Routine perineal shaving on admission in labour

Vittorio Basevi; Tina Lavender

doi:10.1002/14651858.CD001236.pub2

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Figure 1

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Perineal shaving versus no perineal shaving, Outcome 1 Postpartum maternal febrile morbidity.

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Analysis 1.2

Comparison 1 Perineal shaving versus no perineal shaving, Outcome 2 Colonisation.

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Analysis 1.3

Comparison 1 Perineal shaving versus no perineal shaving, Outcome 3 Neonatal infection.

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Analysis 1.4

Comparison 1 Perineal shaving versus no perineal shaving, Outcome 4 Wound infection.

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Analysis 1.5

Comparison 1 Perineal shaving versus no perineal shaving, Outcome 5 Wound dehiscence.

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Analysis 1.11

Comparison 1 Perineal shaving versus no perineal shaving, Outcome 11 Maternal satisfaction continuous data.

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Summary of findings for the main comparison. routine perineal shaving before childbirth for women in labour

Routine perineal shaving before childbirth for women in labour
Population: Women in labour Settings: Hospitals in US (Baltimore, Dallas) and Thailand (Bangkok) Intervention: Routine perineal shaving before childbirth versus clipping of long pubic hairs or cutting of perineal hairs
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Routine perineal shaving before childbirth
Postpartum maternal febrile morbidity	Study population		RR 1.16 (0.74 to 1.80)	997 (3 studies)	⊕⊝⊝⊝ very low^1,2
	67 per 1000	77 per 1000 (48 to 119)
	Low
	18 per 1000	20 per 1000 (12 to 33)
	High
	124 per 1000	141 per 1000 (90 to 213)
Neonatal infection	Study population		Not estimable	458 (1 study)	see comment	The outcome was reported with no events.
	See comment	See comment
	Moderate

Wound infection	Study population		RR 1.47 (0.80 to 2.70)	458 (1 study)	⊕⊕⊝⊝ low³
	70 per 1000	103 per 1000 (57 to 180)
	Moderate
	70 per 1000	103 per 1000 (56 to 179)
Maternal satisfaction Scale from 1 to 5	The mean maternal satisfaction in the control groups was 3.8 (five degrees)⁴	The mean maternal satisfaction in the intervention groups was 0 higher (0.13 lower to 0.13 higher)	MD 0.00 (‐0.13, 0.13)	458 (1 study)	⊕⊕⊝⊝ low⁵
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; MD: mean difference
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Most studies contributing data had serious design limitations. ² Wide confidence interval crossing the line of no effect. ³The total cumulative study population is not very small (sample size 458) and the total number of events is 40, but the 95% confidence interval is very wide. ⁴Likert scales on five degrees to measure a women's intensity of satisfaction (5, excellent; 4, good; 3, average; 2, fair; and 1, poor). ⁵Wide confidence interval crossing the line of no effect and small sample size.

Summary of findings for the main comparison. routine perineal shaving before childbirth for women in labour

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Comparison 1. Perineal shaving versus no perineal shaving

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Postpartum maternal febrile morbidity Show forest plot	3	997	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.73, 1.76]

2 Colonisation Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Gram‐positive	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.16 [0.82, 1.64]
2.2 Gram‐negative	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.70, 0.98]
3 Neonatal infection Show forest plot	1	458	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4 Wound infection Show forest plot	1	458	Risk Ratio (M‐H, Fixed, 95% CI)	1.47 [0.80, 2.70]

5 Wound dehiscence Show forest plot	1	458	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.00]

6 Need for wound resuturing	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Discomfort	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Pain	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Maternal embarrassment	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Maternal satisfaction	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 Maternal satisfaction continuous data Show forest plot	1	458	Mean Difference (IV, Fixed, 95% CI)	0.0 [‐0.13, 0.13]

Comparison 1. Perineal shaving versus no perineal shaving

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