Protocolo ilustrado para a avaliação clínica das mamas e mamilos de puérperas com dificuldades na amamentação

Abstract

Breastfeeding is a very widespread behavior, but it can be compromised when the lactating woman presents alterations in the breast. These changes can be diagnosed early in order to avoid weaning. The literature is vast in information about these changes, but there is no ideal clinical protocol that illustrates such situations, in order to better guide health professionals in the diagnosis of these conditions and, therefore, propose an appropriate treatment. The objective of this study was to develop an illustrated protocol for the clinical evaluation of the maternal breast, which helps health professionals in the evaluation of the breasts and nipples of the nursing mother. Databases were consulted, from 2000 to 2021, in Portuguese and English and the keywords for research were: breastfeeding, protocols; breast; nipples, and the corresponding terms in English: breast feeding, protocols, breast and nipples. The databases of Scielo, Bireme, Medline and Schoolar Google were consulted for the structuring of an evaluation protocol. After this structuring, the graphic illustration based on literature was performed. Results: An assessment instrument was developed consisting of 87 items, divided into three stages, these being the Clinical Aspect of the Breast (five items), Nipple Morphology (four items) and finally the Changes in the Breast and Nipple (sixty-eight items), which was illustrated graphically. A graphic design specialist was provided with images of the aspects evaluated in the Maternal Breast Clinical Assessment Protocol, such as breast engorgement, fissure, excoriation, erosion, areolar edema, erosion, vesicles, laceration, breast candidiasis, Raynaud's phenomenon, obstruction of lactiferous ducts and mastitis. In addition, clinical aspect of the breast and nipple morphology were represented. Based on these images, all clinical situations that were included in the protocol for illustration were created in a standardized way. Conclusions: It was possible to elaborate an illustrated protocol of clinical evaluation of the maternal breast that facilitates the diagnosis of alterations in this structure.