1. Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 1 Operational Obstetrics & Gynecology The Health Care of Women in Military Settings Captain Mike Hughey, MC, USNR

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

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

4. 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.

5. 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.

6. 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.

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

8. 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

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

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

11. 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 Management Operational Setting

12. 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

13. 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.

14. 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?

15. Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 15 Bartholin Duct Cyst and Abscess Drain it or leave it alone?

16. Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 16 Draining a Bartholin Cyst

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

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