Operational Obstetrics & Gynecology

Contents

   

   


Introduction

1st Edition Women's Health Care Purpose of the Manual
Military Medicine Women in the Military

Medical Support of Women in Field Environments

Pre-deployment Planning Menstruation Issues Host Nation Issues
AMAL Supplementation Bathing Pregnancy
Pregnancy Policy Quarters STD's and Safe Sex
Pre-deployment Screening Clothing Aerospace Medicine
Pre-deployment Briefing Liberty Risks Gravitational Forces
Urination Issues Leadership Decompression Sickness
Pregnancy and Aviation

The Prisoner of War Experience

Prisoner of War Pre-deployment Planning Stresses of Captivity
Sexual Abuse The Typical Repatriated Soldier Recovery
The Total Soldier

Routine Care

Annual Exam Weight Pap Smear
Chief Complaint Blood Pressure Cultures
Medical History Face and Eyes Rectal
Medications Ears Urine
Menstrual History Thyroid Wet Mount
Pregnancy History Lungs Mammogram
Contraception Heart Breast Self Exam
Nutrition Breasts Immunization
Exercise Abdomen Counseling
Physical Exam Pelvic Exam Plan

Pap Smears

The Cervix Atrophic Vaginitis HPV
Pap Smear (ASCUS) Atypical Squamous Cells Inadequate Smear
Dysplasia Candida (Yeast) Inconclusive Smear
Mild Dysplasia Chlamydia Inflammation
Moderate Dysplasia CIN IUD Changes
Severe Dysplasia Coccoid Bacteria Koilocytosis
Carcinoma-in-Situ Condyloma Leptothrix
Invasive Cancer Drying Artifact Nuclear Atypia
Adenocarcinoma Endocervical Cells Reactive Changes
Visible Lesions Endometrial Cells SIL
Colposcopy Estrogen Effect Squamous Metaplasia
Actinomycosis Gardnerella Trichomonas
Herpes

Obtaining a Pap Smear

Position the Patient Warm the Speculum Sample the SQJ
Field Expedient Exam Table Insert the Speculum Make a Thin Smear

Pad the Stirrups

Field Expedient Speculum Spray Immediately
Inspect the Vulva The Spatula The Brush
Rotate the Spatula Rotate the Brush

Human Papilloma Virus

Clinical Warts Persistence of Virus Relation to Cervical Cancer
Subclinical Warts Transmission of Virus Evaluation
Treatment Relation to Cervical Dysplasia

Contraception

Birth Control Pills Condom Vaginal Suppositories
Emergency Contraception Female Condom Rhythm
DEPO-PROVERA Diaphragm Withdrawal
Norplant Foam Tubal Ligation
Intrauterine Device (IUD) Film Vasectomy
Gel

Birth Control Pills

Benefits The particular pill she's using is not available. Painful menstrual cramps
Risks Postponing a period with BCPs Continuous Birth Control Pills
Which pill to start Side-effects No period
Starting the pills Breast tenderness Very light period
When are the pills effective? Nausea Spotting between periods
Skipped a pill Weight gain Periods at the wrong time
Migraine headache history Headaches Antibiotics
High blood pressure Moodiness or depression Thinks she may be pregnant
Diabetes Vaginal dryness Emergency Contraception
Blood clot history Decreased sex-drive (libido) Overdose

Vulvar Disease

General Inclusion Cyst Secondary Syphilis
Bartholin Cyst Itching Skene's Gland
Chancroid Labial Abscess Tinea Cruris
Condyloma Lata Lichen Sclerosis VIN
Contact Dermatitis Lymphogranuloma Venereum Vulvar Cancer
Crabs (Lice) Melanosis Vulvar Dystrophy
Epithelial Polyp Molluscum Contagiosum Vulvar Hematoma
Granuloma Inguinale Paget's Disease Vulvar Vestibulitis
Herpes Primary Syphilis Warts (Condyloma, HPV)
Hypertrophic Vulvar Dystrophy Runner's Rash Yeast (Monilia, Candida)
Scabies

Vaginal Discharge

Overview Cervical Ectropion Gonorrhea
History Cervicitis Infected IUD
Physical Chlamydia PID: Mild
Laboratory Foreign Body PID: Moderate to Severe
Treatment Gardnerella Trichomonas
Yeast

Abnormal Bleeding

Normal Bleeding Hormonal Problems Late for a Period
Abnormal Bleeding Malignancy Irregular Periods
Overview What to do about it Too Frequent Periods
Pregnancy Problems Heavy Periods Constant Bleeding
Mechanical Problems Light Periods Hemorrhage

Menstrual Problems

Normal Menstrual Flows Fluid Retention Late for a Period
Cramps Bloating Irregular Periods
Breast Pain Depression, Irritability Too Frequent Periods
Midcycle Pain Heavy Periods Constant Bleeding
Acne Light Periods Hemorrhage
Headaches

Abdominal Pain

Uncertainty of Diagnosis IUD Problems PID
Pain and Bedrest Ovarian Cyst Mild PID
Pain and Fever Ruptured Ovarian Cyst Moderate to Severe PID
Chronic Pain Unruptured Ovarian Cyst Endometriosis
Pregnancy Test Twisted Ovarian Cyst Appendicitis
Pain with BCPs Painful Menstrual Flows Bowel Obstruction
Pregnancy and Bleeding Mittelschmerz Degenerating Fibroid
Threatened Abortion Functional Bowel Syndrome Infected or Rejected IUD
Ectopic Pregnancy Gastroenteritis Cystitis
Placental Abruption Diverticular Disease Pyelonephritis
Placenta Previa

Urination Problems

Painful Urination Hematuria Irritable Bladder
Gonorrheal Urethritis Bad Odor Urethral Diverticulum
Nongonorrheal Urethritis Cannot Urinate Unpredictable Urine Loss
Herpes Bladder Training Urgency
Yeast Incontinence Pyelonephritis
Urinary Frequency Stress Incontinence Kidney Stones
    How to Insert a Foley Catheter

Breast Problems

Breast Development Supernumerary Nipples Non-cyclic Breast Pain
Breast Exam Inverted Nipples Nipple Discharge
Self Breast Exam Adolescent Breast Problems Fat Necrosis
Mammography Pregnancy Changes Paget's Disease
Ultrasound Puerperal Mastitis Breast Mass
Breast Biopsy Nipple Laceration Breast Cyst
Supernumerary Breasts Cyclic Breast Pain Fibroadenoma
Breast Cancer

Sexual Assault

Outline Requisitions Change of Clothing
Staff Assignment History Tests
Serious Injuries Clothing Antibiotics
Notification Photographs Contraception
Consent Combings Follow-up
Gather Supplies Mouth Exam Evidence Disposition
Labels Hands Patient Instructions
Children

Normal Pregnancy

Diagnosis of Pregnancy Disability Thermal Stress
Pregnancy Tests Maternal Skin Changes Noise
Prenatal Care Nausea Vibration
Nutrition Heartburn Solvents
Prenatal Vitamins Sciatica Heavy Metals
Laboratory Tests Carpal Tunnel Syndrome X-rays
Ultrasound Scans URI Radiation
Estimating Gestational Age Antibiotics CRT Exposure
Fetal Heart Beat Other Drugs Diving
Exercise Immunizations Hyperbaric Therapy
Aircrew Status

Abnormal Pregnancy

Miscarriage Septic Abortion Placental Abruption
Abortion Unruptured Ectopic Pregnancy Placenta Previa
Threatened Abortion Ruptured Ectopic Pregnancy Toxemia

Complete Abortion

Blood Transfusion Pre-eclampsia

Incomplete Abortion

Trauma During the 1st Trimester Eclampsia
Inevitable Abortion 2nd and 3rd Trimester Trauma HELLP Syndrome

Normal Labor and Delivery

Labor Contractions Electronic Fetal Monitors
Latent Phase Labor Fetal Heart Rate Pain Relief

Active Phase Labor

Urine Second Stage Labor
Progress of Labor Estimated Fetal Weight Preparing for Delivery
Delivery of the Baby Dilatation and Effacement Managing the Delivery
Delivery of the Placenta Fetal Orientation Episiotomy
Managing Labor and Delivery Leopold's Maneuvers Anesthesia
Initial Evaluation Fetal Membranes Clamp the Cord
History Blood Count The Placenta
Risk Factors Early Labor Uterine Massage
Vital Signs Monitor the Fetal Heart Post Partum Care

Problems During Labor and Delivery

Preterm Labor Shoulder Dystocia Post Partum Hemorrhage
Premature Rupture of Membranes Breech Delivery Placental Abruption
Abnormal Presentation Twin Delivery Placenta Previa
Prolonged Latent Phase Prolapsed Umbilical Cord Group B Streptococcus
Arrest of Active Labor Cord Around the Neck Chorioamnionitis
Retained Placenta Post Partum Fever

Care of the Newborn

Dry the Baby Evaluate the Baby Assign Apgar Score
Replace Wet Towels Color

Breast-Feeding

Position the Baby Ventilate if Necessary Field Expedient Bottle
Suction the Airway Check the Heartbeat Vernix
Keep the Baby Warm Meconium

Menopause

Definition Benefits of Estrogen Birth Control Pills
Symptoms Risks of Estrogen Risk of Pregnancy
Associated Problems Alternatives to Estrogen Libido
Clinical Presentation Standard Treatment Follow-up
Philosophy of Management

Contents -  Introduction -  Medical Support of Women in Field Environments -  The Prisoner of War Experience -  Routine Care -  Pap Smears -  Human Papilloma Virus -  Contraception -  Birth Control Pills -  Vulvar Disease -  Vaginal Discharge -  Abnormal Bleeding -  Menstrual Problems -  Abdominal Pain -  Urination Problems -  Menopause -  Breast Problems -  Sexual Assault -  Normal Pregnancy -  Abnormal Pregnancy -  Normal Labor and Delivery -  Problems During Labor and Delivery -  Care of the Newborn

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Obstetrics & Gynecology - 2nd Edition
The Health Care of Women in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMEDPUB 6300-2C
January 1, 2000

This web version of Operational Obstetrics & Gynecology is provided by The Brookside Associates.  It contains original contents from the official US Navy NAVMEDPUB 6300-2C, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified.

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