The lower genital tract of 280 pregnant women was studied in detail, and symptoms relevant to its morbidity were elicited and recorded. The study was contemporaneous with a study of microbial flora in the genital tract of these women (de Louvois et al, 1975). Complaint was made frequently of discharge (42%), irritation (15%), or both (11%). Apart from these symptoms, 14% admitted a past history of vulvovaginitis, emphasizing the importance of this condition in obstetric and gynaecological practice. The notorious discrepancy between the complaint, and the objective demonstration of discharge, was confirmed, but a significant difference in observations, varying with the clinical observer (P less than 0-001), was also demonstrated. This illustrates the necessity of even more accurate grading of signs when clinicopathological correlations are to be attempted. Only 30% of women had no evidence of vulvovaginitis or cervicitis. Morbidity did not relate to age, gestation or parity, but there was a significant correlation between clinical acumen, as evidenced by a request for a microbiological report with a view to treatment, and morbidity (P less than 0-001), between past vulvovaginitis and present morbidity (P less than 0-01), and between cervicitis and the presence of pus cells in the smear (P less than 0-001). The results indicate that microbiological investigations should be requested when there is past history of vulvovaginitis, and that lesions of the cervix, if not already noted, should be suspected if pus cells are demonstrable in stained smears.
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