Mammary alveolus and myometrium

Target gland or tissue · Prolactin receptor Oxytocin receptor Myoepithelium

Prolactin acts on alveolar epithelium through JAK2 and STAT5 to make milk; oxytocin acts on the myoepithelial cells wrapped around those alveoli and on myometrial smooth muscle through Gq and calcium.

Traced from the start

  1. Tuberoinfundibular dopamine (prolactin-inhibiting factor)Thyrotrophin-releasing hormone (paraventricular nucleus)
  2. Supraoptic and paraventricular magnocellular neurones
  3. Lactotroph — prolactinPosterior pituitary — oxytocin release
  4. Mammary alveolus and myometrium

Detail

Two hormones, two jobs
Prolactin fills the alveolus and oxytocin empties it — milk is still made without oxytocin, it simply cannot be ejected
Timing
High placental oestrogen and progesterone prime the breast but block milk secretion; their fall after delivery of the placenta releases lactogenesis II at about 30-72 hours
Myometrial signalling
Gq coupled: IP3, calcium release and myosin light chain kinase activation, with a rise in uterine prostaglandins

When it goes wrong

Retained placental fragments

Progesterone stays high and lactogenesis is delayed; the same fragments cause secondary postpartum haemorrhage

Uterine atony after delivery

The commonest cause of primary postpartum haemorrhage: rub up a contraction, empty the bladder, give oxytocin, then ergometrine, then carboprost or misoprostol

Practise this structure

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