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A - MSRA Obstetrics [16] > [52] Lactation > Flashcards

[52] Lactation Flashcards

1
Q

What is lactation?

A

The maternal physiological response whereby milk is secreted from the mammary glands to feed the infant

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2
Q

What % of people in the UK breastfed in the UK in 2010?

A

81%

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3
Q

What proportion of mothers in the UK were still breast-feeding after 6 months?

A

1/3

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4
Q

What % of mothers in the UK were exclusively breastfeeding after 6 months?

A

1%

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5
Q

Which mothers are more likely to breastfeed?

A
  • Those from a minority ethnic groups
  • Those in managerial and professional occupations
  • Aged over 30
  • First-time mothers
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6
Q

Where are the mammary glands?

A

Embedded in the breasts

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7
Q

What do the mammary glands comprise of?

A

15-20 lobulated masses of tissue with fibrous tissue connecting the lobes, and adipose tissue in between

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8
Q

What are the lobes of the breast made up of?

A

Alveoli, blood vessels, and lactiferous ducts

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9
Q

How many ducts are present in the breast at birth?

A

Only a few

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10
Q

What happens to the ducts in the breast at puberty?

A

Oestrogen causes the ducts to sprout, and the ends form masses of cells that later become alveoli

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11
Q

What happens to the breasts with each menstrual cycle?

A

There are cyclic changes

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12
Q

What causes the cyclic changes in the breast during the menstrual cycle?

A

Changes in oestrogen and progesterone

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13
Q

What happens to the breasts during pregnancy?

A
  • There is significant hypertrophy of the ductal-lobular-alveolar system
  • Prominent lobules form
  • From mid-gestation, alveolar cells differentiate to be capable of milk production
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14
Q

Is there milk secretion during pregnancy?

A

A little

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15
Q

Why is there only a little milk secretion during pregnancy?

A

Due to the high progesterone:oestrogen ratio, which favours growth rather than secretion

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16
Q

What cells are responsible for milk production?

A

The alveolar epithelial cells

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17
Q

Describe the alveolar epithelial cells of the breast

A

They are polarised, highly differentiated cells

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18
Q

What is the function of the alveolar epithelial cells of the breast?

A

To accumulate, synthesise, package, and export the components of milk

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19
Q

What do the breasts start producing soon after birth?

A

40ml/day of colostrum

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20
Q

What does colostrum contain more of than normal milk?

A
  • Proteins, particularly immunoglobulins

- Fat soluble vitamins

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21
Q

What does colostrum contain less of than normal milk?

A
  • Water soluble vitamins
  • Fat
  • Sugar
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22
Q

What does mature breast milk contain?

A
  • Water
  • Lactose
  • Fat
  • Protein
  • Minerals
  • Vitamins
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23
Q

What % of mature breast milk is water?

A

90%

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24
Q

What % of mature breast milk is lactose?

A

7%

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25
Q

What % of mature breast milk is fat?

A

2%

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26
Q

What % of mature breast milk is protein?

A

1%

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27
Q

What % of mature breast milk is minerals?

A

0.2%

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28
Q

What vitamins are found in mature breast milk?

A
  • A
  • B
  • B2
  • C
  • D
  • E
  • K
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29
Q

What controls the regulation and content of breast milk?

A

Largely under hormonal control, primarily prolactin

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30
Q

Describe the hormones in pregnancy?

A

There is a high progesterone:oestrogen ratio

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31
Q

What is the result of the high progesterone:oestrogen ratio in pregnancy on the breasts?

A

Favours the development of alveoli, but not secretin of milk

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32
Q

What causes the change in oestrogen:progesterone ratio after pregnancy?

A

The delivery of the placenta

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33
Q

Why does the delivery of the placenta change the hormone balance in pregnancy?

A

Because the placenta is the source of a large amount of circulating steroids (more so progesterone), and so its removal changes the ratio

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34
Q

What is the result in the reduction in progesterone after the delivery of the placenta?

A

It allows the alveoli to respond to prolactin

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35
Q

How long after pregnancy does breast milk begin to form?

A

24-48 hours

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36
Q

What is prolactin?

A

A polypeptide hormone

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37
Q

What is prolactin secreted by?

A

The anterior pituitary gland

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38
Q

What controls prolactin section by the anterior pituitary gland?

A

Dopamine

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39
Q

What is dopamine also known as?

A

Prolactin-inhibiting hormone

It actually is i checked it even tho this seems kinda fake news?

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40
Q

Where is dopamine secreted from?

A
  • Hypothalamus

- Decidual cells

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41
Q

What do factors that promote secretion of prolactin do?

A

Reduce dopamine secretion

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42
Q

What is prolactin stimulation promoted by?

A

Suckling

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43
Q

What kind of reflex is the sucking causing prolactin stimulation?

A

Neuro-endocrine reflex

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44
Q

How does suckling stimulate prolactin?

A

It mechanically stimulates receptors in the nipple and impulses pass up the brainstem and to the hypothalamus to reduce the secretion of dopamine and increase vasoactive intestinal protein

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45
Q

What does vasoactive intestinal protein do?

A

Promotes prolactin secretion

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46
Q

What does suckling at one feed do?

A

Promotes prolactin release, which causes production for the next feed

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47
Q

What happens to the next feed after it is stimulated by suckling at the previous feed?

A

It accumulates in alveoli and ducts, causing turgor

48
Q

What is responsible for milk delivery to the infant?

A

Mechanical stimulation of the nipple

49
Q

Do babies suck milk out of the breast?

A

No

50
Q

If the babies don’t suck the milk out of the breast, how does it get into their mouth?

Ive really given up on these questions

A

It is ejected by the let-down reflex

51
Q

How does the let-down reflex work?

A

In response to suckling, oxytocin is released from the pituitary gland which stimulates myoepithelial cells that surround alveoli to contract, thus squeezing milk out of the breasts

52
Q

Other than suckling, what can stimulate the let-down reflex?

A

The reflex can be conditioned (think Pavvys dogs), and the cry or sight of an infant and preparation of the breast for nursing may cause let down

53
Q

What may inhibit the let-down reflex?

A
  • Pain
  • Embarrassment
  • Alcohol
54
Q

What is the key to maintaining milk production?

A

Sufficient suckling stimulation at each feed

55
Q

Why is sufficient suckling at each feed important to maintain milk production?

A
  • Maintains prolactin secretion

- Removes accumulated milk

56
Q

What happens if suckling stops?

A

Milk production ceases gradually

57
Q

Why does milk secretion gradually cease when there suckling stops?

A

Due to turgor-induced damage to secretory cells and low prolactin levels

58
Q

How can milk suppression be achieved iatrogenically?

A

Steroids

59
Q

Why is there reduced fertility whilst breatfeeding?

A

Prolactin secretin during lactation reduces fertility

60
Q

What are the social advantages of breastfeeding?

A
  • Breastmilk is free and available with preparation
  • No need to buy steriliser, bottles, or formula milk
  • Does not need to be pre-warmed
61
Q

What are the medical advantages of breastfeeding for the child?

A
  • Immunity/infection prevention
  • Protective effect of breastfeeding for severe eczema
  • Protective against childhood asthma
  • Reduction in SIDS
  • Positive effect on child’s intelligence
  • Confers protection from future diabetes
62
Q

Give 3 infections that breast-fed children have lower rates of

A
  • Otitis media
  • Lower respiratory tract infections
  • Gastroenteritis
63
Q

What are the medical advantages of breastfeeding for the mother?

A
  • Reduction in rates of breast cancer
  • Reduction of rates of T2DM
  • Reduction in ovarian cancer
  • Can be used as contraception
64
Q

When can breastfeeding be used as contraception?

A
  • Child is up to 6 months old
  • Mother is amenorrhoeic
  • Child is exclusively breast fed
65
Q

What are the social disadvantages of breastfeeding?

A

Breastfeeding in public can be socially taboo

66
Q

What are the medical disadvantages of breastfeeding?

A
  • Transmission of HIV
  • Breastmilk is low in vitamin D
  • Certain bacterial infections in the mother can be transmitted
67
Q

What reduces the risk of transmission of HIV through breastfeeding?

A

ARV drug interventions

68
Q

What are current recommendations regarding breastfeeding and HIV?

A

Mothers with known HIV, regardless of maternal viral load and ARV therapy, should refrain from breastfeeding

69
Q

What is recommended as a result of breastmilk being low in vitamin D?

A

Vitamin D supplementation is recommended for all pregnant women and breastfeeding mothers

70
Q

What bacterial infections can be transmitted through breastmilk?

A
  • Neisseria gonorrhoae
  • Haemophilus influenza
  • Group B streptococci
  • Staphylococci
  • TB
71
Q

How can transmission of bacterial infections through breastmilk be prevented?

A

Should stop for 24 hours, or longer with TB

72
Q

What problems are common in breastfeeding mothers?

A
  • Cracked/sore nipples
  • Blocked ducts and breast engorgement
  • Mastitis/abscess
  • Insufficient milk/hungry baby
73
Q

Is nipple soreness common?

A

Yes, very common

74
Q

When is nipple soreness common?

A

During first few weeks of breastfeeding

75
Q

How might nipple soreness be described?

A

As pinching, itching, or burning

76
Q

What can nipple soreness in breastfeeding be caused by?

A
  • Improper position of the baby
  • Improper feeding techniques
  • Improper nipple care
77
Q

How can nipple soreness be relieved if it is due to improper position of the baby?

A

Altering feeding position may help reduce soresness, providing a good attachment is maintained

78
Q

How can nipple soreness be caused by incomplete feeding techniques?

A

May be caused by incomplete suction release at the end of the baby’s feeding

79
Q

How can nipple soreness caused by incomplete suction release at the end of feeding be improved?

A

Gently inserting finger into the side of the mouth to break the suction may help

80
Q

How can improper nipple care cause nipple soreness in breastfeeding?

A

Excessively dry or excessively moist skin can cause nipple soreness

81
Q

How can nipple soreness caused by improper nipple care be improved?

A

Ointments containing lanolin may be helpful, as may olive oil and expressed milk

82
Q

What normally happens to nipple soreness caused by breastfeeding?

A

Regardless of treatment, for most women the initial pain reduces to mild levels 7-10 days postpartum

83
Q

What are blocked ducts caused by in breastfeeding?

A

Poor drainage of breast

84
Q

How does blocked ducts from breastfeeding present?

A
  • Breasts feel swollen, hard, and painful
  • Redness
  • Systemic symptoms
  • Nipples cannot protrude to allow baby to latch on, and feeding becomes difficult
85
Q

What are the common causes of blocked ducts in breastfeeding?

A
  • Pressure on the breast, e.g. poorly fitting bra or seatbelt
  • Prolonged gaps between feeds
86
Q

How often should the mother be advised to nurse to prevent blocked ducts?

A

8 times or more in 24 hours, for at leat 15 minutes for each feed

87
Q

How can breast engorgement be relived if it does occur?

A

Manual expression of milk or use breast pump

88
Q

What might help relieve the pain associated with breast engorgemeny?

A

Alternative warm showers followed by cold compress

89
Q

What might develop if breast engorgement persists?

A
  • Mastitis

- Milk/milk products may get into bloodstream

90
Q

What happens if milk/milk products get into bloodstream as a result of breast engorgement?

A

Leads to flu-like symptoms, similar to those of incompatible blood transusion

91
Q

What is mastitis?

A

Inflammation of breast

92
Q

In what % of breastfeeding women does mastitis occur in?

A

20%

93
Q

What increases the risk of mastitis in breastfeeding women?

A
  • Nipple damage
  • Over-supply of milk
  • Use of nipple shields
  • Nipple carriage of staph aureus
94
Q

Is mastitis infectious or non-infectious?

A

Can be either

95
Q

What contiuum does mastitis exist on?

A

From blocked ducts and engorgement, to mastitis, to abscess

96
Q

When is an infectious cause of mastitis more common?

A

In the presence of a cracked nipple

97
Q

What bacteria most commonly causes infectious mastitis?

A

S. Aureus

98
Q

Where does the infection take place in infectious mastitis?

A

In the parenchymal tissue of the breast

99
Q

How does infectious mastitis cause symptoms?

A

The infection causes swelling which pushes on the milk ducts, causing pain and swelling

100
Q

What may the treatment of mastitis include?

A

Antibiotics

101
Q

Give an example of an antibiotic used in the treatment of mastitis?

A

Flucloxacillin

102
Q

When are antibiotics used in mastitis?

A

When symptoms haven’t resolved within 24 hours

103
Q

What management may be required for breast abscess?

A

Aspiration, or incision and drainage

104
Q

Should breastfeeding or pumping continue whilst receiving treatment for mastitis?

A

Yes

105
Q

Why is not producing enough milk an important thing to consider in breastfeeding women?

A

It is a common reason women give for giving up breastfeeding

106
Q

What is usually the case when a woman feels she is not producing enough milk?

A

She is actually producing enough milk, but doesn’t think she is

107
Q

Why might a breast-feeding woman not think she is producing enough milk?

A
  • Lacks confidence in her ability to maintain her milk supply
  • Not be aware her breasts will soften as feeding becomes established
  • Not know it is perfectly normal for some breast-fed babies to feed 10 times a day
108
Q

How can a good milk supply be maintained?

A
  • Frequent feeding
  • Offering both breasts at each feed
  • Adequate rest
  • Good nutrition
  • Adequate fluid intake
  • Expressing after feeds
109
Q

What can determine if the baby is getting enough milk?

A

Checking weight and growth

110
Q

What does WHO recommend, regarding establishing breastfeeding?

A
  • Should start within 1 hour of birth
  • Should be ‘on demand’, as often as child wants, day and night
  • Bottles or pacifiers should be avoided if possible
111
Q

What do mothers need to be given in order for successful breastfeeding to occur?

A

Support, confidence, and encouragement

112
Q

When should breastfeeding support be available after delivery?

A

Immediately, even if by C-section

113
Q

What are the requirements for a baby to be able to establish breastfeeding or bottle feeding?

A

Able to co-ordinate sucking, swallowing, and breathing

114
Q

At what gestation are babies likely to be able to co-ordinate sucking, swallowing, and breathing?

A

> 34 weeks

115
Q

When might babies require total parenteral nutrition?

A

Extremely pre-term babies, or those expected to have a prolonged stay in neonatal intensive care

116
Q

What is the problem with pre-term breast milk?

A

Compared to artificial formula milk, it may not provide sufficient nutrition for preterm or low-birth weight infants

117
Q

What may be required with pre-term breast milk?

A

May need fortification

A - MSRA Obstetrics [16] (61 decks)

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