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Routine perineal shaving on admission in labour

  • Review
  • Intervention

Authors

  • Vittorio Basevi,

    Corresponding author
    1. Centro per la Valutazione della Efficacia della Assistenza Sanitaria, Azienda USL di Modena, CeVEAS, Modena, Italy
    • Vittorio Basevi, CeVEAS, Centro per la Valutazione della Efficacia della Assistenza Sanitaria, Azienda USL di Modena, V. le L. Muratori 201, Modena, 41100, Italy. v.basevi@ausl.mo.it.

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  • Tina Lavender

    1. The University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK
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Abstract

Background

Pubic or perineal shaving is a procedure performed before birth in order to lessen the risk of infection if there is a spontaneous perineal tear or if an episiotomy is performed.

Objectives

To assess the effects of routine perineal shaving before birth on maternal and neonatal outcomes, according to the best available evidence.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 January 2008).

Selection criteria

All controlled trials (including quasi-randomised) that compare perineal shaving versus no perineal shaving.

Data collection and analysis

We evaluated trials under consideration for methodological quality and appropriateness for inclusion without consideration of their results.

Main results

Three trials fulfilled the prespecified criteria. In the earlier trial, 389 women were alternately allocated to receive either skin preparation and perineal shaving or clipping of vulval hair only. In the second trial, which included 150 participants, perineal shaving was compared with the cutting of long hairs for procedures only. In the third trial, 500 women were randomly allocated to shaving of perineal area or cutting of perineal hair. The primary outcome for all three trials was maternal febrile morbidity. No differences were found (combined odds ratio (OR) 1.16, 95% confidence interval (CI) 0.70 to 1.90).

No differences were found in terms of perineal wound infection (OR 1.52, 95% CI 0.79 to 2.90) and perineal wound dehiscence (OR 0.13, 95% CI 0.00 to 6.70) in the larger trial, the only one assessing these outcomes.

In the smaller trial, fewer women who had not been shaved had Gram-negative bacterial colonisation compared with women who had been shaved (OR 0.43, 95% CI 0.20 to 0.92).

Authors' conclusions

There is insufficient evidence to recommend perineal shaving for women on admission in labour.

摘要

背景

在分娩時,依慣例於進產房時剃除會陰部陰毛

剃除陰部或會陰部的陰毛,是生產前要處理的過程,目的是要降低感染的風險,以因應如果發生了自發性的會陰撕裂傷,或是如果施行了外陰切開術(episiotomy)的狀況。

目標

根據可取得的最佳證據,在分娩時,依慣例於進產房時剃除會陰部陰毛,評估這種作法對母體與新生兒預後的影響。

搜尋策略

我們搜尋了the Cochrane Pregnancy and Childbirth Group trials register(2003年11月)。

選擇標準

剃除與未剃除會陰部陰毛,所有的對照試驗(包括了半隨機的)將這兩者進行了比較。

資料收集與分析

試驗的內容為考量研究方法的品質以及合適與否,,而不是考量試驗的結果。

主要結論

只有2組試驗完全符合了預先要求的標準。在1篇較早期的試驗當中,以交替式的方法將389名婦女分配到2組,1組是皮膚消毒與剃除會陰部陰毛(對照組),另1組是僅僅修剪陰戶陰毛的那組(實驗組)。在包含了150位參與者的第2篇試驗中,剃除會陰部陰毛之婦女的比較對象,是僅只剃除過長陰毛者。對這2組試驗來說,主要的評估預後為母體發燒率,其中,並沒有發現什麼差異(合併之勝算比(OR) 1.26, 95% 信賴區間(CI) 0.75 to 2.12)。在較小型的試驗中,跟那些已經接受剃除陰毛的婦女比較起來,那些沒有接受剃除陰毛的婦女當中,較少人被篩檢出有革蘭氏陰性的細菌群聚(OR 0.43, 95% CI 0.20 to 0.92)。

作者結論

對於婦女而言,在因為分娩而進產房時,是否要建議剃除會陰部陰毛,並沒有充足的證據。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在因為分娩而住進醫院時,依照慣例要為婦女們剃除陰道附近之區域裡的陰毛。當婦女要被送往醫院進行生產時,她們可能會用刮鬍刀自行剃除陰部的毛髮(剃除會陰部陰毛)。會這樣做的原因是因為她們相信,如果有發生會陰部撕裂傷或是施行了外陰切開術的時候,剃除陰毛可以降低感染的風險,而且這樣可以讓傷口比較容易縫合,並且在器械輔助生產時會有幫助。在某些國家中,剃除陰毛是一項例行性的流程。目前的回顧發現,並沒有證據可以顯示剃除會陰部陰毛會帶來任何的臨床優點。在分娩之前,沒有接受例行性剃除陰毛的婦女,看起來是安全的。在1922年到2005年之間,曾有報告提出包含了總數為1039名婦女在內的3組對照試驗。這些試驗中,每1組都使用皮膚消毒,並將剃除會陰部陰毛與只有修剪陰戶陰毛進行了比較。當我們將這些試驗中的發現統合在一起,不論是剃除會陰部陰毛與否,針對生產之後發生了體溫升高的母親數目(母體發燒的罹病率)而言,都沒有發現任何差異。有1組試驗還觀察了會陰部傷口的感染狀況,在會陰部的修補之後,開放性傷口的發生率與母體的滿意程度且在各組別之間並沒有發現任何差異。如同其中1組試驗裡所描述的內容,大多數的副作用要歸咎於較晚才進行剃除陰毛的措施。這些副作用包括了刺激感、發紅、因為刮鬍刀所造成的表皮刮傷、以及對於陰戶的燒灼傷與發癢。沒有任何試驗曾經針對這些婦女因剃除陰毛所引起的疼痛、難為情、或是在毛髮重新生長期間的不舒適感等來進行回顧評估,而這些評估可以在追求健康的角度上,決定出最適當的照護型式。

Plain language summary

Routinely shaving women in the area around the vagina on admission to hospital in labour

Women may have their pubic hairs shaved with a razor (perineal shaving) when they are admitted to hospital to give childbirth. This is done in the belief that shaving reduces the risk of infection if the perineum tears or a episiotomy is performed and that it makes suturing easier and helps with instrumental deliveries. Shaving is a routine procedure in some countries. The present review found no evidence of any clinical benefit with perineal shaving. Not routinely shaving women before labour appeared safe. Three controlled trials that involved a total of 1039 women were reported on between 1922 and 2005. They each used antiseptic skin preparation and compared perineal shaving with cutting vulval hairs. When the findings of the trials were combined, no differences were found, with and without shaving, on the number of mothers who experiencing high body temperatures after the birth (maternal febrile morbidity). One trial also looked at perineal wound infection, the incidence of open wounds and maternal satisfaction immediately after a perineal repair had been completed and found no difference between groups. Most of the side-effects attributable to shaving occur later, as described by one of the trials. These included irritation, redness, multiple superficial scratches from the razor and burning and itching of the vulva. No trial assessed the views of the women about shaving, such as pain, embarrassment or discomfort during hair regrowth, to determine the most appropriate form of care in terms of health gain.

Plain language summary

Rutinsko brijanje stidnih dlaka žena u trudovima kod prijema u rodilište

Rutinsko brijanje stidnih dlaka žena u trudovima kod prijema u rodilište

Ženama se mogu obrijati stidne dlačice britvicom kod prijema u rodilište, tijekom ranih faza porođaja. Ovo se radi u uvjerenju da brijanje smanjuje rizik od infekcije u slučaju da perineum popuca ili kod epiziotomije te da olakšava šivanje i porode sa vakuumom ili porodničarskim kliještima. Brijanje je rutinska procedura u nekim zemljama. Ovaj pregled literature nije pronašao nikakve kliničke prednosti brijanja stidnih dlaka. Sigurno postoje nedostaci rutinskog brijanja žena prije porođaja. 1922. i 2005. godine napravljene su tri kontrolirane studije koje su uključile 1039 trudnica. U svakoj se koristio antiseptik na koži i uspoređivalo se brijanje sa šišanjem dlačica na vulvi. Kad su se rezultati istraživanja spojili, nije bilo razlika između brijanja i ne brijanja kod žena koje su imale visoku temperaturu nakon porođaja. Jedno istraživanje je također uključilo učestalost infekcija rane na međici, učestalost otvorenih rana i majčino zadovoljstvo odmah nakon šivanja međice te nije bilo razlike između tih skupina. Većina nuspojava šivanja javlja se kasnije, što je objašnjeno u jednoj studiji. Nuspojave uključuju iritaciju, crvenilo, površinske ogrebotine od britvice te peckanje i svrbež vulve. Ni jedna studija nije uključila mišljenje žena o brijanju poput boli, srama ili nelagode kad su dlačice ponovno narasle, kako bi se odredio optimalni način skrbi.

Translation notes

Translated by: Croatian Branch of the Italian Cochrane Centre
Translation Sponsored by: Ministry of Education, Science and Sports

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