IMild analgesics and antispasmodic may be
administered, and for severe and incapacitating
pain, light duty and bed rest for 1 or 2 days may
be indicated. Refer the patient to a medical treat-
ment facility for evaluation if the dysmenorrhea
is interfering with the performance of duties.
Menstrual cycles that are absent or more than
6 months apart are considered to be amenorrhea.
The causes of amenorrhea include ovarian or
uterine tumors, obstruction, endocrine function
abnormalities, and pregnancy, which is discussed
elsewhere in this chapter. Refer nonpregnant
patients with primary amenorrhea for evaluation.
In addition to amenorrhea, any other type of
abnormal uterine bleeding patterns should be
referred as soon as possible for definitive
diagnosis and treatment.
A woman will usually suspect that she is
pregnant before coming to sick call for confirma-
tion. The physical changes that occur in pregnancy
are variable and may not hold true in all cases,
so make sure that a false diagnosis is not made.
The patient will normally reveal a history of
recent coitus with subsequently missed periods.
The classic symptom of morning sickness is
common. Pelvic examination may reveal a soft,
enlarged uterus (detectable at or about the sixth
week) and a purplish hue to the cervix and the
surrounding vaginal mucosa. There may be
frequency of urination and some amount of breast
enlargement and tenderness. Laboratory diagnosis
is accomplished by means of several tests that are
available through the Federal Stock Catalog and
are complete with instructions. In the event of a
pregnancy aboard ship, consult NAVMEDCOM
and NAVMILPERSCOM instructions for dispos-
ition. Refer the patient for an obstetric workup.
Emergency Conditions in Pregnancy
l Ectopic PregnancyThis condition results
when a fertilized ovum is implanted and develops
outside of the uterine cavity. Ectopic gestation
occurs in approximately 1 out of every 200
pregnancies. Most of the time the implantation
occurs in the fallopian tube.
SYMPTOMSThe patient will reveal a
history of amenorrhea or irregular menses,
followed by a sudden onset of bleeding. There
may or may not have been a previously
diagnosed pregnancy. She may complain of severe
abdominal cramping pain in the lower quadrant.
The pain is nonradiating, and a soft, tender pelvic
mass may be palpable. The decidual tissues
may pass and the patient may show signs of
TREATMENTTransfer the patient to a
medical facility as soon as possible. Surgical treat-
ment is required.
. Spontaneous AbortionThis is termina-
tion of gestation before the 24th week of
pregnancy. Most spontaneous abortions are the
result of ovular or sperm defects. It may be the
result of anatomic malformation of the fetus or
SYMPTOMSThe patient will reveal a
history of amenorrhea or irregular menses. A
previous diagnosis of pregnancy mayor may not
have been established. The usual signs and
symptoms of pregnancy are often lacking. An
abortion is classified as follows:
. ThreatenedThis is any time vaginal
bleeding or cramping occurs after conception.
. ImminentBleeding is heavier and
cervical effacement of dilation is present, and it
may be accompanied by cramping pain.
l InevitableThe membranes are
ruptured and portions of tissue may be visible at
the cervical OS.
. IncompleteSome tissue has been
passed, and the remainder of the conceptus re-
mains in the uterus.
. CompleteThere is total passage of all
parts of the conceptus, the uterus has returned
to normal size, and the cervix has closed.
. MissedThe viability of the pregnancy
has been terminated for at least 1 month, but
the concept us has been retained.
TREATMENTPlace the patient on com-
plete bed rest until the transfer is completed. If
bleeding is severe, replace fluids and treat for
shock. Analgesics may be administered to relieve
pain. Administer antibiotics if signs of infection
are present. Transfer the patient to a medical
facility as soon as possible.
Sexual offenses, including rape, may be
associated with serious injury, pregnancy, and