TO SHAVE OR NOT TO SHAVE

It is common practice to perform pubic or perineal shaving before birth in order to lessen the risk of infection especially if there is a spontaneous perineal tear. However in a Systematic Review done by Calibri et al. in Centro Interaziendale in Italy, comparing perineal shaving with that of no perineal shaving, the differences were not significant (odds ratio (OR) 1.26, 95% confidence interval (CI) 0.75, 2.12) with regards to post partum maternal febrile morbidity and perineal wound infection. However in one study from the same review, they found that fewer women who had not been shaved had gram negative bacterial colonization compared with women who had been shaved (OR 0.43, 95% CI 0.20, 0.92).How then can we reconcile this single study from the conclusion of the authors? Surrogate outcomes are those that come from laboratory tests while clinical outcomes are those that are well, clinical. So in effect although the gram negative bacterial colonization is indeed significant, there is still no sufficient Clinical Evidence that it can cause perineal wound infection or post partum febrile morbidity.