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Committee Opinion No. 725 Summary: Vaginal Seeding

doi: 10.1097/AOG.0000000000002396
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ABSTRACT Vaginal seeding refers to the practice of inoculating a cotton gauze or a cotton swab with vaginal fluids to transfer the vaginal flora to the mouth, nose, or skin of a newborn infant. The intended purpose of vaginal seeding is to transfer maternal vaginal bacteria to the newborn. As the increase in the frequency of asthma, atopic disease, and immune disorders mirrors the increase in the rate of cesarean delivery, the theory of vaginal seeding is to allow for proper colonization of the fetal gut and, therefore, reduce the subsequent risk of asthma, atopic disease, and immune disorders. At this time, vaginal seeding should not be performed outside the context of an institutional review board-approved research protocol until adequate data regarding the safety and benefit of the process become available.

For a comprehensive overview of these recommendations, the full-text version of this Committee Opinion is available athttp://dx.doi.org/10.1097/AOG.0000000000002402.

Committee on Obstetric Practice:This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice in collaboration with Kurt R. Wharton, MD, and Meredith L. Birsner, MD.

This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found onwww.acog.orgor by calling the ACOG Resource Center.

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Official Citation: Vaginal seeding. Committee Opinion No. 725. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017:130:e274–8.

Received October 06, 2017

Accepted October 06, 2017

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Recommendations

The American College of Obstetricians and Gynecologists (ACOG) makes the following recommendations:

  • The American College of Obstetricians and Gyne-cologists does not recommend or encourage vaginal seeding outside of the context of an institutional review board-approved research protocol, and it is recommended that vaginal seeding otherwise not be performed until adequate data regarding the safety and benefit of the process become available.
  • The American College of Obstetricians and Gyne-cologists only supports the performance of vaginal seeding in the context of an institutional review board-approved research protocol.
  • Should a patient insist on performing the procedure herself, a thorough discussion with the patient should be held acknowledging the potential risk of transferring pathogenic organisms from the woman to the neonate. Risk stratification is reasonable for such women in the form of testing for infectious diseases and potentially pathogenic bacteria. Serum testing for herpes simplex virus and cultures for group B streptococci, Chlamydia trachomatis, and Neisseria gonorrhea should be encouraged. It is further recommended that the obstetrician–gynecologist or other obstetric care provider document the discussion. Because of the theoretical risk of neonatal infection, the pediatrician or family physician caring for the infant should be made aware that the procedure was performed.
  • Although findings are mixed regarding associations between breastfeeding and the development of asthma and atopic disease in childhood, exclusive breastfeeding for the first 6 months of life has multiple known benefits and remains the recommendation of ACOG for all women who do not have physical or medical conditions that prohibit breastfeeding.
  • The paucity of data on this subject supports the need for additional research on the safety and benefit of vaginal seeding.
© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.