[Sheehan syndrome in the Republic of Niger. 19 cases]

From February 1983 to December 1985, the authors investigated 19 african women with Sheehan's syndrome in Niamey (Republic of Niger). A 15 points diagnostic score was systematically used. Two signs were indispensable for the diagnosis: post-partum agalactia (or severe hypogalactia) and amenorrhea. At least 9 points score was found for every case. Eighteen patients lived along a major road in Niamey and in Dosso departments. The prevalence of this disease is probably important but many cases were not diagnosed since there was no medical examination. Sheehan's syndrome was predominantly diagnosed among Fulani women. Young women (mean age: 26 years) in intensive sexual life, primiparous (8/9) or multiparous (11/19) were concerned. Emergence circumstances of signs were: childbirth at home (18/19), severe vaginal bleeding at placental birth (14/19), rare transfusions (2/19). The infant of a mother with Sheehan's syndrome had a poor prognosis: 9 deaths among 11 deliveries for multiparous, 7/8 for monoparous. The infants were stillborn or more often dead during the first months. Deaths were in relation to absence of maternal lactation. For the primiparous, then infertile women because of hypopituitarism, the repudiation becomes often the only social way of life. Lasting hormonotherapy was not available because 18/19 patients were very poor. Prevention is not possible before long, especially in primiparous, because of: the mentality: the first delivery at home with the mother is the traditional habit; the importance of the required measures.