0071643192.pdf

OBSTETRICS AND GYNECOLOGY

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■ Oral contraceptive pills and progestational agents like oral medroxyproges-

terone acetate and danazol are used if fertility is not wanted.

■ Surgical treatment is indicated in women with infertility or with severe dis-

ease or adhesions.

MASTITIS

Mastitis is cellulitis of breast tissue. It is most commonly due to S. aureus,

coag-negativeStaphylococcus, or viridans streptococci. The source of the

bacteria is usually the feeding infant’s nose or throat. Typically the colonized

infant is asymptomatic, but localized skin and systemic infections occur.

SYMPTOMS/EXAM

Presents with erythema, edema, tenderness, malaise, and often fever

DIFFERENTIAL

■ Breast abscess: Can be confirmed by ultrasound, requires incision and

drainage

■ Inflammatory breast cancer: Skin often has classic orange-peel appearance

in addition to warmth, tenderness, and redness; confirmed by biopsy.

DIAGNOSIS

The physical exam is key for the diagnosis. If concern for an abscess exists, a

breast ultrasound or needle aspiration can be helpful.

TREATMENT

■ Warm compresses or frequent hot baths

■ Antistaphylococcal antibiotics (dicloxacillin 250 mg or cephalexin 500 mg

PO QID ×7 days)

■ With puerperal mastitis, breast feeding should be continued and treat-

ment is the same as listed above except for recommending frequent breast

emptying.

■ Needle aspiration of a breast abscess is thought to have little risk of spreading

cancer (if present) and may be performed by an emergency physician.

■ Surgical consultationor referral is appropriate for patients requiring open

drainageof a breast abscess.