Pregnancy and lactation

Question 1

What is witch’s milk?

Answer 1

Milk produced by neonates due to the influence of maternal hormones

Question 2

How do the breasts differ during the menstrual cycle?

Answer 2

May increase in size due to fluid retention at each period

Question 3

Where are breasts found?

Answer 3

Between ribs 2-6 in the anterior chest wall

Question 4

Where does the nipple lie in the breast?

Answer 4

In the centre of the pigmented areola

Question 5

How does the breast change in puberty?

Answer 5

Rudimentary duct system-> branches
20 lobes, each draining into a lactiferous duct to the nipple
Bundles of smooth muscle arise between nipple and areola

Question 6

How do the breasts change in pregnancy?

Answer 6

Breasts grow and become more vascular

Ducts grow and branch and secretory alveoli replace adipose tissue

Question 7

Describe the blood supply of the breast

Answer 7

Branches of internal thoracic artery, lateral thoracic artery and thoraco-acromial artery (from axillary artery) and by intercostal arteries 3-5

Question 8

Describe the blood supply of the breast

Answer 8

Branches of internal thoracic artery, lateral thoracic artery and thoraco-acromial artery (from axillary artery) and by intercostal arteries 3-5

Question 9

Describe the venous drainage of the breast

Answer 9

Superficial venous plexus around areola

Blood drains to axillary vein, internal and lateral thoracic veins and intercostal veins

Question 10

What is the innervation of the breasts?

Answer 10

T4-6

Question 11

What is the innervation of the breasts?

Answer 11

T4-6

Question 12

What causes the nipple to become erect?

Answer 12

Sympathetic innervation of the smooth muscle between nipple and areola

Question 13

Describe the lymphatic drainage of the breast

Answer 13

Interlobular lymph vessels-> subareolar plexus-> axillary/pectoral/parasternal/apical axillary nodes

Question 14

What are the first secretions of the breast called?

Answer 14

Colostrum, rich in protein, IgA,

Question 15

Function of myoepithelial cells in breast?

Answer 15

Contract to move milk out of epithelial cell into lactiferous ducts

Question 16

What hormones control the development of breasts?

Answer 16

Progesterone, oestrogen, prolactin, human placental lactogen (hPL), dopamine (inhib)

Question 17

Action of oestrogen

Answer 17

Needed for development of ducts in puberty and pregnancy

Inhibits milk secretion in pregnancy by stimulating dopamine

Question 18

Action of progesterone

Answer 18

Needed for development of alveoli in puberty and pregnancy

Inhibits milk secretion in pregnancy by ↓prolactin receptors

Question 19

What are the first secretions of the breast called?

Answer 19

Colostrum, rich in protein, IgA, minerals, vitamins

Question 20

Action of progesterone

Answer 20

Needed for development of alveoli in puberty and pregnancy

Inhibits milk secretion in pregnancy by ↓prolactin receptors

Question 21

What is galactopoesis?

Answer 21

Maintenance of milk production, needs sustained prolactin levels

Question 22

How is galactopoesis achieved?

Answer 22

Needs high sustained prolactin levels

Regular suckling and removal of milk decreases dopamine and increases prolactin and oxytocin

Question 23

How is milk ejection achieved?

Answer 23

Suckling or conditioned stimuli causes oxytocin to be released and myoepithelial cells to contract in alveoli

Question 24

What is milk ejection associated with?

Answer 24

Afterpains of the uterus contracting (due to oxytocin release)

Question 25

What is the composition of 'mature' milk?

Answer 25

High in fats, proteins, lactose, essential amino acids

Question 26

What proteins are found in breast milk and how are they secreted?

Answer 26

casein, α-lactalbumin and lactoglobulin | secreted from vesicles by merocrine method

Question 27

What proteins are found in breast milk and how are they secreted?

Answer 27

casein, α-lactalbumin and lactoglobulin | secreted from vesicles by merocrine method

Question 28

How is fat secreted into breast milk?

Answer 28

Fatty acids synthesis in ER, secreted by apocrine method

Question 29

What sugars are found in breast milk and how are they made?

Answer 29

Lactose | Made in golgi but dependent on α- lactalbumin to make lactose synthetase complex

Question 30

Why is lactose crucial?

Answer 30

Component of myelin and promotes growth of intestinal flora

Question 31

Why is lactose crucial?

Answer 31

Component of myelin and promotes growth of intestinal flora

Question 32

When are non-breastfeeding women fertile again?

Answer 32

After 4 weeks post partum

Question 33

After loss of suckling stimulus, when does milk production stop?

Answer 33

2-3 weeks

Question 34

When do breasts return to normal after stopping breastfeeding?

Answer 34

After 3 months | Milk accumulates, ducts swell and compress capillaries. alveoli then dissapear

Question 35

What is galactorrhoea?

Answer 35

Milk production in the absence of pregnancy or lactation

Question 36

What is gynecomastia?

Answer 36

Male breast development, mild and transient

Question 37

Function of placenta

Answer 37

Exchange of fetal CO2 and waste products to be exchanged for O2 and nutrients from maternal blood Stores nutrients Produces hormones

Question 38

What part of the embryo forms the placenta?

Answer 38

The chorion (and chorionic villi)

Question 39

Name the parts of the maternal endometrium forming the placenta and surrounding structures in pregnancy

Answer 39

Decidua basalis, decidua capsularis, decidua parietalis

Question 40

What is the decidua parietalis?

Answer 40

Modified endometrium lining the walls of the uterus (not near embryo)

Question 41

Describe the arrangement of the umbilical cord

Answer 41

Single umbilical vein containing oxygenated blood, two umbilical arteries from internal iliac artery

Question 42

Describe the arrangement of the umbilical cord

Answer 42

Single umbilical vein containing oxygenated blood, two umbilical arteries from internal iliac artery Outer layer of amnion (Wharton's jelly)

Question 43

Role of relaxin

Answer 43

Hormone which allows pelvis to widen-> pregnancy waddle

Question 44

What happens to the mother's spine in pregnancy?

Answer 44

Increased weight so lumbar lordosis

Question 45

How does the vagina change in pregnancy?

Answer 45

Becomes more vascular- has a blue/purple hue Walls become thicker and softer Increased sexual sensitivity

Question 46

How does the face change in pregnancy?

Answer 46

Increased pigmentation- chloasma (mask of pregnancy)

Question 47

What is a cotyledon?

Answer 47

A section of the decidua basalis of the placenta, consists of a main stem of chorionic villus and its branches etc

Question 48

Why might you see scapula winging after breast cancer?

Answer 48

Damage to the long thoracic nerve-> serratus anterior not innervated