Agalactia

Agalactia is the complete absence of breast milk in a woman in labor in the postpartum period. True pathology is rare, has an organic character, its treatment is currently impossible. In addition, the functional absence of breast milk secretion or low production (hypogalactia) can be caused by different reasons and occur at any time of breastfeeding. In the second case, it is almost always possible to restore lactogenesis. A woman's willingness to breastfeed her baby and active cooperation with a breastfeeding specialist are of great importance for the success of recovery therapy.

Epidemiology

The statistical findings of agalactia studies are very dependent on the purpose and population of the study. Problems with breast milk production in modern women are quite common. Functional hypogalactia is experienced at different periods by about half of breastfeeding mothers, while agalactia affects about 3% of patients.

According to some reports, in the first weeks after delivery, unsatisfactory milk production is observed in 5-15% of women in labor. In most cases (85-90%) this condition is temporary, and breastfeeding can be easily restored, as milk production stops due to the mother's lack of experience and violation of the normal breastfeeding regimen, in particular, with infrequent breastfeeding. And only in the remaining 10-15% of cases of impaired milk secretion has the nature of a disorder of neurohumoral regulation due to pathological internal or external influences.

Only one woman in 10,000 cannot breastfeed because of the anatomical structure of her mammary glands.

Causes of the agalactia

Organic or primary agalactia is associated with anatomical features of the structure of the mammary glands of a particular woman or disorders at the cellular level:

• congenital absence of glandular breast tissue;
• Hereditary lack of mammotropic hormone receptors in the cells that secrete milk, lactocytes;
• some congenital enzymopathies - against the background of deficiency of a number of enzymes, the biochemical chain of lactogenesis is broken and milk secretion becomes impossible.

Insufficient milk production (primary hypogalactia), sometimes complete absence of milk, may also be of organic origin and may occur immediately after childbirth in the following cases in women:

• with endocrine disorders (thyroid, ovarian, pituitary dysfunction), first-time mothers after 35 years of age;
• with uncompensated cardiovascular disease;
• with a large myomatous node;
• preeclampsia, eclampsia - a systemic complication of pregnancy, childbirth and postpartum period, characterized by the development of renal dysfunction with edema, hypertension, cramps, destructive effect on blood vessels and other vital organs;
• with pituitary ischemia due to massive bleeding in a laboring woman;
• as a consequence of severe infectious diseases, with marked intoxication and dehydration.

Also, sometimes involutional atrophy of the breast parenchyma can occur with age or the inability to feed is a consequence of breast surgery.

Primary hypo- or agalactia is quite rare. Much more common is functional cessation of milk production or its insufficiency, when a woman in labor breastfed her baby immediately, but over time the milk became clearly insufficient or disappeared. Such consequences are often caused by the wrong mode of feeding the child - with long breaks, lack of night feedings. Also the secretion of milk can be affected by complicated pregnancy and childbirth, increased physical and nervous stress on the nursing mother.

Risk factors

Agalactia in labor can be congenital pathologies associated with underdevelopment of the mammary glands, in particular, the absence of the parenchymatous component of the mammary gland or dysfunction of neuroendocrine regulation of the process of milk secretion. Sometimes a combination of these pathologies is observed.

Major risk factors:

• hereditary predisposition;
• Congenital infantilism or hypogonadism;
• congenital abnormalities of the pituitary gland.

Factors that may adversely affect lactogenesis in women with initially normal development of secondary sex characteristics:

• the age of the woman in labor is older than 40-45 years;
• carried pregnancy;
• tuberculosis, other severe infections;
• endocrinologic pathologies (pituitary neoplasms, diabetes, thyroid disorders);
• Postpartum pituitary infarction;
• hmt and neurosurgery;
• medication (anticonvulsant treatment; taking drugs that depress female sex hormones; immunosuppressants; calcitonin; diuretics);
• Veganism and other low-calorie diets;
• inadequate fluid intake;
• severe stress;
• intoxication;
• exposure to radiation and other harmful factors.

Pathogenesis

The complete cycle of lactation can be divided into three stages:

1. Mammogenesis is a discrete process that begins in the tenth week of intrauterine development. The main development of mammary glands and their growth begins in puberty, and the morphological completion of the process occurs only during pregnancy. The development of mammary glands is controlled by hormones: in the process of growth of hormone-dependent glandular tissue, the main role is played by insulin and growth hormone; later, in the process of cell division, cortisol prevails. The next stages are related to genetic features of breast cells and are controlled by female sex hormones and growth factors.
2. Lactogenesis is the preparation of a pregnant woman's breasts for the production of colostrum and milk.
3. Lactopoiesis - activation of mechanisms for the development and maintenance of the lactation process. Mammotropic hormone (prolactin) activates milk production. After childbirth in the norm its level increases, under its influence activates blood flow in the mammary gland, which stimulates its parenchyma to start "production" of milk. Regulation of the release of colostrum, and later - milk occurs under the influence of oxytocin. These pituitary hormones must be active and all anatomical structures of the mammary gland must be normally developed.

Congenital disorders of mammary gland development and growth, resulting in the absence of anatomical elements necessary for milk synthesis, trigger the pathogenesis of primary agalactia at the stage of mammogenesis. Organic agalactia occurs in the absence (insufficient quantity) in the tissues of the mammary gland parenchyma or violations of humoral regulation of the lactation process. Mammotropic hormone (prolactin, lactogenic hormone), even if sufficiently synthesized by the pituitary gland, does not stimulate the production of breast milk when there is a negligible amount or complete absence of glandular cells and/or when lactocytes without receptors do not show sensitivity to it.

Hormonal disorders can occur at any stage of the lactation cycle, including in a lactating woman. In addition to congenital pituitary disorders, there is a possibility of their occurrence under the influence of various external and internal factors. Unfavorable events in the life of a laboring or lactating mother (severe pregnancy and childbirth, illness, stress) can affect different stages of lactopoiesis - from cessation (significant decrease) of prolactin secretion to inhibition of milk production by lactocytes, which leads to the development of secondary agalactia. For example, under the influence of stress, the level of adrenaline and noradrenaline increases. These hormones affect the hypothalamus, slowing down the production of oxytocin, which not only regulates milk secretion, but also promotes the release of prolactin. Insufficient activity and amount of oxytocin and lactogenic hormone triggers the pathogenetic mechanism of decreased milk production.

Rarely putting the baby to the breast, underdeveloped sucking reflex in the child (insufficient stimulation of the nipples, congestion in the chest) leads to a decrease in the amount and activity of prolactin in the pituitary gland, which also negatively affects the synthesis of milk. The brain receives a signal of excess milk and reduces its production. Congestion in the alveoli and ducts of the mammary glands, arising from infrequent scheduled feedings, has a depressing effect on the activity of lactocytes and blocks lactopoiesis.

Women who give birth for the first time after the age of 40 may experience a- or hypogalactia, associated with age-related decline in reproductive function, in which the number of glandular cells in the breasts decreases significantly. Visually, however, the increasing volume of fatty tissue masks the problem.

Symptoms of the agalactia

Agalactia is the complete absence of colostrum, later breast milk, in a woman in labor. The first signs of primary agalactia appear at 30-31 weeks of pregnancy, when normally a drop of liquid can be seen when pressing on the perineal circle. Agalactia in pregnancy indicates possible problems with breastfeeding in the future.

The pathology is usually detected immediately after delivery and consists in the fact that in response to pressure from the nipple orifices do not release a drop of colostrum or breast milk.

If a nursing mother suddenly loses milk (secondary agalactia), the breasts stop "filling up" before feeding and the baby's behavior changes. During laying on the breast, he behaves restlessly, throws the breast, twists his head, whimpers or, conversely, he can not "tear" from the breast. You can check your assumption by trying to carefully decant the milk - a drop from the holes in the nipple will not appear.

In hypogalactia, which can develop into a complete absence of breast milk, a drop of colostrum or milk is secreted but not enough is produced. The baby is malnourished and this is immediately noticeable by his behavior. He is hungry, so he cries and irritates more than usual, often wakes up at night.

Usually such signs cause concern in an attentive mother, and she learns about the insufficient milk production even before the child stops gaining weight normally.

Stages

A woman's lack of milk can be classified according to different criteria. In general, the types of agalactia are considered depending on the causes:

• organic - congenital, caused by irreversible underdevelopment of the mammary glands or hormonal problems;
• functional (pathological) - associated with changes in the process of the lactation cycle that occurred later and led to progressive exhaustion of the maternal body (trauma, surgeries, diseases, severe childbirth, mental trauma);
• physiological - associated with an incorrect feeding regimen, technique of putting the baby to the breast and other shortcomings (occurs frequently, usually resolved at the stage of hypogalactia).

Agalactia can be categorized as milder, temporary and permanent, not subject to correction. There are also primary agalactia (diagnosed immediately after childbirth) and secondary agalactia (developed later in a breastfeeding woman).

Agalactia is the complete absence of lactation. In the secondary form of the pathology, the previous stage of development - hypogalactia with a gradual decrease in breast milk production - may be observed at first.

Complications and consequences

Agalactia itself is not dangerous for the health and life of a woman. However, the mother may cause injuries to the mammary gland in the area of the nipple areola when trying to restore the lactation process by home-made methods - incorrectly decompressing the breasts, endlessly placing the baby on an empty breast in the hope that milk will finally appear as a result of nipple stimulation, etc.

In addition, agalactia as a symptom may indicate the presence of somatic pathologies that should be treated or compensated for as early as possible.

Much worse consequences of not recognizing agalactia (hypogalactia) in time can be for the infant, initially manifested by underweight. Inattention to the problem can result in the development of neonatal hypotrophy.

Diagnostics of the agalactia

If agalactia is detected, the patient is examined to confirm its presence, and laboratory and instrumental methods of examination are prescribed, aimed primarily at identifying/excluding organic defects in the structure of the mammary glands and hormonal imbalance leading to impaired lactation function.

First of all, it is a blood test for the presence and level of prolactin. The main instrumental diagnostics is breast ultrasound. If insufficient informativeness additionally can be appointed their magnetic resonance imaging. The brain is scanned with MRI or CT scan to establish/exclude abnormalities of the pituitary gland.

If the primary organic agalactia is not confirmed, consultations and examinations are prescribed to assess the work of the rest of the body systems. The most commonly prescribed tests are blood for the level of thyroid hormones, glucose concentration, biochemical composition. A general practitioner, endocrinologist, neurosurgeon, neurologist and other specialized specialists are involved in the examination and conduct an examination, interview, as well as prescribe the necessary from their point of view tests and instrumental studies.

Differential diagnosis is performed after completion of a comprehensive examination of the patient by sequential exclusion of pathologic conditions that led to secondary agalactia.

Treatment of the agalactia

Clinicians claim, and statistics confirm, that hypogalactia, i.e. Reduced breast milk production, rather than its complete absence, is more common in practice. And in most cases, this is due to a common mistake - trying to feed the baby at certain intervals. Some parents try to reduce the night interval to five or six hours and accustom the baby to it.

Currently, obstetrics care is focused on natural feeding of infants. The clinics practice early breastfeeding, and the baby and mother stay together. Mothers are encouraged to practice on-demand feeding, without specific time intervals between feedings, which promotes more complete emptying of the mammary gland and is a natural prevention of milk stasis in the alveoli and ducts. However, not everyone is able to establish breastfeeding immediately. In addition, during breastfeeding there are so-called "lactation crises" - on the third or fourth day, at two months of feeding there is a temporary decrease in lactation. But if the problem is only this, then with the help of a breastfeeding specialist, it is quite solvable. The main condition for overcoming the crises - frequent putting the baby to the breast, at night - also. A nursing mom needs enough rest. During a good night's sleep, the mammotropic hormone prolactin is produced. A varied diet and sufficient drinking is also important for lactopoiesis.

In pathologic agalactia/hypogalactia, the choice of treatment depends on the nature of the disease that caused the absence of breast milk. The prospects for restoring its production are ambiguous. Complex measures aimed at regeneration of the complex neurohumoral regulation of the process of breast milk synthesis are required. It is necessary to activate peripheral blood circulation in the patient's mammary glands, for which to increase the level of prolactin, oxytocin activity, that is, to normalize the parasympathetic nervous system. Preliminarily eliminate the underlying cause that caused secondary agalactia - infection, acute poisoning, the consequences of a psychological breakdown, etc. For its elimination, medications are prescribed: antibiotics, NSAIDs, sedatives, drugs that restore hemodynamics, immunomodulators, vitamin and mineral complexes, etc.

Drugs are chosen that are safer for mother and child. Preference is given to penicillins, natural and synthetic (ampicillin, ampiox); macrolides (erythromycin, azithromycin), cephalosporins. The choice depends on the sensitivity of the infectious agent. Preferred antidepressants are considered fluoxetine, venlafaxine. Drugs are prescribed by a doctor, it is undesirable to deviate from his recommendations.

At the same time, therapy is prescribed to restore milk production. Drugs that stimulate the process of lactation can also belong to different groups of medicines. Phytopreparations, vitamins E, B3, synthetic analog of oxytocin - desaminooxytocin, lactin, physiotherapeutic procedures are used, in particular, ultrasound delivery of nicotinic acid or vitamin electrophoresis.

Desaminooxytocin is prescribed to stimulate lactopoiesis in the postpartum period and should be taken from the second to the sixth day from two to four times five minutes before feeding. The dose is prescribed by a doctor and is half or a whole tablet (25-50 IU). The drug is chewed by placing it behind the cheek, periodically moving it from right to left. As a rule, there are no clinically significant adverse effects of taking the recommended dose.

Lactin is an injectable lactation stimulant. It is used intramuscularly, one to two injections per day of 70-100 units. Duration of therapy is five to six days.

Vitamin B3 (nicotinic acid, old name vitamin PP) is used as a means of stimulating blood circulation and, consequently, promoting milk flow. The recommended dose is 50 mg three or four times a day. Take 15-20 minutes before the expected laying of the baby to the breast. If the skin area on the breast near the nipple does not turn pink, the dose is increased to 75 mg.

As a stimulant of lactopoiesis Apilac is used - a preparation based on royal jelly with a tonic effect. The effect of Apilak will be noticeable after three to four days. It is taken as a tablet sublingually, that is, sucking it under the tongue three times a day for 10-15 minutes before putting the baby to the breast. The duration of administration - no more than 14 days.

Any of the listed products can cause an allergic reaction, Apilac should not be taken by women with a known intolerance to bee honey.

When anatomical disorders of the structure of the mammary glands, iatrogenic irreversible causes or a serious disease in the mother, when the process of lactation can not be restored there are two ways out - donor milk or transfer of the baby to artificial feeding, which in modern conditions is not a tragedy, because in the trade network is a wide range of breast milk substitutes.

Prevention

Prevention of congenital defects of breast structure and/or hormonal disorders is not possible at this stage of medical development.

Prevention of the development of functional agalactia is a healthy lifestyle, timely treatment of pathologies, support of close people.

In order to maintain lactation, you need to:

• Putting your baby to the breast more often, especially if he or she demands it;
• a full and nutritious diet;
• to keep hydrated;
• avoid increased stress on the body, both physical and psycho-emotional;
• get a good night's sleep;
• to correct any health problems that arise in a timely manner.

Forecast

The prospects for restoring lactopoiesis in agalactia depend on the causes of agalactia. It is mainly found in first-time mothers and older women.

If the case is related to an incorrect feeding regimen, with the proper support of a breastfeeding specialist, the recovery of breast milk production is achievable.

The prognosis of true agalactia is unfavorable. In secondary agalactia, elimination of its causes does not always lead to the desired result. There is a correlation between the possibility of restoring lactopoiesis and the age of the woman in labor, as well as the severity of her disease. The older a woman is and/or the more serious her pathology, the less realistic it is to restore breastfeeding. Nevertheless, timely elimination of the causes and comprehensive stimulation of lactopoiesis are of great importance.