Academic literature on the topic 'Undiagnosed postpartum haemorrhage'

Sheehan’s syndrome, a rare but significant endocrinopathy, often emerges in the backdrop of severe postpartum haemorrhage and can remain undiagnosed for years. Primary care physicians play a crucial role in suspecting and diagnosing this condition, especially in women presenting with a history of puerperal haemorrhage, lactation failure and amenorrhea. The syndrome’s potential to cause life-threatening adrenal crises during episodes of acute illness, such as infections or pulmonary tuberculosis, underscores the need for vigilance and prompt intervention in affected individuals. This report highlights the case of a 35-year-old female who was diagnosed with Sheehan’s syndrome a notable 12 years after experiencing a severe postpartum haemorrhage. Her condition was eventually unmasked following her affliction with pulmonary tuberculosis, emphasising the complexity and delayed presentation of this syndrome. This case underscores the critical need for heightened awareness among healthcare professionals for early identification and management of Sheehan’s syndrome to prevent serious complications.

Abstract Sheehan’s syndrome is a life-threatening endocrine emergency seen in postpartum females secondary to ischemic pituitary necrosis. It is a frequent cause of hypopituitarism in developing countries that occurs secondary to postpartum haemorrhage (PPH). Patients with Sheehan’s syndrome often present with organ dysfunctions in critical care settings, secondary to stressors precipitating the underlying hormonal deficiencies. The initial clinical picture of Sheehan’s syndrome may mimic some other disease, leading to misdiagnosis and diagnostic delay. Strict vigilance, timely diagnosis, and appropriate management are essential to avoid diagnostic delay and to improve the patient outcome. In this case series, we describe 5 cases of previously undiagnosed Sheehan’s syndrome (including young, middle aged and postmenopausal females) that presented to critical care and emergency settings with organ failures.

Hypertensive disorder in pregnancy is a major source of morbidity and mortality worldwide. This is a disease unique to pregnancy typically characterized by blood pressure ≥140/90 mm of Hg after 20 weeks of pregnancy and associated with proteinuria 300 mg/24 hours or 1+ dipstick. If left untreated the disorder often leads to serious maternal and perinatal complications. Here there is a case report of women with undiagnosed hypertension during pregnancy which complicates life of both mother and fetus by complicating labour and birth with precipitate labour and postpartum haemorrhage. This is a preventable complication by educating women about importance of routine antenatal visits.

Background: Thyroid disorders are the most common endocrinopathies encountered during pregnancy in India. Thyroid gland and its functions are immensely influenced by pregnancy. This study was designed to evaluate the prevalence of subclinical hypothyroidism in pregnancy and its foeto-maternal outcome amongst the pregnant mothers having such disorder. Methods: In this hospital based, observational, comparative study, which was carried out on 200 pregnant women attending secondary care hospital of subhimalayan region for the duration of 1 year (2017 to 2018).Morning blood samples of study participants were analyzed for free T4, TSH in their first trimester, and they were followed up till the time of confinement for foeto-maternal outcome. Results: prevalence of thyroid disorder was 16% which was high as compare to other regions of India. Subclinical hypothyroidism was highly prevalent (13.5%) and masked, associated with adverse maternal outcomes like anaemia (p=0.001), abortion (p=0.012), postpartum haemorrhage (p=0.012), puerperal sepsis (p=0.008) and adverse foetal outcome like foetal growth restriction (p=0.034) as compared to euthyroidism. Conclusion: In a developing country like India where undiagnosed thyroid disorders especially subclinical hypothyroidism is highly prevalent and associated with adverse foeto-maternal outcomes, our study recommends universal screening of pregnant women for such disorders.

Women and girls with bleeding disorders (WGBD) share the same bleeding symptoms and limitations in quality of life (QoL) as men, but they also confront unique physical and psychological challenges.1 Physically, WGBD experience joint problems, heavy menstrual bleeding (HMB), postpartum haemorrhage, excessive postoperative bleeding, epistaxis, easy bruising, and oral bleeding, also in haemophilia carriers with factor levels ≥ 40 IU/ml.2 Psychologically, they grapple with feelings of shame regarding HMB and guilt about bearing children with haemophilia.3These challenges can severely diminish QoL, yet they remain underappreciated.4 The primary physiological challenge lies in joint problems.5 WGBD, including haemophilia carriers, are at risk for subclinical joint bleeding, necessitating early detection.6 Inflammation can cause joint dysfunction before structural damage occurs, leading to pain, altered movement, and muscle degeneration, which destabilizes joints further and exacerbates pain.7 Early identification of joint issues is therefore crucial. Although ultrasound can detect joint problems, it is limited to recognizing clinical synovitis, a sign of already advanced joint problems.8 This creates two main barriers to comprehensive diagnosis and early treatment of WGBD: a) incompleteness, as diagnoses have previously concentrated on physiological aspects alone, and b) lateness, due to the absence of tools to identify joint changes before synovitis becomes clinically evident. Consequently, many with WGBD remain undiagnosed and untreated. To address these barriers, we are creating a comprehensive assessment protocol for WGBD, evaluating all bleeding symptoms and their QoL impact. This protocol integrates new tools with existing diagnostic tools such as the Pictorial Blood Loss Assessment Chart (PBAC), Haemophilia Joint Health Score, ISTH Bleeding Score, and Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US). The first new tool is a psychometric QoL questionnaire for WGBD, developed collaboratively with patients and health professionals based on established scientific questionnaire methodologies. The second tool is the Noraxon system, which employs validated sensing methods, including inertial measurement units (IMUs), electromyography (EMG), and paedobarography. This system is highly regarded in biomechanical research, with over 400 peer-reviewed publications supporting its efficacy. A 2018 literature review highlighted 11 studies on biomechanical analysis in paediatric and adult patients with hemophilia, showing significant correlations with functional tests, ultrasounds, and MRI scans. Interim test results are already available and show promising results for a smaller sample size of 26 women. Once our new psychometric questionnaire is validated, we will correlate its results with the other assessment toosl, test the whole protocol on a larger sample size and publish the results for peer review.