Operational Obstetrics

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Operational Obstetrics GynecologyThe Health
Care of Women in Military Settings
Captain Mike Hughey, MC, USNR
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Operational Medicine is not Identical to Civilian
Medicine
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Isolated Settings

• Minimal Support
• Limited Consultation
• Long MEDEVAC times

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Limited Resources

• What did you bring with you?
• Resupply? Maybe
• Whatever you use up today you wont have
  tomorrow.
• IV antibiotics often mean transfer.

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Operational Commitments

• Medical care is not the first priority.
• It may not be the second priority either.

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Then sometimes, medical care is the mission

• Medical personnel, supplies and equipment for
  combat are different than those used for
  humanitarian missions.
• Before deployment, learn as much as you can about
  everything.

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Field Expedient GYN Exam Table

• Litter
• Litter Stands
• IV Poles
• Small Battle Dressings

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Field Expedient Vaginal Speculum

• GI mess kit spoons (2) bent at 45 angle, or
• Two spoons joined by rubber band

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Ectopic Pregnancy ManagementNaval Hospital
Pensacola FL

• Transvaginal ultrasound
• Quantitative ? HCG
• Serial hgb
• Laparoscopy
• Methotrexate
• Blood bank

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Ectopic Pregnancy Management
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Ectopic Pregnancy ManagementOperational Setting

• Laparotomy (sometimes)
• Non-surgical management
• IV fluids
• Mast suit
• Donor-to-victim blood transfusion

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Field Expedient Vaginitis Rx

• If it itches, its yeast. (Monistat)
• If it smells bad, its BV. (Flagyl)

Mucopurulent, chlamydia
Dry, curdy, yeast
Bubbly, frothy, trichomonas
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Urinary Tract Infections

• Treat UTIs based on symptoms.
• Cultures and dipsticks in many operational
  settings are, at best a waste of time, and may be
  misleading and dangerous.

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Unknown Lesions of the Vulva

• Each of these requires some unavailable test to
  confirm the diagnosis.
• What is the test for each of them?

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Bartholin Duct Cyst and Abscess

• Drain it or leave it alone?

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Draining a Bartholin Cyst
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Operational Obstetrics Gynecology
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