Lactation

Question 1

What stimulates the development of glandular tissue of the breat tolrpfiuce milk?

Answer 1

*Human placental lactogen and Progesterone produced by the placenta

*Prolactin produced by the anterior pituitary gland

Question 2

What prevents milk production during pregnancy?

Answer 2

Progesterone inhibits milk let down

Question 3

What is the initial production of breastmilk?

Answer 3

Colostrum, which is high in immune cells and antibodies and low in fat. It acts as a laxative to assist in passing of the first stool.

Question 4

What does typical breastmilk contain?

Answer 4

High fat content with lactose, vitamins, micronutrients and protein, casein, maternal antibodies like IgA.

Question 5

Which vitamins are low in breastmilk?

Answer 5

*Vitamin D
*Vitamin B12
*Vitamin K

Question 6

What is the role of oxytocin?

Answer 6

Contraction of the myopeithelial cells

Question 7

What is the role of prolactin?

Answer 7

Production of ilk

Question 8

What drives breastfeeding initially.

Answer 8

Prolactin production- this switched to mechanical based stimulation for supply and demand

Question 9

Which drugs prevent lactation?

Answer 9

dopamine agonists like cabergoline and bromocriptine

Question 10

How to suppress lactation?

Answer 10

*stop the lactation reflex i.e. stop suckling/expressing
*supportive measures: well-supported bra and analgesia
*cabergoline is the medication of choice if required

Question 11

When is contraception required post partum?

Answer 11

After day 21

Question 12

Which contraception can be started any time post partum?

Answer 12

Progesterone only pill, for breastfeeding and non-breastfeeding women. Additional contraception will be required for the first 2 days.

A small amount of progestogen enters breast milk but this is not harmful to the infant

Question 13

What contraceptive should be avoided post partum?

Answer 13

Combined oral contraceptive pill, especially in the first 21 days due to the increased venous thromboembolism risk post-partum

Question 14

When is COCP completely contraindicated post partum?

Answer 14

Less than 6 weeks post-partum

Question 15

What is the UKMEC post 6 weeks?

Answer 15

UKMEC 2 - if breastfeeding 6 weeks - 6 months postpartum

Question 16

What is alternative to pill contraceptive?

Answer 16

The intrauterine device or intrauterine system can be inserted within 48 hours of childbirth or after 4 weeks.

Question 17

When is no contraceptive required post poarttum?

Answer 17

Lactational amenorrhoea method (LAM)
is 98% effective providing the woman is fully breast-feeding (no supplementary feeds), amenorrhoeic and < 6 months post-partum

Question 18

What are the implications of conceiving during the post partum period?

Answer 18

An inter-pregnancy interval of less than 12 months between childbirth and conceiving again is associated with an increased risk of preterm birth, low birth weight and small for gestational age babies

Question 19

What can occur in women who have recently stopped breastfeeding?

Answer 19

Galactocele which is occlusion of a lactiferous duct from A build up of milk creates a cystic lesion in the breast

Question 20

How to differentiate Galactocele from abscess?

Answer 20

galactocele is usually painless, with no local or systemic signs of infection

Question 21

When can COCP be restarted after birth in non breastfeeding mothers?

Answer 21

3 weeks due to high oestrogen

Question 22

When can COCP be restarted after birth in breastfeeding mothers?

Answer 22

6 weeks as oestrogen reduces the milk supply in the breasts and increases the risk of VTE in the first 6 weeks after pregnancy

Question 23

What is the only drug associated with epilepsy to avoid with breastfeeding?

Answer 23

Diazepam as it could elicit adverse effects such as lethargy and weight loss in infants

Question 24

When to stop breastfeeding with mastitis?

Answer 24

Suspicion of infection if:
*Symptoms do not improve or are worsening after 12-24 hours despite effective milk removal.
*The woman has a nipple fissure that is infected.
*Bacterial culture is positive (breast milk culture is not routinely required unless mastitis is severe, there has been no response to antibiotics, or this is recurrent mastitis).

Question 25

What to encourage with mastitis?

Answer 25

Breastfeeding which improves milk removal and prevent nipple damage

Question 26

What is a side effect of bromocriptine?

Answer 26

hypertension and neurological symptoms

Question 27

Which drugs to avoid when breastfeeding?

Answer 27

LAMBAST Lithium Amiodarone Methotrexate Benzos Aspirin Sulfonamides Tetracyclines