Análise do manejo de mastite lactacional de mulheres atendidas em hospitais de São Paulo, Brasil
Data
2022-06-13
Autores
Silva, Márcia Juliana Mello da 
Orientadores
Coca, Kelly Pereira
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A mastite é um problema comum em mulheres durante a fase de lactação, estimada em até 20% das mulheres que amamentam. Escolher o tratamento certo e fornecer informações e orientações terapêuticas para a mulher com mastite lactacional é de grande importância para assegurar o manejo adequado e prevenir o desmame precoce. Objetivo: Investigar a assistência prestada a mulheres com mastite lactacional em três hospitais de São Paulo. Método: Estudo transversal, multicêntrico, com coleta de dados retrospectiva, desenvolvido em três hospitais públicos ligados a Bancos de Leite Humano de São Paulo. Fizeram parte da amostra prontuários de mulheres atendidas entre janeiro de 2017 e dezembro do 2018. A coleta foi realizada no período de junho de 2020 a dezembro de 2021, por meio da plataforma RedCap. Os dados foram analisados por meio da estatística descritiva e do teste Qui-Quadrado, associação foi significativa quando o valor de p foi menor que 0,05 (p<0,05). Resultados: Foram identificados 148 casos de mastite, a média da idade das mulheres foi de 27,25 anos (DP: ± 6,33), a maioria (59,7%, 77/129) tinha ≤ 8 semanas pós-parto, 50% (37/74) eram primíparas, 57,5% (75/113) tiveram parto vaginal e 82,6% (38/46) estava em aleitamento materno exclusivo. Quanto à mastite identificada, a maioria (88,6%, 124/140) era unilateral, a maioria das mulheres (68,3%, 69/101) apresentou persistência dos sinais e sintomas por ≥ 48 horas, 93,8% (136/145) relataram dor local, 77,2% (112/145) apresentaram mama inflamada/eritema, 72,9% (105/144) nódulo palpável, 33,3% (41/123) lesão mamilar e 11,7% (17/145) presença de exsudato. Foi identificado que 23,6% (35/148) das mulheres tiveram solicitação de ultrassom da mama, sendo 54,3% (19/35) com diagnóstico de abscesso mamário e 2,7% (4/148) com registro de cultura do leite materno. Sobre o manejo não medicamentoso realizado, apenas 49,3% (73/148) receberam esse tipo de tratamento, destas 46,6% (69/148) foram orientadas quanto aos cuidados com as mamas e 10,8% (16/148) das mulheres receberam orientação para manter a amamentação. Quanto ao tratamento medicamentoso, 71,6% (106/148) receberam antibioticoterapia e, destes, 64,2% (68/106) com antibiótico da classe das cefalosporinas e 39,2% (58/148) com prescrição de analgésicos. Conclusão: A assistência prestada às mulheres com mastite lactacional nos hospitais estudados mostrou-se deficiente, com baixa valorização da dor e prescrição de analgésicos, assim como das orientações para o manejo não farmacológico da mastite lactacional.
Introduction: Mastitis is a common problem among women during the lactation phase, estimated in up to 20% of lactating women. Choosing the correct treatment and giving the women with lactating mastitis information and orientation is of great importance to ensure the right management and prevent the early weaning. Objective: Investigate the assistance given to women with lactating mastitis in three hospitals of São Paulo. Method: Transversal, multicenter study with retrospective data collection, developed in three public hospitals linked to São Paulo´s Human Milk Banking. The sample was composed by medical records of women assisted between January 2017 to December 2018. The collection was made from June 2020 to December 2021, through RedCap. The data were analyzed with descriptive statistics and the Chi-Square test; the association was significant when p value was lower than 0.05 (p<0.05). Results: 148 cases of mastitis were identified, the women´s mean age was 27.25 (DP: ± 6.33), most of whom (59.7%, 77/129) were ≤ 8 weeks after-birth, 50% (37/74) were primiparous, 57.5% (75/113) had vaginal delivery and 82.6% (38/46) were exclusively breastfeeding. As for the cases of mastitis identified, most of them 88.6% (124/140) were one-sided, most of them 68.3% (69/101) showed persistent signals and symptoms for ≥ 48 hours, 93.8% (136/145) showed local pain, 77.2% (112/145) had inflamed breasts/erythema, 72.9% (112/145) had palpable nodes, 33.3% (41/123) nipple lesion and 11.7% (17/145) showed exsudate. It was identified that 23.6% (35/148) of the women had been requested to undergo breast ultrasound, being 54.3% (19/35) with breast abscess and 2.7% (4/148) performing milk culture. Regarding the non-pharmacological management performed, only 49.3% (73/148) received this type of treatment, of these 46.6% (69/148) were oriented on breast care and 10.8% (16/148) of women received guidance to maintain breastfeeding. As for drug treatment, 71.6% (106/148) received antibiotic therapy, of which 64.2% (68/106) received cephalosporin antibiotics, and 39.2% (58/148) received analgesics. Conclusion: The assistance provided to women with lactation mastitis in the hospitals studied was shown to be deficient, as in low valorization of the pain and the prescription of analgesics, as well as instructions for the non-drug orientations of the lactation mastitis.
Introduction: Mastitis is a common problem among women during the lactation phase, estimated in up to 20% of lactating women. Choosing the correct treatment and giving the women with lactating mastitis information and orientation is of great importance to ensure the right management and prevent the early weaning. Objective: Investigate the assistance given to women with lactating mastitis in three hospitals of São Paulo. Method: Transversal, multicenter study with retrospective data collection, developed in three public hospitals linked to São Paulo´s Human Milk Banking. The sample was composed by medical records of women assisted between January 2017 to December 2018. The collection was made from June 2020 to December 2021, through RedCap. The data were analyzed with descriptive statistics and the Chi-Square test; the association was significant when p value was lower than 0.05 (p<0.05). Results: 148 cases of mastitis were identified, the women´s mean age was 27.25 (DP: ± 6.33), most of whom (59.7%, 77/129) were ≤ 8 weeks after-birth, 50% (37/74) were primiparous, 57.5% (75/113) had vaginal delivery and 82.6% (38/46) were exclusively breastfeeding. As for the cases of mastitis identified, most of them 88.6% (124/140) were one-sided, most of them 68.3% (69/101) showed persistent signals and symptoms for ≥ 48 hours, 93.8% (136/145) showed local pain, 77.2% (112/145) had inflamed breasts/erythema, 72.9% (112/145) had palpable nodes, 33.3% (41/123) nipple lesion and 11.7% (17/145) showed exsudate. It was identified that 23.6% (35/148) of the women had been requested to undergo breast ultrasound, being 54.3% (19/35) with breast abscess and 2.7% (4/148) performing milk culture. Regarding the non-pharmacological management performed, only 49.3% (73/148) received this type of treatment, of these 46.6% (69/148) were oriented on breast care and 10.8% (16/148) of women received guidance to maintain breastfeeding. As for drug treatment, 71.6% (106/148) received antibiotic therapy, of which 64.2% (68/106) received cephalosporin antibiotics, and 39.2% (58/148) received analgesics. Conclusion: The assistance provided to women with lactation mastitis in the hospitals studied was shown to be deficient, as in low valorization of the pain and the prescription of analgesics, as well as instructions for the non-drug orientations of the lactation mastitis.