How is DVT treated?
A course of heparin injections will be commenced and this will continue for several days. The traditional heparin may be used or alternatively newer forms of what are known as "low molecular-weight heparin" may be used. The commonest brands used in the UK are Fragmin® (Dalteparin) and Clexane® (Enoxaparin). They all do the same thing, but the administration regimes and monitoring are different. The patient may then be gradually switched to oral warfarin. Treatment will continue for several weeks, with regular clinical assessment and occasional blood tests to monitor the progress.
While treatment will almost certainly be commenced in hospital, after the condition has stabilized, treatment will continue on an outpatient basis. The patient is taught to self-inject heparin or her partner may do this.
An additional measure will be the almost continuous wearing of special pressure stockings (tights). These can be quite uncomfortable, but they are necessary especially if the clot was in the lower limbs.
Breast issues post-delivery
What sort of breast problems could occur after delivery?
The most common problem is marked breast engorgement, without infection. It may affect up to one in five new mothers. There is extreme discomfort and it may cause moderate fever. If there is no evidence of infection, all that is required is simple analgesics (such as paracetamol), adequate breast support, ice packs and - if the mother is not breastfeeding - fluid restriction.
What about infectious mastitis?
This is less common. It is estimated that about 2.5% or one in forty new mothers will have infectious mastitis. A small minority of these will go on to develop a breast abscess.
Are there any predisposing factors to infectious mastitis?
Breast engorgement, nipple trauma and poor breast-feeding technique are some of the commonly cited factors increasing the risk of mastitis. Cracked nipples are thought to be the main route of bacterial entry into breast tissue.
The cause or risk factor is not always apparent.
How can one recognize infectious mastitis?
Infectious mastitis commonly (but not always) affects one breast or the other and not both. Simple breast engorgement mastitis without infection tends to affect both breasts, though to varying degrees. Apart from the discomfort, even pain, there may be other less specific symptoms, including malaise and fever. Examination of the breasts will almost always reveal inflammation of the affected breast.
What is the treatment for infectious mastitis?
Once recognized, broad-spectrum antibiotics should be commenced promptly. This should be complemented with painkillers such as Paracetamol or stronger ones, according to need, as well as adequate breast support.
Women who are breast-feeding do not need to stop. If continuing to breast-feed is impractical, then breast expression to prevent engorgement should be done. This could be done manually or by using a pump.
The antibiotic course will be continued for a week or more.
Suppose the mastitis progresses into an abscess?
In this case, incision and drainage of the abscess is required. Adequate drainage means the procedure normally requires a general anaesthetic.
Drainage will be combined with an antibiotic course. Breast-feeding is usually difficult to maintain on the affected breast before the abscess is drained. However, after this, there is no reason to prevent recommencing.