Puerperium and Lactation

Dr. DHIREN B. BHOI

M.V.Sc., (Gynaecology)
E. Mail:-drdhirenvet@gmail.com
 Puerperium
• The period after parturition when
reproductive tract repairs itself and returns to
its non-pregnant condition (Uterine
involution)

• Become prepared for another pregnancy

• Begins immediately after parturition and

recovery period varies among species

• Short and smooth recovery period is

desirable
 Events of Puerperium

1. Myometrium contraction and expulsion of

lochia

2. Endometrial repair

4. cyclcity:

6. Elimination of bacterial contamination

Stage 1: Myometrium contraction and expulsion of lochia
Stage 2 & 3: Endometrial repair
Resumption of ovarian function

– Necrosis of caruncular tissues

– Sloughing of the caruncular tissues

– Reorganization of uterine
endometruim

– First postpartum ovulation

Stage 4: Elimination of bacterial contamination

• Continuation of uterine contraction

• Rise in Estradiol and increase in leukocytes

• High degree of
Lactation
 The Mammary Gland

• Exocrine gland; common to all mammals

• Function: nourish the neonate

- Food source: fat, protein, sugar (CHO),

vitamins, minerals, water

- Protection: immunoglobulins
 The Mammary Gland

• 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 Gland

Embryo Origin:

• The mammary gland is a skin gland

–
 The Mammary Gland

Secretory Tissues:

• Glandular; secreting tissue =

– Alveoli:

– Duct system; lined by epithelial cells

– Lobules & lobes; clusters of alveolar tissue

supported by connective tissue
 The Mammary Gland

Alveolus:
– basic secretory unit; lined by epithelial cells
which synthesize and/or secrete:

• lipid - triglycerides & free fatty acids (FFA)

• protein -

• lactose –

• minerals & vitamins - Ca, P, K; Vits. A, B, C, D

• water
 Milk 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
–
–
 Blood Components

Blood Flow
(cattle)
Example:
What volume of blood would a 1400 lb. Holstein
pump per day?

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
 Blood Components

Blood Flow (cattle)

• Volume of blood/ volume of milk synthesized =

(this is an approximation; actual ratio is
affected by stage of lactation, efficiency, etc.)
Steroid Hormones and Mammogenesis

• Estrogens:
– follicle, placenta,

• Progesterone:
– corpus luteum, placenta,

• Corticoids:
– adrenal cortex
 Steroid Hormones and Mammogenesis

• Estrogens (E2) (follicle, placenta)

1)

2)

3) synergize with progesterone & prolactin to

stimulate protein synthesis and duct growth
 Steroid Hormones and Mammogenesis

• Progesterone (P4) (corpus luteum, placenta)

1) stimulates lobulo-alveolar growth– retards milk

synthesis

2) retards synthesis of enzymes (a-lactalbumin)

necessary for lactogenesis in the prepartum
mammary gland
 Lactogenesis; Cortisol

• Action of cortisol:( from adrenal cortex)

(dexamethasone is synthetic cort.)

1) synthesis stimulated by maternal, fetal ACTH

essential to lactogenesis (adrenalectomy

> nolactogenesis)

2)
 Mammogenesis
(Mammary Growth and Development)

• Placental E2 + luteal P4 =
– duct development
– lobulo-alveolar development
– suppression of milk synthesis
(P4 suppresses
α-lactalbumin; lactose synthesis
 Mammogenesis
(Mammary Growth and Development)

• Action of cortisol + PRL:

– increase PRL receptor synthesis
–
–
– increase protein transcription/translation
–
• cortisol is permissive to action of PRL
 Lactogenesis
(Milk Synthesis)
• How does P4 retard milk synthesis in the
nonlactating mammary gland?

• Blocks glucocorticoid (cortisol) receptors

• Cortisol + PRL stimulates synthesis of PRL

receptors on mammary cells

P4 blocks induction of PRL receptors

• Retards synthesis of a-lactalbumin, casein mRNA

• Retards casein, a-alactalbumin, lactose synthesis

thus, retards milk synthesis
 Endocrine Glands Supporting
Mammary Function

Posterior pituitary (protein hormones):

Oxytocin

Synthesized in the hypothalmus

Ttransferred to post. pit.

Secreted into blood > acts on myoepithelial cells

Contraction of myoepithelial, smooth muscle

 Endocrine Glands Supporting
Mammary Function
• GH (STH, BST): •
– increases milk yield
Action: • increases gluconeogenesis
• • increases blood glucose
• increases efficiency of
production (greater lbs. of
milk/ lb. DMI)
•
 Endocrine Glands Supporting
Mammary 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

 Lactogenesis

• Lactogenesis = initiation of
milk 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