A lactating mother develops a painful, erythematous right breast on day 12 postpartum with fever of 38.8 degrees C. After 48 hours of appropriate oral flucloxacillin she remains febrile and a fluctuant tender mass is palpable in the upper outer quadrant. What is the next step in management?
- A Switch to intravenous ceftriaxone and continue conservative care
- B Abrupt weaning of both breasts and bromocriptine suppression
- C Incision and drainage of the abscess with continued expression of milk from the affected breast ✓
- D Add oral metronidazole and review in 1 week
Correct answer: C. Incision and drainage of the abscess with continued expression of milk from the affected breast
Explanation
Puerperal mastitis is usually caused by Staphylococcus aureus; failure to improve after 48 hours of appropriate antistaphylococcal therapy signals abscess formation, confirmed clinically by fluctuance or by ultrasound. Treatment is incision and drainage (or ultrasound-guided aspiration) along with continued milk drainage from the affected breast, since abrupt weaning worsens engorgement and delays resolution, killing option B. Antibiotic escalation alone cannot cure an organized abscess, and anaerobic cover is unnecessary in community acquired lactational mastitis.
Reference: DC Dutta's Textbook of Obstetrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.