14. Post Partum Period Flashcards
What happens to the mothers white cell count post partum?
Very high white cell count immediately, with pregnancy-related changes still being present 6-8 weeks after delivery.
What hormones control the growth and development of mammary tissues and what are their effects?
Progesterone, oestrogen, prolactin and adrenal steroids cause hypertrophy in pre-existing alveolar-lobular structures in the breast. Also formation of new alveolar by budding from the milk ducts with proliferation of milk-collecting ducts.
Why are only minimal amounts of milk formed during pregnancy, despite high levels of prolactin and placental lactin (lactogenic hormones)?
Oestrogen and progesterone inhibit their effects.
What causes milk production?
Prolactin released by the action of suckling at the nipple.
What are prolactin levels and milk production dependant on?
Frequency and duration of suckling (prolactin).
Adequate emptying of the secreting glands.
When are prolactin levels at their highest and what happens after this?
Early puerperium and reduce slowly, only returning to normal after weaning.
What happens if there is accumulation of milk inside the alveoli?
Distension and atrophy of the glandular epithelium, so less milk produced.
Describe the let down reflex.
Oxytocin released in response to sensory inputs eg suckling, seeing or hearing the baby. Causes contraction of the myoepithelial cells situated around the alveolae, causing them to contract and expel the milk into the milk collecting ducts. Longitudinal cells in the milk collecting ducts are also stimulated, causing them to dilate and improve the free flow of milk towards the nipple along the dilated ducts.
What can cause inhibition of oxytocin release, thus inhibiting the let down reflex?
Emotional stress or anxiety.
Where is oxytocin released from?
The posterior pituitary in a pulsatile manner.
How does milk differ from the onset of lactation after birth, until it is fully established?
Onset - volumes are low and colostrum is initially produced. Has a high fat content (so is enough for the baby despite low volume) and high immunoglobulins.
Suckling continues - amount of milk increases until approximately 800ml a day are produced.
How do the constituents of breast milk differ from early to late lactation?
Early - foremilk has a higher water content.
Late - hindmilk is higher in fats and iron.
What supports breast tissue?
Cooper’s suspensory ligaments.
What 3 arteries supply the breast tissue?
External mammary artery.
Internal mammary arteries.
Inter-costal arteries.
