Special Operations Forces Medical Handbook

3-108

Using Advanced Tools: Lab: Urinalysis for urine protein (dipstick); platelet count.

Assessment:
Differential Diagnosis
Appendicitis, diabetes, gallbladder disease, gastroenteritis, glomerulonephritis, hyperemesis gravidarum
(excessive vomiting in pregnancy), kidney stones, peptic ulcer, pyelonephrits, lupus, viral hepatitis. See
appropriate sections of this book.

Plan:
Stabilize and evacuate. Definitive therapy in the form of delivery is the only cure for preeclampsia. The difficulty
in therapy is deciding when to deliver the infant. The decision to deliver will depend on the severity of
the disease, the status of the mother and the fetus, and the gestational age at the time of the evaluation.
Take the severity of the condition and the fetal gestational age into consideration, and either deliver the
pregnancy or place the patient on bed rest. Perform close surveillance until the pregnancy reaches term
or the preeclampsia worsens, dictating the need to deliver. There is no advantage to cesarean delivery
over vaginal delivery for preeclampsia. Therefore, delivery route should be based on obstetric indications
(worsening condition).

Treatment
Mild Preeclampsia:

1. Observe for worsening signs of the disease.

Repair of 3rd and 4th Degree Episiotomy

Reapproximate rectal mucosa with

interupted, fine 4-0 sutures (usually

two layers), taking care not puncture

the mucosa and to leave the ends

of the suture in the tissue, not the

rectal lumen.

Repair the torn ends of the donut-

shaped anal sphincter with four

well-spaced interrupted sutures

that traverse through the capsule

of the muscle.

Figure 3-15