Sheehan’s Syndrome – Excessive Bleeding During Childbirth

Causes of Excessive Bleeding During Childbirth

After the delivery of the baby, the uterus generally expels the placenta through continuous contractions. The bleeding vessels around the area of the placenta then get compressed with the help of these contractions. If this process named uterine atony does not happen properly then those blood vessels continue to bleed freely and lead to massive blood loss and hemorrhage. According to the Children’s Hospital of Philadelphia, the risk of bleeding during childbirth gets high in the cases of

• Placenta previa
• Placental abruption
• Placenta accreta
• Placenta increta
• Overdistended uterus
• Multiple pregnancies
• Prolonged labor
• Preeclampsia or high blood pressure and hypertension during pregnancy
• Usage of vacuum-assisted delivery or forceps
• Tear in the cervix or uterine blood vessels
• Obesity
• Multiple previous childbirths

[Read : Placental Abruption]

Symptoms of Sheehan’s Syndrome

The symptoms of Sheehan’s Syndrome depend on how much damage occurs to the pituitary gland and how much it is incapable of secreting hormones. As a result, the symptoms of Sheehan’s syndrome will vary in women. Also in most cases, the symptoms of Sheehan syndrome occur gradually with time. Sheehan syndrome has two types according to its impact on the pituitary gland – acute and chronic.

In acute Sheehan syndrome, a considerable amount of damage happens in the pituitary gland thus symptoms will show within days or weeks after delivery. But in the case of the chronic subtype of Sheehan syndrome, the damage is much less so symptoms may take months or years to emerge. The symptoms of Sheehan syndrome are

• Weakness and fatigue
• Low blood pressure
• Low blood sugar
• Irregular menstruation (oligomenorrhea) or not getting periods after childbirth (amenorrhea)
• Loss of hair in underarms and pubic region
• Inability to produce milk for breastfeeding
• Reduction in the size of breasts and breast shrinkage
• Hypothyroidism
• Dryness in skin
• Weight gain
• Thinning of the vaginal lining
• Hot flashes
• Rapid and irregular heartbeats
• Decreased interest in sex
• Insulin sensitivity
• Reduction in muscle strength
• Frequent urination caused by diabetes insipidus

Diagnosis of Sheehan’s Syndrome

It is quite difficult to diagnose Sheehan’s syndrome as its symptoms often resemble other diseases such as anemia or diabetes. Also, the symptoms of Sheehan’s syndrome generally show up gradually and make it more complicated to diagnose the actual reason.

Thus it will be helpful for the doctor to diagnose Sheehan’s syndrome if you discuss your blood loss during childbirth or if you never lactate or menstruate after childbirth.

Here are some tests that can be conducted to diagnose 

• Imaging tests such as a CT scan or an MRI of the pituitary gland
• Blood tests to measure the pituitary hormone levels
• Pituitary hormone stimulation test

The CT scan is vital to rule out the chances of having a brain tumor or pituitary tumor causing the condition of hypopituitarism. And in the case of massive blood loss that can lead to acute Sheehan’s syndrome diagnostic tests can be conducted right after the delivery.

Complications of Sheehan’s Syndrome

The pituitary gland does not only secret hormones, it also controls the secretion of hormones from other glands like the thyroid and adrenal gland. The consequences of Sheehan syndrome thus can lead to complications like

Reduction in the secretion of pituitary hormones such as Thyroid-stimulating hormone, Luteinizing hormone, Follicle-stimulating hormone, prolactin, adrenocorticotropic hormone, and growth hormone.

• Adrenal crisis i.e. a condition where the adrenal glands stop producing stress hormones like cortisol
• Low blood pressure
• Irregular periods or not resuming periods after childbirth
• Unexpected weight loss

Treatment Options For Sheehan’s Syndrome

There is only one way for treating this or any type of hypopituitarism i.e. hormone replacement therapy. For this, the doctor will take several blood tests to measure the hormone levels that may need outward help to balance. Common treatments to increase or replace the hormone levels affected by Sheehan’s syndrome are

1. Thyroxine

In one of the treatment methods, thyroxine is injected as a replacement for the thyroid hormone

2. Levothyroxine

In this treatment method, the patient may have to take it to increase thyroid-stimulating hormones

3. Estrogen and Progesterone Through Oral Contraceptives

The patient will have to take the contraceptive pills till the age of her menopause to balance the levels of these two hormones. In the case of patients with hysterectomy or removal of the uterus, only estrogen is prescribed.

[Read : Emergency Contraceptive Pills]

4. Prednisone and Hydrocortisone

The patient will have to take these two cortisones as a replacement for adrenocorticotropic hormone or ACTH

5. Growth Hormone

Your doctor can prescribe you to take GH to increase muscle strength, and stamina, and to decrease cholesterol levels.

How Can Sheehan’s Syndrome Be Prevented?

Sheehan’s syndrome can be prevented only by having an expert medical care team at your service. The hospital, the doctor, and the medical staff you chose should be aware of your medical condition. You will need an experienced and well-equipped medical team to avoid it as once severe blood loss occurs, Sheehan syndrome is unpreventable.

So Sheehan’s syndrome is life-threatening but thankfully a rare condition that can occur only if you do not get proper medical care during your childbirth. But if it happens when with the help of hormone replacement therapy you will be able to live a somewhat normal life.

FAQ’s

1. Can You Breastfeed With Sheehan’s Syndrome?

Sheehan syndrome can affect and reduce the secretion of prolactin hormone. This means you may fail to produce breast milk for the baby.

2. Can You Get Pregnant Again With Sheehan’s Syndrome?

The chances are very rare to get a smooth and successful pregnancy while having Sheehan’s syndrome. Even with the help of assisted reproductive technology, risks of pregnancy complications cannot be avoided.

3. Is Sheehan’s Syndrome Permanent?

Yes, Sheehan’s syndrome is permanent as once the pituitary cells get damaged there is no way to revive or replace them. You can only get hormone replacement therapy to substitute those hormones secreted by the master gland.

Read Also: What Causes Postpartum Fatigue And How To Deal With It?