Marina Lotfy

SLS group F
Supervisor : Dr. Jehad
CONTENT
1. Normal lactation physiology
2. Deficit lactation
3. Cracked nipple
4. Inhibition of lactation
5. Engorgement
6. Mastitis
7. Abscess
8. Galactocele
9. Drugs and breastfeeding
Normal lactation physiology
 The sudden fall in estrogen level after delivery is associated with
reduction in the secretion of prolactin inhibiting factor from the
hypothalamus and release of prolactin from the anterior pituitary.
 Prolactin is responsible for milk formation (initiation and
maintenance).
 Oxytocin released from the posterior pituitary due to suckling is
responsible for milk ejection
 Estrogen causes an increase in duct proliferation and growth , BUT IT
ASLO ANTAGONIZES THE EFFECT OF PROLACTIN ON MILK
PRODUCTION… CLINICALLY ? DON’T GIVE COCP FOR
CONTRACEPTION, ONLY THE PROGESTIN PILLS!

 Progesterone causes an increase in alveolar development

Deficit lactation
Causes
 Constitutional
 Bad general condition and malnutrition.. Leads to poor development
 Infrequent or irregular suckling.
 Sheehan’s syndrome.
Treatment
 Regular breast feeding preferred from both breasts and the rest is
removed by a pump
 Prolactin preparations – can help
 Good diet and plenty of fluids.
Cracked nipple
Causes
 Lack of cleanness and dryness of the nipples.
 Vigorous suckling of a hungry baby in deficient lactating breasts.
 Leaving the baby too long at the breast.
 Repeated taking and leaving the nipple by the baby to breathe if its
nose is obstructed by the breast.
 Monilial (candida) infection.
Treatment
 Rest: the baby should not put on the affected breast till healing
occurs while it is emptied manually. Gradual going back to the breast
is recommended to prevent recurrence.
 Hot fomentations.
 Panthenol ointment or flavine in liquid paraffin: applied locally.
Inhibition of lactation
Indications
 Maternal:
 Decompensated heart failure.
 Active pulmonary tuberculosis.
 Acquired immune deficiency syndrome (AIDS).
 Acute illness as pneumonia.
 Fetal:
 Cleft palate.
 Marked hare lip.
 Marked prematurity.
 Death of the infant.
Methods
 Cold fomentations.
 Restriction of fluids and diuretics.
 Tight breast binders to prevent accumulation of milk.
 Dopamine agonists: starting as early as possible for 14 days;
 Bromocriptine (Parlodel) 2.5mg twice daily.
 Estrogens: alone, with androgen or in contraceptive pills was used
but :
 increase the risk of thrombo-embolic complications,
 withdrawal bleeding usually occurs,
 lactation may return again and
 not effective if not started immediately after delivery.
 Engorgement

 Usually occurs in the 3rd day after delivery when secretion of milk begins.
Clinical picture
 Breasts are overdistended with visible dilated veins.
 Breasts are painful and tender.
 Pyrexia may develop.
Treatment
 Breast evacuation: in early stage baby suckling can be sufficient, but later on congestion
press on the ducts preventing flow of milk so an electric breast pump is needed.
 Cold fomentations or one-two doses of bromocriptine (2.5 mg): may occasionally needed
and there is no risk of suppressing lactation.
 Analgesics -antipyretics.
Engorgement VS mastitis
 Mastitis
Causative organism
 Staphylococcus aureus which may reach the breast from infected
baby.
Clinical picture
 Breast is painful, tender, red, tense and hot.
 Axillary lymph nodes are enlarged.
 High fever may reach 40.50C.
.COMPLICATIONS:
 Recurrence- Women who have had mastitis are more likely to get it again, compared
to other women. In most cases recurrence is due to late or inadequate treatment.

 Abscess-If the mastitis is not treated properly there is a risk that a collection of pus
(abscess) can develop in the breast. Abscesses usually require surgical draining.
Treatment
Proper treatment is indicated otherwise
breast abscess will develop.
Stop lactation: from the affected breast and
breast is emptied manually or by an electric
pump. When the acute phase is over breast
feeding can be resumed.
Support the breast: over a pad of cotton
wall.
Antibiotic therapy: A sample of milk is sent
for culture and sensitivity then antibiotic
started. Flucloxacillin 500 mg/6 hours is
suitable.
Analgesics - antipyretics.
 Breast abscess
A breast abscess is a painful collection of pus that forms in the
breast.
Clinical picture
 A segment of the breast becomes painful and tender and fluctuation
can be detected.
 The skin over it is edematous.
 Fever and enlarged axillary lymph nodes.
Treatment
 As soon as an abscess is formed it should be incised and drained under
general anesthesia. Do not wait for fluctuation as by that time breast
disorganization would occur
Galactocele
 It is a retention cyst of a large mammary duct due to its obstruction.
 If it is persistent it is excised or aspirated.
 Clinical feature :
 A local fluctuating swelling
Medications & Breast Feeding
 Drugs and breast milk. Drugs concentrated in breast milk tend to be
weak bases (such as metronidazole, antihistamines, erythromycin, or
antipsychotics and antidepressants).
Drugs absolutely contraindicated in breast feeding.
 Chemotherapeutic or cytotoxic agents, all drugs used recreationally
(including alcohol and nicotine), radioactive nuclear medicine tracers,
lithium carbonate, chloramphenicol, phenylbutazone, atropine,
thiouracil, iodides, ergotamine and derivatives, and mercurial.
 Drugs to strongly avoid or consider bottle feeding.
Antipsychotics, antidepressants, metronidazole, tetracycline, sulfonamides, diazepam,
salicylates, corticosteroids ,phenytoin, phenobarbital, or warfarin.
Drugs safe to use in normal doses.
Acetaminophen, insulin, diuretics, digoxin, beta-blockers, penicillin, cephalosporins,
erythromycin, birth control pills, OTC cold preparations, and narcotic analgesics (short term
in normal doses).
Lactation-suppressing drugs.
Levodopa, anticholinergics, bromocriptine, trazodone, and large-dose estradiol
birth control pills.