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The use of ultrasound to identify milk ejection in women - tips and pitfalls.

Geddes DT - Int Breastfeed J (2009)

Bottom Line: At milk ejection, the echogenic duct walls expand as milk flows forward towards the nipple.Milk flow appears as echogenic foci rapidly moving within the milk duct.This paper provides a detailed description of the ultrasound technique used for the detection and reviews nuances associated with the procedure.

View Article: PubMed Central - HTML - PubMed

Affiliation: M310, Biomedical, Biomolecular and Chemical Sciences, Faculty of Life and Physical Sciences, The University of Western Australia, Western Australia, Australia. donna.geddes@uwa.edu.au.

ABSTRACT
Diagnostic ultrasound imaging of the breast has been limited principally to the abnormal, non-lactating breast. Due to the rapid improvement of imaging technology, high-resolution ultrasound images can now be obtained of the lactating breast. Ultrasound scanning techniques, however, require modifications to accommodate the breast changes that occur in lactation. Furthermore, the function of the breast with regard to milk ejection can be assessed with ultrasound by identification of milk duct dilation and milk flow. At milk ejection, the echogenic duct walls expand as milk flows forward towards the nipple. Milk flow appears as echogenic foci rapidly moving within the milk duct. This paper provides a detailed description of the ultrasound technique used for the detection and reviews nuances associated with the procedure.

No MeSH data available.


Related in: MedlinePlus

Ultrasound scanning position for detection of milk ejection in the lactating breast. The breast that is not suckled/expressed is monitored using a high frequency linear array ultrasound transducer. The milk duct monitored is in the lateral portion of the breast near the base of the nipple. Minimal pressure must be used to avoid compression of the duct.
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Figure 3: Ultrasound scanning position for detection of milk ejection in the lactating breast. The breast that is not suckled/expressed is monitored using a high frequency linear array ultrasound transducer. The milk duct monitored is in the lateral portion of the breast near the base of the nipple. Minimal pressure must be used to avoid compression of the duct.

Mentions: The mother should be seated comfortably during a scan to facilitate either breastfeeding or pumping in a natural position. Prior to either breastfeeding/pumping a milk duct in the un-suckled/non-expressed breast is identified and monitored for the session. The mother should be instructed to limit her movements where possible in order to reduce movement artefact during the scan. Milk ducts conducive to monitoring tend to be ducts greater than 1 mm in diameter beneath the areola in the lateral portion of the breast (Figure 3). The probe is rotated until the long axis of the portion of the duct to be monitored is obtained. The gain is set so that the duct is not completely anechoic (devoid of echoes, black) and milk flow can then be identified. It is prudent to use colour Doppler flow imaging [19] to discriminate between milk ducts and blood vessels, particularly when the milk ducts are very small. It is critical that the ultrasound technician adopts a comfortable, ergonomically correct position, as the transducer must be held still for the duration of the breastfeeding/pumping session. Consistently light pressure also must be applied to ensure that the milk duct is not compressed thereby reducing duct dilation at milk ejection. Testing compression levels prior to the scan is wise, to ensure the duct is not already partially compressed prior to commencement of the monitoring period. The scan begins as soon as either the baby attaches to the mother's breast or the breast pump is switched on. A marker can be used to indicate the beginning of the feed/pump. It is also useful to instruct the mother to indicate if she senses milk ejection and to mark this on the scan for later analysis. Identification of milk ejection enables one to switch the breast pump to an expression pattern if this is an available feature. In addition, the collection bottle can be changed to determine how much milk is removed prior to milk ejection [20]. An accurate measurement of the milk removed before milk ejection can be made by weighing the collection bottle with accurate digital scales. The difference in weight between the bottle containing the milk removed prior to milk ejection and the empty bottle is the amount of milk removed prior to milk ejection. The difference in grams is equivalent to millilitres; for example one gram of breast milk corresponds to approximately one millilitre of breast milk. It is essential that the scan be videotaped to allow careful retrospective analysis, particularly in difficult cases.


The use of ultrasound to identify milk ejection in women - tips and pitfalls.

Geddes DT - Int Breastfeed J (2009)

Ultrasound scanning position for detection of milk ejection in the lactating breast. The breast that is not suckled/expressed is monitored using a high frequency linear array ultrasound transducer. The milk duct monitored is in the lateral portion of the breast near the base of the nipple. Minimal pressure must be used to avoid compression of the duct.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2710318&req=5

Figure 3: Ultrasound scanning position for detection of milk ejection in the lactating breast. The breast that is not suckled/expressed is monitored using a high frequency linear array ultrasound transducer. The milk duct monitored is in the lateral portion of the breast near the base of the nipple. Minimal pressure must be used to avoid compression of the duct.
Mentions: The mother should be seated comfortably during a scan to facilitate either breastfeeding or pumping in a natural position. Prior to either breastfeeding/pumping a milk duct in the un-suckled/non-expressed breast is identified and monitored for the session. The mother should be instructed to limit her movements where possible in order to reduce movement artefact during the scan. Milk ducts conducive to monitoring tend to be ducts greater than 1 mm in diameter beneath the areola in the lateral portion of the breast (Figure 3). The probe is rotated until the long axis of the portion of the duct to be monitored is obtained. The gain is set so that the duct is not completely anechoic (devoid of echoes, black) and milk flow can then be identified. It is prudent to use colour Doppler flow imaging [19] to discriminate between milk ducts and blood vessels, particularly when the milk ducts are very small. It is critical that the ultrasound technician adopts a comfortable, ergonomically correct position, as the transducer must be held still for the duration of the breastfeeding/pumping session. Consistently light pressure also must be applied to ensure that the milk duct is not compressed thereby reducing duct dilation at milk ejection. Testing compression levels prior to the scan is wise, to ensure the duct is not already partially compressed prior to commencement of the monitoring period. The scan begins as soon as either the baby attaches to the mother's breast or the breast pump is switched on. A marker can be used to indicate the beginning of the feed/pump. It is also useful to instruct the mother to indicate if she senses milk ejection and to mark this on the scan for later analysis. Identification of milk ejection enables one to switch the breast pump to an expression pattern if this is an available feature. In addition, the collection bottle can be changed to determine how much milk is removed prior to milk ejection [20]. An accurate measurement of the milk removed before milk ejection can be made by weighing the collection bottle with accurate digital scales. The difference in weight between the bottle containing the milk removed prior to milk ejection and the empty bottle is the amount of milk removed prior to milk ejection. The difference in grams is equivalent to millilitres; for example one gram of breast milk corresponds to approximately one millilitre of breast milk. It is essential that the scan be videotaped to allow careful retrospective analysis, particularly in difficult cases.

Bottom Line: At milk ejection, the echogenic duct walls expand as milk flows forward towards the nipple.Milk flow appears as echogenic foci rapidly moving within the milk duct.This paper provides a detailed description of the ultrasound technique used for the detection and reviews nuances associated with the procedure.

View Article: PubMed Central - HTML - PubMed

Affiliation: M310, Biomedical, Biomolecular and Chemical Sciences, Faculty of Life and Physical Sciences, The University of Western Australia, Western Australia, Australia. donna.geddes@uwa.edu.au.

ABSTRACT
Diagnostic ultrasound imaging of the breast has been limited principally to the abnormal, non-lactating breast. Due to the rapid improvement of imaging technology, high-resolution ultrasound images can now be obtained of the lactating breast. Ultrasound scanning techniques, however, require modifications to accommodate the breast changes that occur in lactation. Furthermore, the function of the breast with regard to milk ejection can be assessed with ultrasound by identification of milk duct dilation and milk flow. At milk ejection, the echogenic duct walls expand as milk flows forward towards the nipple. Milk flow appears as echogenic foci rapidly moving within the milk duct. This paper provides a detailed description of the ultrasound technique used for the detection and reviews nuances associated with the procedure.

No MeSH data available.


Related in: MedlinePlus