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 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 won’t 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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• Laparotomy (sometimes)

Non-surgical management• IV fluids• Mast suit• Donor-to-victim blood

transfusion

Ectopic Pregnancy ManagementOperational Setting

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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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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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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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