lactation by
expressing.
INVERTED NIPPLE FLAT NIPPLE

8. Using your thumb and
index finger, gently squeeze
the areola about 1 inch
behind the nipple. This
technique will make a normal
nipple protrude.
The nipple on this breast protrudes
normally.
imple "pinch test" will show you whether
your nipple is inverted:

9. pinch test will make an inverted nipple pull inw

10. Breast Engorgement
Deep breast pain
Cracked &
Retracted Nipple
Mastitis

11. •Exaggerated normal venous and
lymphatic engorgement of the breast
which precedes lactation
•Manifests after the milk secretion starts
(3rd or 4th day of post-partum)

13. • Considerable pain & feeling of tenseness or
heaviness in both the breasts.
• Generalized malaise or ever transient rise
of temperature.
• Painful breast feeding
• The breasts are hard – often edematous,
painful and sometimes flushed.

14. •To avoid pre-lacteal feeds.
•To initiate breast feeding early
and feeding at frequent intervals)
• Exclusive breast feeding on demand
• Feeding in the correct position.

15. support the breast with a binder or brassiere.
Manual expression if any remaining milk after ea
eed and keeping the interval short between feed
n also use breast pump gently.
dminister analgesics for pain if required.

16. •The baby should be put to the breast
regularly after manual expression of milk.
•Milk suppressive drug e.g. Bromocriptine
2.5 mg daily for 2-3 days should be
administered in cases where the breast
remains tight even after suckling or
expression.
•Fluid intake should not be restricted.
•Cabbage leaves can be applied to the

17. • Unclean hygiene resulting in formation
of crust over the nipple.
• Retracted nipple.
• Vigorous suckling in engorged breast or
associated with depressed nipple or in
case having inadequate milk flow.

19. •Local cleanliness during pregnancy
and in the puerperium before and after
each breastfeeding to prevent crust
formation over the nipple.

20. • Applying Tincture Benzoin after the night feeding
• Nipples are to be kept dry and exposed to air.
• Gentian violet is applied over the nipple as well
as the baby’s mouth if there is oral thrush.
• If all these failed to heal up then rest is given to
the affected nipple for 24 hours and breasts are
strapped with a tight bandages.
• In severe cases breast feeding has to be suspended
to prevent mastitis.

21. • Manually pulling out of the retracted nipple
during last two months of pregnancy is
useful to rectify the defect.
• After delivery, nipple is pulled out by
suction action of a disposable syringe.

22. •It is likely to be due to raised intra-
ductal pressure caused by inefficient
milk removal.
•Very very deep breast pain may be the
result of ductal thrush infection.

23. • Inflammation of the breast.
• Non-infective (acute inflammatory)
occurs during early days as a result of
un-resolve engorgement
• It may also developed at any time when
poor feeding techniques results in the
milk not being efficiently remove by the
baby from one or more segment of the
breast.
MASTITIS

24. MASTITIS
• Infective mastitis is caused by the damage to
the epithelium which allows bacteria to enter
the underlying tissues.
• Milk stasis will increase further and ideal
condition for pathogenic bacteria to
replicate.

25. CLINICAL FEATURES
• Generalized malaise and headache.
• Fever with chills and rigor.
• Severe pain and tender swelling in one
quadrant of the breast.
• Presence of wedge shaped swelling on
the breast with its apex at the nipple.
• The overlying skin is hot and flushed
• Feels tense and tender.

26. PROPHYLACTIC TREATMENT
• Antenatal care of breast.
• Wash the nipples periodically during last two
months to keep the patency of the duct
openings.
• Use nipple shield during last three months in
cases of depressed nipple.
• Teach the art of manual expression and
clearance of colostrum from 36th
weeks
onwards.

27. CURATIVE TREATMENT
• Mother n baby has to be isolated.
• Breast feeding on the affected breast has to
be suspended.
• Cloxacillin 500mg 6 hourly or Cephalosporin
should be administered after sensitivity
report.
• Analgesic n sedative

28. BREAST ABSCESS
SIGNS N SYMPTOMS
• Flushed breasts not responding to
antibiotics promptly.
• Brawny edema of the overlying
skin.
• Marked tenderness.
• Swinging temperature

29. TREATMENT
• It is to be drained under general
anesthesia by a deep radial incision
extending near the areolar margin to
prevent injury of the lactiferous ducts.

30. NURSING DIAGNOSIS
• Pain related to cracked/sore nipple
secondary to engorge.
• Hyper pyrexia related to infection
secondary to mastitis.
• Altered feeding pattern related to
anatomical variation of the breast n
complications
• Ineffective bonding related to unable to
breast feed secondary to complications.