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