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Women's Health > Lactation & Breastfeeding > Flashcards

Lactation & Breastfeeding Flashcards

1
Q

Sir Ashley Cooper was wrong about the presence of….

A

Lactiferous sinuses (they do NOT exist)

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2
Q

The functional component of the breast

A

glandular tissue

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3
Q

It is possible for milk to be drained from behind a clog because….

A

it is UNLIKELY that the problematic lobe is drained by a single duct

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4
Q

Ducts and glands of the breast are both types of _____ tissue in the breast

A

glandular

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5
Q

Fibroblasts, adipocytes, blood vessels, plasma cells, and nerve are all types of ______ tissue in the breast

A

stromal

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6
Q

In the third trimester, the epithelial cells lining the breast alveoli differentiate into….

A

secretory cells, capable of milk production

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7
Q

Milk is stored in the alveoli until it can be expressed through the….

A

ducts (branching ducts > terminal ducts), which deliver milk from the alveoli to the nipple

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8
Q

Majority of milk is produced while…..

A

the infant is feeding

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9
Q

Each duct directly connects to around _______ lobes

A

10-15 lobes

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10
Q

Each lobe contains ~ _____ alveoli

A

10-100 alveoli

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11
Q

All lactational structures are [deep vs. superficial] to the pectoralis muscles

A

superficial

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12
Q

Support the breast by connecting the chest wall to the skin surface

A

Cooper’s ligaments

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13
Q

(2) hormones responsible for relaxation and stretching of the Cooper’s ligaments during pregnancy

A

relaxin, progesterone

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14
Q

Artery that feeds the blood supply of the breast

A

internal mammary artery (internal thoracic artery)

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15
Q

Sebaceous and lactiferous glands opening on and around the areolas

A

Montgomery tubercles

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16
Q

Proteins in human milk (3)

A

casein, whey, IgA

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17
Q

Type of sugar in human milk

A

lactose (native species lactose intolerance is rare)

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18
Q

Prolactin is produced by the….

A

anterior pituitary gland

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19
Q

Embryogenesis of breast development

A

4 weeks - breast ridge
18 weeks - buds appear
Secondary buds elongate, eventually canalize, forming a rudimentary duct system. As the fetus lays down more subcutaneous fat, the stored fat plays a critical role in allowing the ducts to extend and elongate.

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20
Q

Congenital condition in which infant is born with extra nipples along the original mammary ridge

A

supernumerary nipples

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21
Q

Why may infants have transient secretions from their nipples in first few days of life

A

r/t exposure to circulating maternal hormones like prolactin around the time of birth

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22
Q

After birth, the development of breasts is called…

A

mammogenesis

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23
Q

Mammogenesis during prepubescence is largely limited to….

A

fat deposition (no duct development)

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24
Q

Changes to the breast during puberty

A

fatty tissue growth, increase in mammary tissue volume/size, maturation of the terminal duct-lobe units (lobuloalveolar development)

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25
Q

Changes to the breast during puberty are driven by the influence of (3)

A

progesterone, estrogen, prolactin

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26
Q

______ marks the final phase of mammogenesis

A

pregnancy

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27
Q

Estrogen and progesterone are not directly involved in lactation, but contribute to lactation by…..

A

helping proliferate the cells needed for milk production

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28
Q

Changes to the external breast structures during pregnancy (3)

A

areolar pigmentation, enlarged montgomery tubercles, skin appears thinner with vessels more prominent

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29
Q

Changes to the internal breast structures during pregnancy (3)

A

ductal system proliferates, lobules increase in size, epithelium transforms

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30
Q

Stage of breast development that begins in embryo and is completed during pregnancy

A

mammogenesis

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31
Q

Stage of breast development that begins mid-pregnancy and is completed by day 8 postpartum

A

Lactogenesis Stage 1 - 2

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32
Q

Stage of breast development that begins day 9 postpartum and continues until weaning

A

Lactogenesis stage 3 (galactopoiesis)

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33
Q

Stage of breast development from commencement of weaning

A

involution

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34
Q

Lactogenesis I occurs…..

A

mid-to-late pregnancy

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35
Q

Lactogenesis II occurs…..

A

postpartum

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36
Q

Stage of lactogenesis marked by differentiation of the alveolar cells from secretory cells, producing colostrum

A

Lactogenesis I

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37
Q

During Lactogenesis I, the role of prolactin is ….

A

limited (priming the cells, but not producing milk)

38
Q

In the absence of _____ after expulsion of the placenta, prolactin dominates and causes milk production

A

estrogen and progesterone

39
Q

After the first 2-4 days, milk production switches from endocrine control (hormonal) to…

A

autocrine, meaning that the feeding behavior of the infant takes precedence over hormonal influence

40
Q

Colostrum is made in the breasts as early as…..

A

16 weeks gestation

41
Q

Lactogenesis III is also known as….

A

galactopoiesis

42
Q

(3) hormones influencing lactogenesis III

A

prolactin, oxytocin, prolactin-inhibiting factor

43
Q

Initiation of milk production occurs during…..

A

lactogenesis

44
Q

Ongoing maintenance of milk production occurs during…

A

galactopoiesis

45
Q

True or false: Pain is normal in the first 2 weeks of breastfeeding

A

FALSE! Pain is not normal

46
Q

Which is more responsible for postpartum breast “droopiness” : the pregnancy or breastfeeding?

A

pregnancy

47
Q

Prolactin is highest at….

A

night

48
Q

Oxytocin is released from the ….

A

posterior pituitary

49
Q

oxytocin role in breastfeeding

A

causes smooth muscle contraction of the cells of the breast alveoli

50
Q

If the infant is working hard and feeding well, that may be an indication of intact….

A

cranial nerves

51
Q

Required for lactogenesis II initiation

A

“letdown”, or milk ejection reflex

52
Q

Non-pharm methods to facilitate letdown reflex (2)

A

gentle massage to breast and nipple before latch, moist heat to the breast and nipple x2-5 minutes before latch

53
Q

Inhibitors of letdown reflex (5)

A

fear, anxiety, pain, fatigue, poor latch

54
Q

Milk letdown reflex is stimulated by….

A

oxytocin

55
Q

Maternal signs of the milk ejection reflex (5)

A

breast tingling, hot flash, cramps, thirst, sleepiness

56
Q

Infant signs of the milk ejection reflex (2)

A

increased swallows, increased gulps

57
Q

Characteristics of the foremilk

A

watery to quench thirst, high in protein

58
Q

Characteristics of the hindmilk

A

fat-rich for satiety

59
Q

Colostrum lasts from…..

A

16 weeks to 2-4 days pp

60
Q

Transitional milk lasts from….

A

2-4 days pp to 2 weeks pp

61
Q

Mature milk comes in at….

A

~2 weeks pp

62
Q

Immune system components in breastmilk (4)

A

antibodies, immunoglobulins (IgA), lymphocytes, macrophages

63
Q

Breast fed babies have lower incidence of (6) compared to formula-fed

A

otitis media, asthma, allergies, diabetes, SIDs, gastroenteritis

64
Q

Breastfeeding uses about ____ extra calories per day

A

500 (helps with pp weight loss)

65
Q

Should your tobacco-smoking pt still breastfeed?

A

Yes

66
Q

Reduce or avoid these substances in the diet while breastfeeding (4)

A

caffeine (including in chocolate), alcohol, drugs, nicotine

67
Q

Characteristics of a medication that would be more likely to get into the breastmilk in higher amounts

A

lipid soluble, low-molecular weight, long half life, low protein binding, large doses, chronic use

68
Q

With perfect use, how effective is lactational amenorrhea/

A

98% effective for 3-6 months

69
Q

An infant’s first visit to a pediatrician should be at….

A

2-3 days after she goes home

70
Q

Breastfeeding decreases the risk of these cancers (2)

A

breast and ovarian cancer

71
Q

Compared with cow milk, human milk has more _____ than _____

A

more WHEY than curd

72
Q

Most infants regain their birth weight by ….

A

7-10 days pp

73
Q

Colostrum has higher _____ but lower ____(2) than mature milk

A

higher protein, lower lactose and fat

74
Q

Your pt is a strict vegan and is 8 months pregnant. She plans to breastfeed. What supplement should you address with her?

A

B12 supplement

75
Q

Engorgement is best treated by….

A

allowing baby to attach and feed

76
Q

The most important criterion for assessing milk transfer during a feeding is…

A

audible swallow

77
Q

Roughly how many times per day should an infant feed?

A

8-10x (Q2-3 hours)

78
Q

What is the next best thing to use for a newborn less than 2 weeks old when breastfeeding is temporarily unavailable?

A

a cup with expressed breastmilk

79
Q

The addition of complementary foods to breastfed infants is recommended at about….

A

6 months

80
Q

How is an obstructed duct best treated?

A

Change the baby’s positioning with each feed

81
Q

Pain during breastfeeding may indicate…

A

a problem with latch

82
Q

Why does the milk supply come in within a few days instead of being at sufficient levels at birth?

A

Progesterone and estrogen levels decrease with the loss of the placenta, leaving a relative elevation of prolactin

83
Q

The average capacity of the stomach of a full term newborn on day 1 is….

A

20mL

84
Q

A breastfeeding mother with a 3 month old infant has a red, tender, wedge-shaped area on the outer quadrant of one breast. She has flu-like symptoms and a fever. Your management includes (4)

A

extra rest, moist heat to the region, antibiotics for 10-14 days, continue breastfeeding

85
Q

Why is vitamin D supplementation required for exclusively breast-fed infants?

A

vitamin D supplementation is required, not due to inherent deficiency of breast milk, but because our modern lifestyle [maternal vit D deficiency, not enough time in the sun, living in northern latitudes] makes our breastmilk deficient in vitamin D

86
Q

Human milk is considered mature by….

A

2 weeks pp

87
Q

Contraindication to breastfeeding (5)

A

galactosemia, active TB, HIV in the US, abusing drugs, receiving chemo

88
Q

Yellow color of the colostrum is due to….

A

beta carotene

89
Q

formula contains little to no ______ which is important for the development of the myelin sheath and nerve conduction in the brain

A

cholesterol

90
Q

Feedings lasting 30 minutes or longer may be a sign of…..

A

baby not feeding well

Women's Health (4 decks)

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