puerperium and lactation-by:dr.dhiren bhoi
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Puerperium and LactationPuerperium and Lactation
Dr. DHIREN B. BHOI
M.V.Sc., (Gynaecology)
E. Mail:[email protected]
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PuerperiumPuerperium The period after parturition when
reproductive tract repairs itself and returns toits non-pregnant condition (Uterineinvolution)
Become prepared for another pregnancy
Begins immediately after parturition andrecovery period varies among species
Short and smooth recovery period isdesirable
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Events of PuerperiumEvents of Puerperium
1. Myometrium contraction and expulsion of
lochia
2. Endometrial repair
4. cyclcity:
6. Elimination of bacterial contamination
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Stage 1:Myometrium contraction and expulsion of lochia
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Stage 2 & 3:Stage 2 & 3: Endometrial repairEndometrial repairResumption of ovarian function
Necrosis of caruncular tissues
Sloughing of the caruncular tissues
Reorganization of uterine
endometruim
First postpartum ovulation
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Continuation of uterine contraction
Rise in Estradiol and increase in leukocytes
High degree of
Stage 4:Stage 4:Elimination of bacterial contamination
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LactationLactation
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The Mammary GlandThe Mammary Gland
Exocrine gland; common to all mammals
Function: nourish the neonate
-Food source: fat, protein, sugar (CHO),
vitamins, minerals, water
-Protection: immunoglobulins
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Loosely considered part of the reproductive system:
Serves a reproductive function; nourishment of
the neonate = survival of species.
Relies on same endocrine (hormonal) support for
development and function.
Example: gonadal steroids, prolactin, etc.
The Mammary GlandThe Mammary Gland
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Embryo Origin:
The mammary gland is a skin gland
The Mammary GlandThe Mammary Gland
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Secretory Tissues:
Glandular; secreting tissue =
Alveoli:
Duct system; lined by epithelial cells
Lobules & lobes; clusters of alveolar tissue
supported by connective tissue
The Mammary GlandThe Mammary Gland
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Milk SynthesisMilk Synthesis
Milk synthesis is dependent on: no. secreting cells
supply of milk precursor
milking frequency
No. secreting cells is dependent on:
genetics endocrine support for mammogenesis
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Example:
What volume of blood would a 1400 lb. Holstein
pump per day?
Blood Flow
(cattle)
Blood ComponentsBlood Components
1400 lb. Cow ~ .9 liters/ heart stroke
Volume/day = .9 x 70 strokes/min = 63 liters/min
63 liters/min x 1440 min/day = 90,720 liters/day
= ~ 22,600 gal/day
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Blood Flow (cattle)
Volume of blood/ volume of milk synthesized =(this is an approximation; actual ratio is
affected by stage of lactation, efficiency, etc.)
Blood ComponentsBlood Components
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Steroid Hormones and MammogenesisSteroid Hormones and Mammogenesis
Estrogens:
follicle, placenta,
Progesterone:
corpus luteum, placenta,
Corticoids:
adrenal cortex
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Estrogens (E2) (follicle, placenta)
1)
2)
3) synergize with progesterone & prolactin tostimulate protein synthesis and duct growth
Steroid Hormones and MammogenesisSteroid Hormones and Mammogenesis
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Progesterone (P4) (corpus luteum, placenta)
1)stimulates lobulo-alveolar growth retards milksynthesis
2)retards synthesis of enzymes (a-lactalbumin)
necessary for lactogenesis in the prepartummammary gland
Steroid Hormones and MammogenesisSteroid Hormones and Mammogenesis
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Lactogenesis; CortisolLactogenesis; Cortisol
Action of cortisol:( from adrenal cortex)
(dexamethasone is synthetic cort.)
1) synthesis stimulated by maternal, fetal ACTH
essential to lactogenesis (adrenalectomy
> nolactogenesis)
2)
M iM i
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Placental E2 + luteal P4 =
duct development
lobulo-alveolar development
suppression of milk synthesis
(P4 suppresses
-lactalbumin; lactose synthesis
MammogenesisMammogenesis
(Mammary Growth and Development)(Mammary Growth and Development)
M iMammogenesis
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Action of cortisol + PRL:
increase PRL receptor synthesis
increase protein transcription/translation
cortisol is permissive to action of PRL
MammogenesisMammogenesis
(Mammary Growth and Development)(Mammary Growth and Development)
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LactogenesisLactogenesis
(Milk Synthesis)(Milk Synthesis)
How does P4 retard milk synthesis in thenonlactating mammary gland?
Blocks glucocorticoid (cortisol) receptors
Cortisol + PRL stimulates synthesis of PRLreceptors on mammary cells
P4blocks induction of PRL receptors
Retards synthesis of a-lactalbumin, casein mRNA
Retards casein, a-alactalbumin, lactose synthesisthus, retards milk synthesis
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Endocrine Glands SupportingEndocrine Glands Supporting
Mammary FunctionMammary Function
GH (STH, BST):
increases milk yield
Action:
increases gluconeogenesis
increases blood glucose
increases efficiency of
production (greater lbs. of
milk/ lb. DMI)
E d i Gl d S tiE d i Gl d S ti
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Endocrine Glands SupportingEndocrine Glands Supporting
Mammary FunctionMammary Function
Pancreas (islets of Langerhans; protein hormones)
(responsive to blood glucose concentration)
Glucagon (alpha cells):
increases lipolysis
increases glycogenolysis
depresses cellular glucose uptake
catabolic to adipose, muscle, liver tissue
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Lactogenesis = initiation ofmilk synthesis
initiated in the E2/P4
primed mammary
gland when:
corpus luteum regresses
P4 declines
cortisol increases
PRL, GH increase
these circumstances occur
at parturition
Lactogenesis
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