Breast in Pregnancy and Breastfeeding
· Changes during pregnancy:
o Oestrogen, progesterone, HPL, PRL and HCG ® acinar cellular hyperplasia in early pregnancy, hypertrophy in later pregnancy, duct sprouting
o By end of pregnancy, breast is composed almost entirely of lobules
separated by relatively scant amount of stroma
· Immediately after childbirth:
o ¯Progesterone ® milk production under the influence of PRL
o Milk let down: sucking ® pulsitile oxytocin ® myoepithelial cells squeezes milk down duct. Also due to neuroendocrine reflex (eg hearing baby cry). Sensitive to emotional stress
o Sucking also stimulates PRL ® continued milk production
· Advantages of breast feeding:
o Infant: ¯infant mortality (two fold), bonding, cheap, anti-infective properties (lysozyme, IgA, lactoferrine, etc), ¯SIDS
o Maternal: contraceptive, sucking promotes uterine contractions ® ¯PPH, ¯pre-menopausal breast cancer
o Sufficient on its own until 4 – 6 months
·
Contra-indications: maternal
HBsAg, CMV or HIV +ive, active breast HSV lesions, amiodarone
·
Breast care:
o Sore/cracked nipple prevention:
§ Poor position, poor hygiene, irritation (clothing, soap)
§ Treatment: shields, advice on position, break suction with finger
o Breast engorgement:
§ Supply > demand ® enlarged breast ® baby can‟t latch on
§ Management: feed on demand, no other fluids for baby, express,
paracetamol
o Mastitis:
§ Cellulitis of interlobular connective tissue (mainly Staph Aureus)
§ Fever, tiredness, muscle aches and pains
§ Treatment: antibiotics (flucloxacillin), analgesics, regularly empty
breast, massage lumps towards nipple when feeding
· Abscess:
o Secondary to mastitis, febrile and toxic, red and tender > 48 hours
o Treatment: surgical drainage, antibiotics, antipyretics, analgesics,
?suppress lactation
·
Inverted or retracted nipples:
gently pull out through pregnancy
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