Vasospasm of the Nipple Presenting as Painful Lactation

Page, Sarah M.; McKenna, David S.

doi:10.1097/01.aog.0000214671.19023.68

Cited by 18 publications

(11 citation statements)

References 5 publications

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“…Additionally, the many parallels between the infectious mastitis and ductal infection bodies of literature also may explain some of the unique traits of ductal infections. Thus, until randomized controlled trials of treatment are run or until there is information that conflicts with the hypotheses of biofilms and small‐colony variants, ruling out conditions like nipple vasospasm, 35 culturing women with these symptoms, and then treating them is a reasonable method of management. Empirical treatment using antibiotics or fluconazole or both can be based on maternal history and presentation, together with infant findings, or providers can wait to base treatment on culture results.…”

Section: Resultsmentioning

confidence: 99%

Results of Microbial Testing Exploring the Etiology of Deep Breast Pain During Lactation: A Systematic Review and Meta‐analysis of Nonrandomized Trials

Betzold

2012

J Midwife Womens Health

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In lactating women reporting deep breast pain, evidence consistent with infection is persistently found, and explanations exist for the disorder's atypical characteristics. Although lactating women with deep breast pain are more likely to test positive for Candida, the risk of testing positive for S aureus is also present. Thus, these women should have cultures done. Management options include treating immediately while awaiting results or waiting until results are available to guide treatment. With either approach, providers must consider the risk of falsely negative tests.

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Section: Resultsmentioning

confidence: 99%

Results of Microbial Testing Exploring the Etiology of Deep Breast Pain During Lactation: A Systematic Review and Meta‐analysis of Nonrandomized Trials

Betzold

2012

J Midwife Womens Health

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“…Examples are algodystrophy or acute posttraumatic ischaemic of the limbs [93], exercise-induced amaurosis fugax-like symptoms [94] due to vasospasm of the retinal arteries, painful and ischaemic mammilla provoked by nursing [95,96] or orgasmic headache due to transient vasospasm [97-99]. All these symptoms fortunately occur infrequently.…”

Section: General Symptoms and Signs Of Pvdmentioning

confidence: 99%

The primary vascular dysregulation syndrome: implications for eye diseases

2013

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Vascular dysregulation refers to the regulation of blood flow that is not adapted to the needs of the respective tissue. We distinguish primary vascular dysregulation (PVD, formerly called vasospastic syndrome) and secondary vascular dysregulation (SVD). Subjects with PVD tend to have cold extremities, low blood pressure, reduced feeling of thirst, altered drug sensitivity, increased pain sensitivity, prolonged sleep onset time, altered gene expression in the lymphocytes, signs of oxidative stress, slightly increased endothelin-1 plasma level, low body mass index and often diffuse and fluctuating visual field defects. Coldness, emotional or mechanical stress and starving can provoke symptoms. Virtually all organs, particularly the eye, can be involved. In subjects with PVD, retinal vessels are stiffer and more irregular, and both neurovascular coupling and autoregulation capacity are reduced while retinal venous pressure is often increased. Subjects with PVD have increased risk for normal-tension glaucoma, optic nerve compartment syndrome, central serous choroidopathy, Susac syndrome, retinal artery and vein occlusions and anterior ischaemic neuropathy without atherosclerosis. Further characteristics are their weaker blood–brain and blood-retinal barriers and the higher prevalence of optic disc haemorrhages and activated astrocytes. Subjects with PVD tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.

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“…After delivery of the infant and prior to diagnosis of retained placenta, active management is recommended to facilitate spontaneous placental separation, including oxytocin, controlled cord traction, and uterine massage 4. These maneuvers have been shown to decrease the risk of postpartum hemorrhage, though it has not been shown that active management will prevent retained placenta 22…”

Section: Managementmentioning

confidence: 99%

“…This is typically diagnosed when the placenta fails to spontaneously separate during the third stage of labor when a patient experiences excessive bleeding in absence of placenta separation or if there is confirmation of placenta tissue remaining after the majority of the placenta delivers spontaneously 1–3. Placentas that fail to spontaneously separate can be a cause of significant surgical and hemorrhagic morbidity 4,5. Untreated, retained placenta is considered the second leading cause of postpartum hemorrhage (PPH) 5,6…”

Section: Introductionmentioning

confidence: 99%

<p>Retained placenta after vaginal delivery: risk factors and management</p>

Perlman¹,

Carusi²

2019

IJWH

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Retained placenta after vaginal delivery is diagnosed when a placenta does not spontaneously deliver within a designated amount of time, variably defined as a period of 18–60 mins. It may also be diagnosed if a patient experiences significant hemorrhage prior to delivery of the placenta. Normal placenta delivery requires adequate uterine contractions, with shearing of the placenta and decidua from the uterine wall and expulsion of the tissue. Thus, retained placenta can occur in the setting of significant uterine atony, abnormally adherent placenta, as with placenta accreta spectrum (PAS), or closure of the cervix prior to placental expulsion. Risk factors for retained placenta parallel those for uterine atony and PAS and include prolonged oxytocin use, high parity, preterm delivery, history of uterine surgery, and IVF conceptions. History of a prior retained placenta and congenital uterine anomalies also appear to be risk factors. Management entails manual removal of the placenta with adequate analgesia, as medical intervention alone has not been proven effective. Complications can include major hemorrhage, endometritis, or retained portions of placental tissue, the latter of which can lead to delayed hemorrhage or infection. Prophylactic antibiotics can be considered with manual placenta removal, though evidence regarding effectiveness is inconsistent. If hemorrhage is encountered, deployment of a massive transfusion protocol, uterine evacuation with suction, and use of intrauterine tamponade, as with an intrauterine balloon, should be initiated immediately. When a separation plane between the placenta and uterus is particularly difficult to create, PAS should be considered, and preparations should be made for hemorrhage and hysterectomy. Patients with risk factors for retained placenta should have a laboratory sample sent for blood type and antibody screening on admission to labor and delivery, and plans should be made for appropriate analgesia and preparations for hemorrhage if a retained placenta is encountered.

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Vasospasm of the Nipple Presenting as Painful Lactation

Cited by 18 publications

References 5 publications

Results of Microbial Testing Exploring the Etiology of Deep Breast Pain During Lactation: A Systematic Review and Meta‐analysis of Nonrandomized Trials

Results of Microbial Testing Exploring the Etiology of Deep Breast Pain During Lactation: A Systematic Review and Meta‐analysis of Nonrandomized Trials

The primary vascular dysregulation syndrome: implications for eye diseases

<p>Retained placenta after vaginal delivery: risk factors and management</p>

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