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The potential
risks associated with practice of vaginal seeding (VS) in Cesarean Delivery
outweighs the hypothetical benefits and consequently we do not recommend it at
present says the national recommendations released by Danish Society of
Obstetrics and Gynaecology at the national meeting on 19 January 2017.
The
recommendation along with a commentary was published online 22 AUG 2017 in
British Journal of Obstetrics and Gynecology.
“We could
not identify any other national or international society that had
systematically investigated the clinical approach to VS,” write Thor Haahr, MD,
PhD, from the Department of Obstetrics and Gynaecology at the Institute for
Clinical Medicine, Aarhus University Hospital, Skejby, Denmark.
The
recommendations are aimed at providing fellow obstetricians and midwives with the
basic information about VS so that it can be discussed with couples and
families opting for it.
The recommendations
state that:
Maternity
wards should not take part in screening, guiding or encouraging women for
Vaginal Seeding.
Vaginal
seeding is contraindicated in infants born before 37 weeks, born to mothers who
meet national criteria for group B streptococci(GBS) prophylaxis during
delivery, situations in which the cesarean section is done to prevent vertical
transmission of infection such as—primary vaginal herpes infection, HIV
infection with HIV-RNA >50 copies/ml and any other situations in which the
VS will cause potential harm to the fetus.
Parents who
still wish to perform VS, can do so provided “it does not interfere with or
delay other procedures.” They should be informed about insufficient evidence in
favor of any potential benefit and should be provided with patient information
booklet. They should also be educated about signs of infection in neonates
should any infection occurs after the procedure.
Interest in
VS sparked after Dominguez-Bello and colleagues published the results of their pilot study in 2016 stating that Neonatal colonization can be partially restored in
cesarean born babies by VS. Several
other studies have since followed involving VS which stress the importance of
more research and publications on this topic.
Although, the
risk associated with VS is very low, the immediate concern after VS is early
onset neonatal sepsis (EOS) with Escherichia coli or GBS.
David A.
Eschenbach, MD, from the Department of Obstetrics and Gynecology, University of
Washington, Seattle raised several questions in his accompanying commentary that need to be addressed before
VS becomes a routine practice.
His major
concern was our current inability to identify that which vaginal bacteria/gut
bacteria will produce potential benefit while minimizing the harm. Choosing
between ‘harmful’ and ‘helpful’ bacteria is expensive procedure and it is here
the cost -benefit analysis comes in.
"We
simply are too far behind in knowledge to start this practice without heeding
the Society's recommendations," he concluded.
The authors
suggest that clinicians whose patients want to adopt the practice should be
told about the risk involved and other ways of that have an effect on neonatal
colonization, including early skin-to-skin contact, breast-feeding, and diet
during pregnancy.
