Someone asked about what volume of acute blood loss post partum could cause
pituitary necrosis, or Sheehan's syndrome.  It isn't the volume of blood
lost so much as whether the woman was in deep shock (characterized by
precipitous fall in blood pressure and loss of consciousness) with
consequent lack of perfusion to the pituitary.  So if she were getting
adequate fluid replacement, and eventually plasma expanders and/or blood
transfusions, right along, one wouldn't expect to see the kind of tissue
damage in Sheehan's at all.
I have cared for women who have lost almost their entire blood volumes (up
to 5 liters) and we have more catastrophic hemorrhages than I care to admit
- remember I am NOT working in the labor ward these days and I don't know
what is going wrong but most of these women are not experiencing spontaneous
onset labor which proceeds on its own to the spontaneous birth of a child,
so they are complicated at the outset.
One woman who had a uterine inversion and a huge blood loss, who I remember
from my student days, did experience delay of lactogenesis and she might
never have gone on to bring in a milk supply; I don't know because we didn't
get to follow women over time while in school.
Nonetheless, I have never in all my subsequent years of practice (16) seen a
clinically manifested case of Sheehan's in a woman who has survived this
kind of hemorrhage.  I am aware of one woman who died tragically after
hemorrhaging intractably post partum; she didn't live long enough for us to
see whether she had any long term complications.
Rachel Myr
Kristiansand, Norway

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