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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 1
Operational Obstetrics & GynecologyThe Health Care of Women in Military Settings
Captain Mike Hughey, MC, USNR
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 2
Operational Medicine is not Identical to Civilian Medicine
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 3
Isolated Settings
• Minimal Support• Limited Consultation• Long MEDEVAC times
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 4
Limited Resources
• What did you bring with you?
• Resupply? Maybe• Whatever you use up today
you won’t have tomorrow.• IV antibiotics often mean
transfer.
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 5
Operational Commitments
• Medical care is not the first priority.• It may not be the second priority
either.
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 6
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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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 7
Field Expedient GYN Exam Table
• Litter• Litter Stands• IV Poles• Small Battle Dressings
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 8
Field Expedient Vaginal Speculum
• GI mess kit spoons (2) bent at 45° angle, or
• Two spoons joined by rubber band
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 9
Ectopic Pregnancy ManagementNaval Hospital Pensacola FL
• Transvaginal ultrasound• Quantitative HCG• Serial hgb• Laparoscopy• Methotrexate• Blood bank
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 10
Ectopic Pregnancy Management
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 11
• Laparotomy (sometimes)
Non-surgical management• IV fluids• Mast suit• Donor-to-victim blood
transfusion
Ectopic Pregnancy ManagementOperational Setting
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 12
Field Expedient Vaginitis Rx
• If it itches, it’s yeast. (Monistat)• If it smells bad, it’s BV. (Flagyl)
Dry, curdy, yeast
Mucopurulent, chlamydia
Bubbly, frothy, trichomonas
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 13
Urinary Tract Infections
• Treat UTI’s 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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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 14
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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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 15
Bartholin Duct Cyst and Abscess
• Drain it or leave it alone?
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 16
Draining a Bartholin Cyst
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 17
Operational Obstetrics & Gynecology
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 18