Agalactia is a pathology of the postpartum period, which is characterized by a complete absence of breast milk secretion. When making a diagnosis, ultrasound of the mammary glands, laboratory examination of prolactin levels, computed tomography of the brain are used to exclude pituitary diseases. To restore lactogenesis, drugs with a lactogenic effect are used in combination with physiotherapy procedures and diet correction. If a specific cause of lactation disorder is known, treatment is aimed at eliminating it. Therapy of the so-called primary agalactia is currently impossible.
ICD 10
92.3 Agalactia
General information
Although insufficient secretion of breast milk is noted in almost half of women in labor, its complete absence occurs in no more than 3% of patients and only in 1 woman out of 10,000 it is caused by anatomical reasons. In most cases, lactation stops under the influence of various exogenous and endogenous factors caused by somatic, infectious and endocrine diseases. Agalactia is more often detected in primiparous women and in women in labor in the age group of 40 and over. According to the observations of mammologists and obstetricians-gynecologists, the prospects for restoring lactation decrease with increasing age of the patient.
Causes of agalactia
The complete absence of milk in a woman in labor may be caused by morphological changes in the parenchymal breast tissue and disorders of the neuroendocrine regulation of the lactation process. In some patients, a combination of these factors is observed, usually milk production stops after a certain period of breastfeeding. The main causes of agalactia are:
- Absence of glandular tissue. Congenital underdevelopment of the mammary glands is one of the signs of hypogonadism and infantilism, and in overweight women, pathology is often masked by excessive development of adipose tissue in the breast area. In patients older than 40-45 years, the parenchyma atrophies due to age-related involution of the mammary glands.
- Violation of prolactin secretion. The production of lactotropic hormone decreases during post-term pregnancy, postpartum Sheehan syndrome, tuberculosis and pituitary tumors, after neurosurgical interventions and severe traumatic brain injuries. The level of mammotropin is reduced in patients with diabetes mellitus and diabetes insipidus.
- Genetic predisposition. In some women in labor, agalactia has a hereditary nature, it occurs due to the lack of mammotropic hormone receptors in lactocytes. Lactation also becomes impossible with a number of congenital fermentopathies, when the biochemical chain of lactogenesis is disrupted due to enzyme deficiency.
- Taking medications. There are several groups of drugs that affect the lactation process. Breast milk is more often absent in patients who take calcitonin, dopaminergic and anticonvulsant drugs, cyclosporine A, antagonists of female sex hormones, primarily estrogens.
- Feverish states. Diseases accompanied by hyperthermia are one of the common causes of a decrease in lactogenesis. More often they lead to hypogalactia, but with a significant increase in temperature, lactation stops completely. The situation is aggravated by a temporary ban on breastfeeding for a number of infections.
- External factors. The anti-lactation effect is provided by a low-calorie diet with an insufficient amount of liquid foods and water, the use of herbal decoctions with a diuretic effect. Agalactia can develop with severe stress, poisoning, radiation exposure.
Pathogenesis
The mechanism of occurrence of agalactia is based on the absence of a morphological substrate for milk production or insufficient stimulation of the lactation process. If there are few or no glandular cells in the breast tissues or lactocytes are insensitive to prolactin, mammotropic hormone secreted by the pituitary gland cannot have a lactostimulating effect. On the other hand, with insufficient mammotropin levels, lactogenesis in the breast alveoli does not begin. Fermentopathies, feverish conditions, some medications and other external factors affect different parts of lactation – from a decrease in prolactin production to inhibition of milk secretion by lactocytes.
Classification
When systematizing individual forms of agalactia, the time of occurrence of the disorder is taken into account, as well as the reasons that led to the absence of lactation after childbirth. At the same time, most specialists in the field of mammology consider the theoretical possibility of the functioning of the mammary glands to be one of the key classification criteria. There are the following variants of the disease:
- Primary (absolute, true) agalactia. Lack of milk due to the impossibility of its production due to underdevelopment of the breast parenchyma, gross endocrine disorders and fermentopathies.
- Secondary (relative) agalactia. Complete cessation of lactogenesis in a previously lactated woman caused by external causes or various pathological conditions.
Symptoms of agalactia
The fact that there is no milk in the breast is indicated by the absence of any discharge from the nipple during its compression or an attempt to express the breast. With the primary failure of lactogenesis, both milk and colostrum are not produced, which normally appears at 30-31 weeks of pregnancy. A sign of secondary agalactia is the cessation of lactation, which occurred suddenly or after a gradual decrease in lactation: it is difficult to tear the child from the breast, he becomes restless, sleeps poorly, does not gain weight. When pressing on the nipple before feeding, milk droplets do not stand out.
Complications
As an independent pathological condition, agalactia does not pose any danger to the health and life of a woman. With an incorrect assessment of the clinical situation and rude attempts at decoupling, breast injuries are possible. If the secretion of milk is suppressed after the lactation period, but the woman continues to apply the baby in the expectation that he will dissolve the breast, there is a high probability of damage to the nipple-areolar zone – maceration, cracks and eczema of the nipple. The great danger of untimely recognized agalactia is for a child who may develop hypotrophy of newborns.
Diagnostics
The key task of the diagnostic stage in the complete absence of milk in the postpartum period is to identify the causes that led to agalactia. The patient is prescribed a comprehensive examination that allows an objective assessment of the condition of various organs involved in lactation or affecting it. For diagnosis, the most informative are:
- Breast ultrasound. The method allows you to determine how the glandular component of the mammary glands is formed. Underdevelopment of parenchymal tissue is characteristic of primary agalactia.
- The level of prolactin in the blood. A decrease in the concentration of lactotropic hormone may indicate both a primary violation of lactogenesis and a secondary inhibition of lactation.
- CT scan of the brain. Since prolactin is synthesized by the anterior pituitary lobe, it is important to exclude organic damage and volumetric processes in the hypothalamic-pituitary region.
Other instrumental and laboratory methods are prescribed by specialized specialists if a specific pathological condition is suspected. Differential diagnosis is usually performed between secondary agalactia and hypogalactia. To clarify the causes of impaired lactogenesis, an endocrinologist, a neurosurgeon, a therapist, an infectious disease specialist may be involved in the examination of the patient (with inhibition of lactation against the background of a febrile condition).
Treatment of agalactia
The prospects for the restoration of lactogenesis depend on the form of pathology. With primary (true) lactation disorders, breast milk synthesis cannot be restored. In this case, it is recommended that the child be transferred to artificial feeding, and if a serious illness that caused the disorder is detected, the woman should be treated by a doctor of the appropriate specialty. Complex therapy of secondary agalactia involves:
- Elimination of the causes of lactation depression. The patient is prescribed treatment for the underlying disease or condition that led to the loss of milk — acute infection, poisoning, disruption of adaptation due to stress, etc. For this purpose, antibiotics, nonsteroidal anti-inflammatory drugs, sedative and infusion therapy, immunocorrectors and vitamin and mineral complexes are used.
- Stimulation of lactogenesis. Lactogenic preparations (lactin, deaminooxytocin, vitamin E, nicotinic acid), herbal remedies, physiotherapy techniques (ultrasound, ultraviolet irradiation, electrophoresis with nicotinic acid) are used to resume milk secretion. Effective correction of the diet with an increase in its total caloric content.
Prognosis and prevention
The prognosis of breastfeeding in primary agalactia is unfavorable, in secondary it depends on the causes of inhibition of the lactogenesis process. Timely complex stimulation of milk production and rapid elimination of the causes that have disrupted lactation improve the prospects of breastfeeding. It is impossible to prevent primary agalactia. To preserve the lactation that has already begun, it is recommended to observe a sleep and rest regime, consume enough water and high-calorie foods, avoid significant psychoemotional and physical exertion, and treat concomitant diseases in a timely manner. An important role in maintaining lactogenesis is played by the regularity of applying the baby to the breast.
