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Operational Obstetrics & Gynecology: The Health Care of Women in Military Settings

This document discusses healthcare considerations for women in military settings. It notes that operational medicine has limited resources and different priorities than civilian medicine. Medical care may not be the top priority in operational environments due to isolated settings with minimal support, limited consultation times, and long medical evacuation times. Doctors must provide care with limited supplies and may not be resupplied if resources are used up. The document provides examples of how common gynecological issues like ectopic pregnancies, vaginal infections, and urinary tract infections can be managed in operational settings with improvised equipment and without diagnostic tests that are unavailable. It emphasizes treating based on symptoms when cultures and tests cannot be conducted.

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Subhada Gosavi
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80 views18 pages

Operational Obstetrics & Gynecology: The Health Care of Women in Military Settings

This document discusses healthcare considerations for women in military settings. It notes that operational medicine has limited resources and different priorities than civilian medicine. Medical care may not be the top priority in operational environments due to isolated settings with minimal support, limited consultation times, and long medical evacuation times. Doctors must provide care with limited supplies and may not be resupplied if resources are used up. The document provides examples of how common gynecological issues like ectopic pregnancies, vaginal infections, and urinary tract infections can be managed in operational settings with improvised equipment and without diagnostic tests that are unavailable. It emphasizes treating based on symptoms when cultures and tests cannot be conducted.

Uploaded by

Subhada Gosavi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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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 1
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
• 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
Bartholin Duct Cyst and Abscess
• Drain it or leave it alone?

Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 15
Draining a Bartholin Cyst

Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 16
Operational Obstetrics & Gynecology

Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 17
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 18

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