ObjectiveTo assess the relation of clinical variables and laboratory data to pelvic laproscopic observations of tubal occlusion, adnexal adhensions, and peritoneal exudates in women with acute salpingitis.MethodsClinical and Laboratory evaluations were performed systematically before laproscopy in 155 women with suspected acute pelvic inflammatory disease (PID), 82% of whom proved to have acute salpingitis conformed with laparoscopy. Laparoscopic findings were scored in three categories (tubal patency, adhension, and exudates.)ResultsTwo general categories of laparoscopic findings were present: 1) tubal occlusion and moderate to severe adhensions in 30 women, and 2) pelvic-abdominal exudates in 27 women. In the remaining 16 women, these laparoscopic findings occurred alone or in other combinations. Among women with acute salpingitis, tubal occlusion was associated positively with older age, palpable adnexal mass, and moderate to severe pelvic adhesions; negative associations were found with abdominal rebound tenderness, mean abdominal-pelvic tenderness score, pelvic-abdominal exudates, and isolation of eitherNeisseria gonorrhoeaeorChlamydia trachomatis. Moderate or severe pelvic adhesions were associated positively with increased duration of abdominal pain (5 versus 3 days) compared with limited or no pelvic adhesions, but they were associated negatively with mean abdominal-pelvic tenderness score and with pelvic-abdominal exudates (47% versus 73%). Free exudates in the pelvis or abdomen as compared with limited or no exudates was associated positively with abdominal rebound tenderness (86% versus 65%), abdominal-pelvic tenderness score, elevated white blood cell count (83% versus 52%), and recovery ofN gonorrhoeae(79% versus 57%). Free exudates was associated negatively with the median duration of pain (3 versus 6 days), oral contraceptive use (4% versus 26%), and palpable adnexal mass (7% versus 25%). Analysis limited to women without a history of PID gave similar results.ConclusionsAlthough clinical and laboratory criteria traditionally used to judge the clinical severity of acute PID partially predict the degree of tubal or other pelvic abnormalities among women with acute salpingitis and tend to distinguish those with tubal occlusion or moderate to severe adhesions from those with peritonitis, these criteria have low predictive value and are not reliable in the individual patient.