Mastitis

Background

• Occurs due to bacterial colonization 2/2 areolar inflammation and glandular obstruction
• Often occurs during the first few weeks to months postpartum

Clinical Features

1. Fever/chills
2. Flulike symptoms
3. Breast exam shows erythematous region on breast w/ well-localized area of tenderness

Work-Up

• US useful to differentiate mastitis from breast abscess

Differential Diagnosis

3rd Trimester/Postpartum Emergencies

• Acute fatty liver of pregnancy
• Amniotic fluid embolus
• Chorioamnionitis
• Eclampsia
• HELLP syndrome
• Mastitis
• Peripartum cardiomyopathy
• Postpartum endometritis (postpartum PID)
• Postpartum headache
• Postpartum hemorrhage
• Preeclampsia
• Resuscitative hysterotomy
• Retained products of conception
• Septic abortion
• Uterine rupture

Treatment

• There is no need to routinely interrupt breastfeeding with puerperal mastitis
  • Frequent breast emptying is therapeutic
• Antibiotics
  • Indicated for severe pain or signs of systemic infection
    • Dicloxacillin 250mg QID x10–14d OR
    • Cephalexin 500mg QID x10–14d OR
    • Clindamycin 300mg QID x10–14d

Disposition

• If suspect breast abscess refer for immediate surgical drainage

Source

Tintinalli