This is a patient who presented to the emergency room with right vulvar pain and drainage. Her exam showed vulvar erythema and a fluctuate mass consistent with an abscess. It was tender to palpation. Vital signs showed a temperature of 100.7 degrees Fahrenheit (F) otherwise, they were normal. Her white blood cell count was 18.5. A pelvic ultrasound was normal. She was admitted as an inpatient and was given intravenous antibiotics and oral antibiotics with pain management. The abscess was aspirated with a needle by midwife with 3 cubic centimeters (cc) of fluid. The health plan's determination is upheld
The patient presented and was diagnosed with a vulvar abscess in the emergency department. Fluid was aspirated by the nurse midwife, however, no incision and drainage was attempted. In addition, no oral antibiotics were attempted nor was any other outpatient management attempted prior to admission. She was febrile, however, she was not hemodynamically unstable as all of her vital signs were normal. She had no other medical morbidity to support the need for inpatient hospital admission.