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 treatment facility for evaluation if the dysmenorrhea is interfering with the performance of duties.
Amenorrhea
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.
Pregnancy
A woman will usually suspect that she is pregnant before coming to sick call for confirmation. 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 disposition. Refer the patient for an obstetric workup.
Emergency Conditions in Pregnancy
Ectopic Pregnancy—This 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.
SYMPTOMS—The 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 shock.
TREATMENT—Transfer the patient to a medical facility as soon as possible. Surgical treatment is required.
Spontaneous Abortion—This is termination 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 diet deficiencies.
SYMPTOMS—The 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:
Threatened—This is any time vaginal bleeding or cramping occurs after conception.
Imminent—Bleeding is heavier and cervical effacement of dilation is present, and it may be accompanied by cramping pain.
Inevitable—The membranes are ruptured and portions of tissue may be visible at the cervical OS.
Incomplete—Some tissue has been passed, and the remainder of the conceptus remains in the uterus.
Complete—There is total passage of all parts of the conceptus, the uterus has returned to normal size, and the cervix has closed.
Missed—The viability of the pregnancy has been terminated for at least 1 month, but the concept us has been retained.
TREATMENT—Place the patient on complete 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 Assault/Rape
Sexual offenses, including rape, may be associated with serious injury, pregnancy, and 2-39