Ran across an interesting patient today. She had had a home delivery on the 3rd, had a retained placenta, finally came to the hospital to our high-risk unit. She had manual extraction of the placenta, with total blood loss of 3L. The next morning she had a severe headache. After four units of blood, her crit is 27, headache still present. I gave her two Tylox, no relief. Benadryl and Phenergan, no relief. We called neurology to consult. This was the headache from hell. She couldn't even stand to speak. I gave 100mcg of Fentanyl; didn't touch it. Then we moved to morphine, and after 20mg in two hours, she was able to talk a little. MRI showed enlarged pituitary, and after further MRI studies, it is found that she has ischemia of the pituitary, consistent with Sheehan's syndrome. This is described in William's obstetrics as occurring in 1 out of 10,000 deliveries, and almost never being seen now because of good obstetric care. It involves necrosis of the pituitary secondary to large postpartum blood loss. The treatment is symptomatic, thyroid replacement for hypothyroidism, adrenocorticosteroids for adrenal insufficiency, etc.
This was very interesting to me, thought I'd pass it along. I won't comment on the home-birth concept.
May 5, '01
Originally posted by kday:
<STRONG>Wow. That's absolutely fascinating!! I'd never heard of such a thing!!! Wow. Thanks for the education, Lisa!
By the way, I'LL comment on the home birth thing...one of the docs I work with said it best, I believe...only pizzas should be delivered at home.
That's my story and I'm sticking to it....</STRONG>
Greetings All Nurses,
Thank you for the education rdhdnrs
I will also comment on the "Home Birth" It was not the fact she had a homebirth that resulted in this scernario, it was an act of Mal-Practice on the part of her Midwife. Lets assign blame where it is due!
Have a Blessed Day,
May 5, '01
rd: Thanks for the education. It's a fascinoma! Never heard of this. I've always found that information comes right before one's needs it, so I'll bet I encounter this soon, and I will think of you.
May 6, '01
I'm wondering what the treatment was for Sheehan's syndrome? Would it have been an old med "Pituitrin"? Made from the pituitary gland of domesticated animals, this was recently requested by one of our "Older" GYNs for a full blown case of DIC when blood, plasma, hemabate, methergine and pitocin was not working. Anyone KNOW? or heard of it?
Thanks for this info'. Like Mustang---now it will show up for me.
May 7, '01
Never heard of pituitrin, but our neurologists say there's really no treatment except supportive adrenocorticosteroids and symptomatic treatment.
May 10, '01
That IS a very interesting pt. What about her headache? What did it take to fix it?
May 13, '01
Wow--new to me, also!! How about this one--pt. at 20 weeks gest. in for hyperemisis, found on floor of her room, CT done of head to CYA and she was found to have a fast growing pit. tumor that killed her when that baby was four months old--SAD--becuz of the hormones from the pregnancy the tumor grew in record time.
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