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Scientific Basis of Midwifery > Lactation > Flashcards

Flashcards in Lactation Deck (42)
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Describe the basic anatomy of the breast

- Alveoli surrounded by fat
- Ducts branch right to the end of the nipple
- Glandular tissue lies very close to the nipple
- Subcutaneous fat is minimal at the base of the nipple


What are the 4 stages of breast growth and development?

1. Mammogenesis - the period of development from conception, through puberty and into pregnancy
2. Lactogenesis I & II - transition from pregnancy to lactation - neuroendocrine response
3. Galactopoiesis - maintenance of established milk production - autocrine response
4. Involution - process that removes the milk producing cells on weaning


Describe the development of breasts during embryogenesis

- Development begins at 4 weeks gestation for males and females
- Week 12-16 = development of nipples and areola
- Lactiferous ducts open into mammary pit which elevates to become the nipple and areola
- No further development until puberty


Describe the development of breasts during puberty

- Increasing levels of oestrogen and progesterone lead to growth of lactiferous ducts, alveoli, the nipple and areola
- Increase in breast size caused by deposition of adipose tissue
- Oestrogen and pituitary factor influence breast growth with proliferation of milk ducts
- Progesterone stimulates alveolar development


Describe the development of breasts in week 3-4 of pregnancy

- Prickling, tingling sensation, particularly around the nipple
- Caused by increased blood supply


Describe the development of breasts in week 6-8 of pregnancy

- Oestrogen promotes growth of lactiferous ducts
- Progesterone, prolactin and hPL levels lead to proliferation and enlargement of alveoli
- Veins become visible
- Increase in size and become painful, tense and nodular due to hypertrophy of alveoli


Describe the development of breasts in week 8-12 of pregnancy

- Montogmery's tubercles become more prominent on areola
- Pigmented area around nipple (primary areola) darkens, may enlarge and become more erectile
- Caused by hypertrophic sebaceous glands secreting sebum which keeps nipple soft and by increased melanin activity


Describe the development of breasts in week 16 of pregnancy

- Colostrum produced (lactogenesis I) due to prolactin and hPL
- Complete milk production suppressed by oestrogen and progesterone
- Secondary areola develops with further extension of pigmented area, causing a mottled appearance


Describe the development of breasts in week 24 of pregnancy

- Colostrum may leak
- Nipples become more prominent and mobile due to progesterone


What is an epulis?

A specific angiogranuloma which can be caused by advanced gingivitis


What is leptin?

A peptide hormone secreted by placental and adipose tissue that plays a key role in regulation of body fat and energy expenditure


What is the first indication that a woman is pregnant?

Breast changes


Which hormones are involved in breast changes during pregnancy?

- Progesterone
- hPL
- Prolactin
- Oestrogen


Outline the major changes that occur to the breasts in pregnancy

- Skin appears more thin/ translucent
- Veins become more prominent
- Areola diameter increases and nipple/areola become darker
- Nipples become more erect
- Ductal system proliferates (oestrogen)
- Lobes, lobules and alveoli increase in size (progesterone)


Describe what happens to the Montgomery's tubercles during pregnancy

- Enlarge
- Combination of sebaceous glands and mammary milk glands
- Secretions provide maternal protection from mechanical stress of sucking and pathogenic invasion


How is the milk brought into the ducts?

1. Stimulation of nipples initiates milk ejection via initiation of nerve impulses to the hypothalamus
2. This stimulates posterior pituitary gland to release oxytocin into blood
3. This causes myoepithlial cells surrounding alveoli to contract, forcing milk into ducts


Outline what occurs in lactogenesis I

- Occurs during 2nd part of pregnancy and lasts until 2 days postpartum
- Initiation of milk synthesis
- Prolactin stimulates milk (colostrum) production as we all increasing breast mass


Outline what occurs in lactogenesis II

- Occurs day 3-8 postpartum
- Triggered by delivery of placenta which causes rapid drop in progesterone levels, oestrogen, hPL and PIF
- Onset of copious milk secretion
- Retained placenta can inhibit milk production because hormone levels don't drop


What does PIL stand for?

Prolactin Inhibiting Factor


What does hPL stand for?

Human Placental Lactogen


How are the alveoli adapted for lactation?

- Contain acini cells which produce milk
- Surrounded by myoepithlial cells which contract and propel the milk out


What is the purpose of the lactiferous ducts?

- Carry milk to alveoli
- Several large ducts = Lactiferous tubules (emerge on nipple surface)
- Myoepithlial cells lie longitudinally along ducts and, under influence of oxytocin, these smooth muscle cells contract and tubule becomes shorter and wider - called the let down reflex
- Tubule distend during active milk flow while myoepithelial cells maintain state of contracting
- Fuller breast = greater ductal distension


What does distend mean?

Swell or cause to swell by pressure from inside


What happens as lactation progresses?

- Prolactin response to suckling diminishes and milk removal becomes driving force behind milk production
- Due to whey proteins in milk able to inhibit synthesis of milk constituents
- Protein accumulates in breast as milk accumulates and exerts negative feedback control on continued milk production
- Removal of this autocrine inhibitory factor by removing milk allows milk production to increase again; this is the Feedback Inhibitor of Lactation


What is the role of progesterone?

- Most is secreted from placenta
- Maintains pregnancy
- Inhibits lactation
- Lactogenesis II is triggered by decrease in progesterone levels


Where is prolactin released from?

Anterior pituitary gland


What are the main functions of prolactin?

- Acts on alveoli
- Essential for initiating and maintaining milk production
- Production influenced by nipple sensation
- Involved in suppression of ovulation, so BF mothers less likely to get pregnant


What is Circadian rhythm?

Prolactin levels are higher at night


What causes the prolactin levels to rise and fall?

- Frequency, intensity and duration of feed
- Always a baseline level present
- Increases with anxiety/ psychological stress and beer drinking
- Decreases with smoking


What happens if too many feeds occur in 1 day (8 feeds)?

Prevents decrease in prolactin concentration between feeds