LACTATION (Latin lac, lactis milk) — release of milk a mammary gland.
Complete cycle of L. includes mammogenez (development of gland), lactogenesis (emergence of secretion of milk after the delivery) and laktopoez (development and maintenance of release of milk).
Development mammary gland (see) from the moment of a bookmark before emergence of milk after the delivery (mammogenez) it is caused by synergistic influence of anterior pituitary hormones, ovaries, adrenal glands and placentae. A bookmark and development of a mammary gland begins already at the earliest stages of an embryogenesis. In the course of growth, development, preparation for secretion the structure and function of tissue of mammary gland undergo essential changes. Most snowballing of a mammary gland is noted during pregnancy; with 2 — the 3rd month of pregnancy there comes the hyperplasia of its ferruterous parenchyma. Under influence estrogen (see), progesterone (see), prolactin (see) and Somatotropinum (see. Somatotropic hormone ), and also the laktogenina occurs expansion and proliferation of the lacteal courses and considerable development of alveoluses of a mammary gland. The full complex of lactic hormones is up to the end not found out from the person. Believe that decrease in level of estrogen and progesterone after the delivery stimulates secretion of pituitary prolactin and, perhaps, other hormones of a lactogenic complex. Release of prolactin is controlled by a hypothalamus, in Krom the special prolaktinosvobozhdayushchy factor is developed (see. Hypothalamic neurohormones ).
Lactogenesis is closely connected with a reflex of a molokovydeleniye which has a neurohumoral origin, and it can conditionally be divided into two phases. The first is connected with irritation of receptors of a mammary gland during the act of suction and momentum transfer on nerve pathways therefore there is a relaxation of a mamillar sphincter and motor reaction of smooth muscle elements of channels and sine becomes more active. The second phase is continuation by the first and differs in the fact that reflex molokovydelitelny reaction includes a humoral link. The hypophysis excretes oxytocin which with a blood flow reaches a mammary gland and causes reduction of milk and epithelial cells. Alveoluses contract, milk from them comes through milk channels to sine and becomes available to the child at suction. Final formation and fixing of a reflex of a molokovydeleniye happen by the end of the first week. This period is considered critical for all the subsequent L.
During the first days of a lactation it is allocated so-called. colostrum (see), the structure to-rogo changes and it turns in breast milk (see). The amount of breast milk gradually increases, reaching the maximum sizes to 8 — the 9th week, and remains, as a rule, stable (to 1 — 1,5 l a day).
Sufficient L. depends on many factors and first of all on full emptying of mammary glands. Besides, on L. the age, constitutional features of the woman, type of a nervous system, the state of health during pregnancy, childbirth and L influence., mode of its food and mode of feeding of the child and many other factors. High products of milk are usually observed at women with strong, balanced and mobile type of a nervous system, and low can be at persons weak, unbalanced. Cases of decrease in L are well-known. or its complete cessation at strong negative emotions. Breastfeeding — the interacting process, in Krom mother and the child participate, and his current depends on behavior both.
Usually by the end of the first year of life of the child the reflex of a molokovydeleniye dies away and completely disappears after an otnyatiya of the child from a breast.
Release of milk can be absent (agalaxia), to be reduced (hypogalactia) or excessively plentiful (gipergalaktiya), milk can spontaneously expire (galactorrhoea).
Agalaxia it is observed extremely seldom. Most often it is caused by inborn lack of ferruterous elements of a mammary gland. Less often the agalaxia is connected with the progressing exhaustion of the woman or a strong mental shock; elimination of these factors can lead to recovery of L.
Hypogalactia it is observed, according to a number of authors, at 6 — 8% of women in childbirth. It can be caused morfol, or funkts, by inferiority of a mammary gland. In some cases the reason of a hypogalactia consists in insufficiency of a sucking reflex at the newborn. Sometimes the reasons leading to a hypogalactia can be combined, and in some cases remain not clear. There are data indicating value of a genetic factor in disturbance of L. at women.
The hypogalactia is subdivided on primary and secondary. Primary hypogalactia can be caused by hormonal disturbances in an organism of the woman (e.g., a diabetes mellitus, a diffusion toxic craw). The secondary hypogalactia can be caused by various diseases of mother (except endocrine), complications of pregnancy (increase in the ABP), childbirth and a puerperal period. The secondary hypogalactia can be caused also by disturbances, irrational food, mental and physical. overstrain. Hyposecretion is promoted by diseases of mammary glands, napr, nipple cracks, mastitis (see).
On time of emergence distinguish early (comes to light in the first 10 days after the delivery) and late hypogalactias) (10 days later after the delivery).
Depending on deficit of milk in relation to daily need of the child allocate 4 degrees of a hypogalactia: the 1st degree — deficit is not higher than 25%; the 2nd degree — 50%; the 3rd degree — 75%; the 4th degree — deficit of milk of St. 75%.
It is necessary to distinguish temporary insufficient secretion of milk in the first 2 — 4 days from a hypogalactia after the delivery, edges it is quite often observed at young primapara women. At the correct mode and care of mammary glands of L. quickly increases to fiziol, needs of the child.
Diagnosis hypogalactias it is usually put when the amount of the emitted milk does not tend to increase after elimination of the reasons promoting lowered by L.
Treatment primary hypogalactia consists in treatment of a basic disease. At a secondary hypogalactia appoint massage, thermal wrappings of mammary glands, radiation by a lamp sollyuks and use of ultrasound. The good stimulating lactogenic effect render an apilak and glutaminic to - that, beer yeast (3 — 4 tablets a day). At the secondary hypogalactia connected with increase in the ABP and late toxicosis Reserpinum in a dose of 0,25 mg 2 times a day within 7 — 10 days is recommended.
Prevention hypogalactias it is more effective concerning a secondary hypogalactia. It consists in elimination of the reasons promoting its development, creation of the optimum mode and diet of the pregnant woman and the feeding woman. The correct mode of feeding of the child, rhythmical and full emptying of a mammary gland create and fix funkts, a stereotype. Early decantation (in 12 hours after the delivery) 10 — 15 min. every 3,5 hour should be carried out not only at the feeding women in childbirth, but that is especially important, at temporarily not feeding, napr, at the birth of the premature child, a birth trauma, a hemolitic disease of the newborn and for other reasons. At irregular shape of nipples (small, sharp-pointed, flat, involved etc.) it is necessary to use slips and a milk pump. Prevention of primary hypogalactia is difficult and depends on a basic disease.
the Galactorrhoea — the spontaneous expiration of milk from a mammary gland. It is shown in the form of two forms: milk is emitted from one mammary gland spontaneously during the feeding of the child another or milk follows out of fiziol. L. and feedings (persistent L.). The first form of a galactorrhoea is observed at the feeding women with a hyperexcitability of a nervous system; it is often mistakenly treated as manifestation of so-called multilactescence and limit feeding of the child though in most cases the galactorrhoea is combined with a hypogalactia. The galactorrhoea can be plentiful, moderate, spontaneous, unilateral and bilateral, from single and many channels. In case of long postnatal L., combined with disturbance of a menstrual cycle, an atrophy of outside and internal generative organs, it is necessary to exclude a lactogenic amenorrhea (see. Kiari — Frommelya a syndrome ).
The reasons of the second form of a galactorrhoea are various, frequent it is a symptom of difficult disturbance of correlation of endocrine system with hypersecretion of oxytocin and prolactin; excess of lactogenic hormone oppresses release of follicle-stimulating hormone therefore in an organism of the woman there is a lack of estrogen. This form of a galactorrhoea can arise out of pregnancy at a hyperplasia and a tumor of a hypophysis, appendages, a uterus. At a wedge, inspection of patients with a galactorrhoea first of all it is necessary to exclude a tumor of a hypophysis by radio-gramophones., Ophthalmolum, and nevrol, researches to make careful ginekol, survey.
Duration of a galactorrhoea is various depending on etiol, the moments and fluctuates from several weeks to many years.
Treatment of a galactorrhoea at women with a hyperexcitability of a nervous system shall come down to psychotherapy and fortifying actions. It is necessary to pay special attention to need of protection of skin of area of mammary glands against constant irritation the following milk. It is the for this purpose best of all to apply a breast often replaced bandage from the gauze put several times or other material which is well absorbing moisture. Appoint hexestrol; means of the choice is purpose of oestradiol of Dipropionas on 1 mg intramusculary 4 times a month, Pregninum on 1 tablet 3 times a day. At detection of a tumor of a hypophysis the roentgenotherapy is shown. In some cases a galactorrhoea spontaneous recovery is noted.
Gipergalaktiya — excessively plentiful release of milk at the feeding woman (at some to 4 — 5 l a day). Consider that the reasons of a gipergalaktiya are identical to those which cause a galactorrhoea). Treatment is performed by the same principles, as treatment of a galactorrhoea.
Lactic psychoses — combined group of the psychoses arising in L. V period it enter as endogenous (schizophrenia, maniac-depressive psychosis, etc.), and exogenous psychoses. In the latter case the speech goes about the toxi-infectious mental disorders caused such patol, processes more often as mastitis, infections of a female genital, septic states, and also such diseases as, e.g., flu, acute respiratory diseases, etc.
Lactic psychoses are observed rather seldom. Their number gradually decreases that is explained by achievements of medicine in the field of protection of motherhood and the childhood.
The picture of lactic psychoses changes eventually. So, if in old literature on psychiatry it is specified dominance of pictures of an amentia and catatonia (see. Amental syndrome , Catatonic syndrome ), in sovr, clinic the depressions which are characterized by feeling of melancholy, ideatorny and motor block dominate; sometimes the crazy ideas join, self-accusations are more often — depressive and paranoid states (see. Paranoid syndrome ).
In the period of L. also disorders of neurotic character (the increased physical and mental fatigue, causeless uneasiness, sleeplessness), sometimes with elements of frustration of mood and an inclination, decrease in memory and other manifestations of an endocrine psychosyndrome can develop (see. Endocrine mental syndromes ).
Development of mental disorders of the period of L. it is connected not only with the reasons which cause their emergence, but also with instability of endocrine functions, the psychoinjuring moments connected with adaptation of the woman to conditions of motherhood and the corresponding changes in her social life, new family functions, the exhausting factors of somatic and mental character (a puerperal adynamy). A certain part is assigned also to features premorbidal a warehouse of the identity of the woman (the increased vulnerability and sensitivity, sensitive and schizoid lines).
Treatment of mental disorders of the lactic period is carried out depending on their reason and a wedge, symptoms.
Holding necessary preventive actions in a puerperal period, and also prenatal psychological preparation is created by premises of decrease in number of psychoses of the lactic period.
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A. V. Papayan; D. D. Orlovskaya (psikhiat.).