The incidence of Sheehan’s syndrome after obstetric hemorrhage

Abstract

The purpose of this study was to determine the incidence of Sheehan’s syndrome in a well described cohort of patients with obstetric hemorrhage. A retrospective cohort study. Women who delivered at Prentice Women’s Hospital from July 1998 through February 2002 who had a post partum hemorrhage were matched by day of delivery and route of delivery to women who did not hemorrhage. Charts were reviewed to ensure blood loss was as stated and to gather information on delivery and interventions (hypotension, transfusion, hysterectomy, intensive care unit admission). Questionnaires were sent to 200 women asking about symptoms including menstrual dysfunction, lactation difficulty, cold intolerance, fatigue, axillary and pubic hair loss, and secondary infertility. Women who experienced two or more symptoms were referred for hormone testing of insulin-like growth factor 1 (IGF-1), free thyroxine (T4), prolactin and early morning cortisol levels. A total of 109 patients responded to the survey, a 55% response rate. 14 (27%) patients in the hemorrhage group identified themselves as suffering from two or more symptoms on the questionnaire. 8 of the 14 patients were tested, but none had hormonal evidence of hypopituitarism. 4 (7.5%) control patients also identified themselves as suffering from two or more symptoms, but none of 2 tested had hormonal evidence of hypopituitarism. Clinically significant Sheehan’s syndrome is an uncommon consequence of obstetric hemorrhage in today’s environment.