Inadequate visits to the emergency department by pregnant women.

Inadequate emergency visits, which could be resolved in primary care, are an unnecessary expense for the healthcare service. We did a review of all gynaecology and obstetrics emergency visits by pregnant or postpartum women during 2010 and 2011 in order to describe the adequacy of the visits by pregnant women to the emergency service. We defined three levels of adequacy: adequate, moderately adequate, and inadequate. One thousand seven hundred and forty-three visits to the emergency room of gynaecology and obstetrics were studied. These consultation motivations were adequate in 38.9%, moderately adequate in 46.7% and inadequate in 14.4%. This shows that the amount of inadequate and moderately adequate visits to the emergency department could be reduced by 61% by implementing different interventions, and also reducing health spending for emergencies. Impact statement What is already known on this subject: Visits to the emergency room constitute a basic pillar in the hospital structure, and it generates great health expense. Other authors have reported high rates of inadequacy of these visits to the emergency services. They find inadequate visits are associated with young age and female gender among other factors. What the results of this study add: Knowing the adequacy of the visits generated by pregnant young women is a starting point for implementing health policies that could reduce these inadequate visits and consequently health expenditure could be reduced. What the implications are of these findings for clinical practice and/or further research: These health policies could consequently reduce health expenditure.

Periurethral granuloma following injection with dextranomer/hyaluronic acid copolymer for stress urinary incontinence.

Periurethral injection of bulk-enhancing agents provides a simpler and cost-effective therapeutic approach for stress incontinence in women. We report a case of periurethral granuloma secondary to dextranomer/hyaluronic acid (Dx/HA) copolymer injection. A 73-year-old woman with history of radiotherapy for cervical carcinoma at the age of 55 presented with stress urinary incontinence. She underwent periurethral injection of Dx/HA copolymer, and incontinence was resolved. At 4 months postoperatively, a 3-4 cm noninflammatory painless mass in the external genitalia was noted. Cystic images compatible with urethral diverticula were seen in the magnetic resonance imaging scan, but voiding cystourethrography was unrevealing. Transvaginal tumor puncture yielded abundant creamy material, the culture of which was negative. Microscopic examination revealed refractile foreign material surrounded by foreign body giant cells. Surgical debridement of the granuloma using a cold scalpel was performed. Stress urinary incontinence recurred but resolved spontaneously within 1 month. One year later, the patient continues to be asymptomatic.