Obstetrics & Gynecology>>>>>The Puerperium, Lactation, and Immediate Care of the Newborn
Question 2#

A 24-year-old primigravid woman, who plans to breastfeed, decides to have a home delivery. Immediately after the birth of a 4.1-kg (9-lb) newborn, the patient experiences massive hemorrhage from extensive vaginal and cervical lacerations. She is brought to the nearest hospital in shock. Over the course of 2 hours, nine units of blood are transfused, and the patient’s blood pressure returns to a reasonable level. A hemoglobin value the next day is 7.5 g/dL, and three more units of packed red blood cells are given.

The most likely late sequela to consider in this woman is which of the following?

a. Hemochromatosis
b. Stein-Leventhal syndrome
c. Sheehan syndrome
d. Simmonds’ syndrome
e. Cushing syndrome

Correct Answer is C


A disadvantage of home delivery is the lack of facilities to control postpartum hemorrhage. The woman described in the question delivered a large baby, suffered multiple soft tissue injuries, and went into shock, needing nine units of blood by the time she reached the hospital. Sheehan syndrome seems a likely possibility in this woman. This syndrome of anterior pituitary necrosis related to obstetric hemorrhage can be diagnosed by 1-week postpartum, as lactation fails to commence normally. Other symptoms of Sheehan syndrome include amenorrhea, atrophy of the breasts, and loss of thyroid and adrenal function. The other presented choices for late sequelae are less likely. Hemochromatosis would not be expected to occur in this healthy young woman, especially since she did not receive prolonged transfusions. Cushing, Simmonds, and Stein-Leventhal syndromes are not known to be related to postpartum hemorrhage. It is important to note that home delivery is not a predisposing factor to postpartum hemorrhage.