Operational Obstetrics & Gynecology

Contents

Introduction

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

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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

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The Prisoner of War Experience

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

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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

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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

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.

This formatting C. 2006 Brookside Associates, LLC.
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