When pregnancy occurs alongside hypopituitarism in the setting of Sheehan syndrome, a specific and structured approach to hormonal management is required — one that accounts for the changing physiological demands of pregnancy and the particular risks at labour and delivery.
Because fertility is often impaired in hypopituitarism, natural pregnancy is rare. When it does occur, pre-existing hormonal deficiencies must be carefully managed across all stages of pregnancy, labour, and delivery.
The protocol specifies a preferred glucocorticoid agent for use in pregnancy, with individualized dose management across the trimesters and distinct provisions for the active phase of labour and caesarean delivery.
Because fertility is often impaired in hypopituitarism, natural pregnancy is rare.
We suggest using HC as the preferred GC in pregnancy and increasing the dose based on the individual clinical course; higher doses may be required, in particular during the third trimester.
We recommend HC stress dosing during the active phase of labor, similar to that used in major surgical stress.
During labor and delivery, clinicians should administer a stress dose of GC (50 mg iv HC in the second stage of labor).
For cesarean section, we recommend a dose of 100 mg every 6 – 8 hours.
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