Agalaxia — pathology of the postnatal period which is characterized by total absence of secretion of breast milk. At diagnosis use ultrasonography of chest glands, a laboratory research of level of Prolactinum, a computer tomography of a brain for an exception of diseases of a hypophysis. Apply medicines with laktogonny effect in combination with physiotherapeutic procedures and correction of a diet to restoration of lactogenesis. If the concrete cause of infringement of a lactation is known, treatment is directed to its elimination. Therapy of so-called primary agalaxia is impossible now.
Though insufficient secretion of breast milk is noted practically at a half of women in labor, its total absence occurs no more than at 3% of patients and from 10 000 it is caused only in 1 woman by the anatomic reasons. In most cases the lactation stops under the influence of various exogenous and endogenous factors caused by somatic, infectious and endocrine diseases. The agalaxia comes to light at primipara women and at women in labor in age group of 40 and more years more often. On observations of mammologists and obstetricians-gynecologists, the prospects of restoration of a lactation decrease with increase in age of the patient.
Total absence of milk can be caused in the woman in labor by morphological changes of parenchymatous tissue of breast and violations of neuroendocrine regulation of process of a lactation. At some patients the combination of these factors is observed, usually production of milk stops after some period of breastfeeding. Are the main reasons for an agalaxia:
- Lack of ferruterous fabric. Congenital insufficient development of chest glands — one of signs of a gipogonadizm and infantility, and at stout women pathology often masks excess development of fatty tissue in a breast. At patients 40-45 years are more senior the parenchyma atrophies owing to age involution of mammary glands.
- Prolactinum secretion violation. Production of laktotropny hormone decreases at perenoshenny pregnancy, a postnatal syndrome of Shikhan, tuberculosis and tumors of a hypophysis, after neurosurgical interventions and severe craniocereberal injuries. Level of a mammotropin is reduced at patients with sugar and not diabetes.
- Genetic predisposition. At a part of women in labor the agalaxia has the hereditary nature, arises because of absence at laktotsit of receptors to mammotropny hormone. The lactation also becomes impossible at a number of congenital fermentopatiya when the biochemical chain of lactogenesis is broken owing to fermental insufficiency.
- Reception of medicamentous medicines. There are several groups of the medicines influencing laktatsionny process. Breast milk is absent more often at patients who accept a calcitonin, dofaminergichesky and anticonvulsive medicines, And, antagonists of female sex hormones, first of all estrogen.
- Feverish states. The diseases which are followed by a hyperthermia — one of common causes of decrease in lactogenesis. More often they lead to a gipogalaktiya, but at substantial increase of temperature the lactation stops completely. The situation is aggravated with a temporary ban on breastfeeding at a number of infections.
- External factors. Anti- effect the low-calorie diet with insufficient quantity of liquid products and waters renders, the use of vegetable broths with diuretic action. The agalaxia can develop at severe stresses, poisonings, radiative effects.
The mechanism of developing of an agalaxia is based on lack of a morphological substratum for production of milk or insufficient stimulation of laktatsionny process. If in tissues of a mammary gland it is not enough or at all there are no ferruterous cages or laktotsita are tolerant to Prolactinum, the mammotropny hormone emitted by a hypophysis cannot render the lactostimulating effect. On the other hand, at the insufficient level of a mammotropin lactogenesis in alveoluses of a breast does not begin. Fermentopatiya, feverish states, some medicamentous medicines and other external factors influence different links of a lactation — from decrease in production of Prolactinum to oppression of secretion of milk of a laktotsitama.
At systematization of separate forms of an agalaxia consider frustration emergence time, and also the reasons which resulted in lack of a lactation after the delivery. At the same time most of experts in the sphere of a mammology consider one of key criteria of classification a theoretical possibility of functioning of chest glands. There are following options of a disease:
- Primary (absolute, true) agalaxia. Lack of milk because of impossibility of its production owing to underdevelopment of a parenchyma of a breast, rough endocrine frustration and fermentopatiya.
- Secondary (relative) agalaxia. The complete cessation of lactogenesis at earlier lactating woman caused by the external reasons or various pathological states.
That in a breast there is no milk, lack of any allocations from a nipple at its compression or attempt of decantation of a mammary gland demonstrates. At primary insolvency of lactogenesis both milk, and colostrum which normal appears on 30-31 weeks of pregnancy is not produced. A symptom of a secondary agalaxia is the termination of a lactation which arose suddenly or after gradual decrease in a lactation: the child it is difficult to tear off from a breast, he becomes uneasy, sleeps badly, does not gain weight. When pressing before feeding dairy droplets are not allocated for a nipple.
As an independent pathological state the agalaxia does not constitute any danger to health and the woman's life. At the wrong assessment of a clinical situation and rough attempts of a rastsezhivaniye injuries of a mammary gland are possible. If secretion of milk is oppressed after the lactation period, but the woman continues to put the child counting on the fact that it rassost a breast, the probability of damage mamillar zones — macerations, cracks and eczema of a nipple is high. Out of time recognizable agalaxia constitutes big danger to the child at whom the hypotrophy of newborns can develop.
Key problem of a diagnostic stage at total absence of milk in the postnatal period — identification of the reasons which led to an agalaxia. To the patient appoint the comprehensive examination allowing to estimate objectively a condition of various bodies participating in a lactation or influencing it. For diagnosis are most informative:
- Ultrasonography of a breast. The method allows to define, the ferruterous component of mammary glands is how created. Underdevelopment of parenchymatous fabric is characteristic of primary agalaxia.
- Prolactinum level in blood. Decrease in concentration of laktotropny hormone can demonstrate both primary violation of lactogenesis, and secondary oppression of a lactation.
- Brain KT. As Prolactinum is synthesized by a forward share of a hypophysis, it is important to exclude organic damages and volume processes to gipotalamo-hypophysial area.
Other tool and laboratory methods are appointed by profile experts at suspicion to existence of a concrete pathological state. Differential diagnostics is usually carried out between a secondary agalaxia and a gipogalaktiya. For specification of the reasons of the broken lactogenesis the endocrinologist, the neurosurgeon, the therapist, the infectiologist (can be involved in inspection of the patient at oppression of a lactation against the background of a febrilny state).
Treatment of an agalaxia
The prospects of restoration of lactogenesis depend on a pathology form. At primary (true) violation of a lactation synthesis of breast milk does not manage to be restored. Transfer of the child to artificial feeding is in that case recommended, and at detection of the serious disease which caused frustration – treatment of the woman at the doctor of the corresponding specialty. Complex therapy of a secondary agalaxia assumes:
- Elimination of the reasons of oppression of a lactation. To the patient appoint treatment of the main disease or a state which led to milk loss — a sharp infection, poisoning, failure of adaptation owing to a stress, etc. For this purpose use antibiotics, nonsteroid resolvents, sedative and infusional therapy, immunoproofreaders and vitamin and mineral complexes.
- Lactogenesis stimulation. Apply laktogonny medicines to renewal of secretion of milk (, , vitamin E, nicotinic acid), phytomeans, physiotherapeutic techniques (ultrasound, ultra-violet radiation, an electrophoresis with nicotinic acid). Correction of a diet with increase in its general caloric content is effective.
Forecast and prevention
The forecast of breastfeeding at primary agalaxia adverse, at secondary depends on the lactogenesis process oppression reasons. Timely complex stimulation of production of milk and bystry elimination of the reasons which broke a lactation improve the prospects of feeding of the child a breast. It is impossible to warn primary agalaxia. For preservation of already begun lactation it is recommended to observe the mode of a dream and rest, to use enough water and high-calorie products, to avoid considerable psychoemotional and physical activities, to treat in due time associated diseases. An important role in maintenance of lactogenesis is played by a regularity of applying of the baby to a breast.