Suppression of a puerperal lactation

Description:

Development and functional condition of a mammary gland is controlled and stimulated with neurohumoral system of an organism which includes a hypophysis, ovaries, adrenal glands, a thyroid gland, etc. endocrine organs Regulation of neurohormonal system is carried out by a hypothalamus by means of the allocated neurohumoral transmitters (transmitters) transferred to a front share of a hypophysis through special vascular system in a hypophysis leg. Transmitters, changing biosynthesis of hypophyseal hormones, change in turn and activity of peripheral closed glands. Activity of a hypothalamus is controlled by the central nervous system. Neurohumoral regulation of a functional condition of a mammary gland is shown in a lactation reflex which is normal shown when applying the child to a breast.

However, in some cases the prevention, decrease and even complete cessation of a lactation is necessary. Such indications can arise in a puerperal period (a nagrubaniye of mammary glands, various forms of a milk fever, a still birth, serious condition of the woman in childbirth. At which feeding by a breast is undesirable or it is contraindicated), and also after abortions, preferential big terms. In rare instances it is necessary to resort to preventive suppression of a lactation.
In practice of pediatricians need of the termination of a lactation quite often meets at the child's excommunication from a breast in connection with transition to artificial feeding according to various indications.

According to B. L. Gurtovy (1981), at mastitis in some cases it is necessary to resort to suppression of a lactation. The indication for this purpose at patients with the heavy course of process and resistance to the carried-out therapy is:
- quickly progressing inflammatory process – transition of a serous stage in
infiltrative within 1-3 days, despite active complex treatment;
- purulent mastitis with a tendency to formation of the new centers after surgical
interventions;
- purulent mastitis, slow, resistant to therapy (after operational treatment);
- gathered and gangrenous breast;
- mastitis in the presence of the expressed diseases of other bodies and systems.

The issue of existence of indications to suppression of a lactation should be resolved individually, by itself, only at the informed consent of the patient.

Many methods of suppression of a lactation are insufficiently effective and represent now, generally historical interest. This considerable restriction of the liquid accepted inside, hard bandaging of mammary glands, bubbles with ice, purpose of salt laxatives, diuretics, camphor drugs inside and subcutaneously. E. K. Aylamazyan 1985) for the purpose of suppression of a lactation recommends an endonasal electrophoresis of a pyridoxine (B6 vitamin) within 2-3 days. The effect suppressing a lactation renders also the drug having dofaminergichesky activity a levodopa (L-dofa) in capsules on 0, 5 - 2 times a day within 8-10 days. The intolerance is quite often noted: nausea, vomiting, appetite loss, headache, hyperhidrosis, orthostatic hypotonia, arrhythmias, etc. Reception of a levodopa at endocrine diseases is not recommended, to an idiopathic hypertensia, and also diseases of a liver and kidneys.

Modern methods of suppression of a lactation are much more effective, do not demand restriction of reception of liquid and hard bandaging of mammary glands. Administration of estrogen, for example, of Sinestrolum is widely used. For reduction of a lactation Sinestrolum appoint inside on 0, 001 - 2 times a day, or on 1 ml of 0,1% of Solutio oleosa intramusculary once a day two days running, and for complete cessation of a lactation – on 0,002-0,003 - 2 times a day, or on 1 ml of 0,1% of solution intramusculary
2 times a day within 5-7 days.

Earlier introduction of high doses of estrogen, for example, of Sinestrolum of 2% - on 0,5 ml intramusculary, on a course of 5-6 injections was applied. Now use of synthetic oestrogenic drug Microfollinum (ethinylestradiol) is more reasonable. For the purpose of elimination of an undesirable lactation during the first three days after the delivery (abortion) drug is appointed on 0,02 mg by 3 times a day, then within three next days on 0,01 3 times a day, further within three days on 0,01 in day. Nausea, vomiting, a headache can be by-effects of an estrogenoterapiya.

Recommends to B. L. Gurtova the combined use of estrogen and androgens: 1 ml of 0,1% - a leg of Solutio oleosa of oestradiol of Dipropionas and 0, 5 ml of 5% - a leg of Solutio oleosa of Testosteroni propionas enter intramusculary in one syringe of 1 times a day or every other day; on a course of 6-12 injections.

Oestrogenic (it is also oestrogenic - androgenic) suppression of a lactation is contraindicated at hyperplastic processes in a mammary gland, tumors of genitalias, disturbances of a menstrual cycle in the anamnesis, a virilny syndrome and a hirsutism, a number of extragenital diseases (the expressed hypertension, a varicosity, thrombophlebitis, a diabetes mellitus, diseases of a liver, kidneys).

Among the methods of suppression of a lactation applied recently it should be noted gestagenny drug Norcolutum (Norethisteronum). Contraindications and by-effects at its use are similar to estrogen, but meet much less often and are considerably less expressed.