Operational Obstetrics Gynecology The Health Care of Women

Operational Obstetrics & Gynecology The Health Care of Women in Military Settings Captain Mike Hughey, MC, USNR Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide

Operational Medicine is not Identical to Civilian Medicine Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 2

Isolated Settings • Minimal Support • Limited Consultation • Long MEDEVAC times Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 3

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. Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 4

Operational Commitments • Medical care is not the first priority. • It may not be the second priority either. Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 5

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. Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 6

Field Expedient GYN Exam Table • • Litter Stands IV Poles Small Battle Dressings Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 7

Field Expedient Vaginal Speculum • GI mess kit spoons (2) bent at 45° angle, or • Two spoons joined by rubber band Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 8

Ectopic Pregnancy Management Naval Hospital Pensacola FL • • • Transvaginal ultrasound Quantitative HCG Serial hgb Laparoscopy Methotrexate Blood bank Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 9

Ectopic Pregnancy Management Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 10

Ectopic Pregnancy Management Operational Setting • Laparotomy (sometimes) Non-surgical management • IV fluids • Mast suit • Donor-to-victim blood transfusion Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 11

Field Expedient Vaginitis Rx • If it itches, it’s yeast. (Monistat) • If it smells bad, it’s BV. (Flagyl) Mucopurulent, chlamydia Dry, curdy, yeast Bubbly, frothy, trichomonas Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 12

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. Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 13

Unknown Lesions of the Vulva • Each of these requires some unavailable test to confirm the diagnosis. • What is the test for each of them? Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 14