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JOINT EBOH/CORE SEMINAR SERIES

Azar Mehrabadi, PhD

Assistant Professor
Perinatal Epidemiology Research Unit
Departments of Obstetrics & Gynaecology and Pediatrics
Dalhousie University

WHEN: Monday, February 24, 2025, from 4 to 5 p.m.
WHERE: Hybrid | SPGH, 2001 9I制作厂免费 College, Rm 1140 |
Note: Azar Mehrabadi will be presenting from Halifax

Abstract

Approximately 21% of all births worldwide are delivered by cesarean, with rates of 25.7% in Europe and 31.6% in North America. Currently, the most common indication for cesarean delivery in Canada (over 30% of cesareans) is a previous cesarean delivery. Increased adoption of planned vaginal births following a previous cesarean is a key strategy for reducing overall cesarean delivery rates in Canada and globally. However, controversy remains as to whether the wider adoption of planned vaginal deliveries in this population is safe. A national study of Canada (excluding Quebec) suggested worsening neonatal outcomes over time with a planned vaginal birth between 2003 and 2014. We conducted a population-based cohort study including 12 681 pregnancies with a previous cesarean delivery using the detailed clinically oriented perinatal database in Nova Scotia, Canada. Our study found that among those with a planned vaginal birth versus a repeat cesarean, severe maternal morbidity and severe perinatal-neonatal morbidity increased over time from 2003-08 to 2015-21, balancing for numerous maternal and clinical characteristics. Oxytocin induction and augmentation increased markedly in this population and could not be ruled out as a factor associated with worsening outcomes. Our study included two internal validation studies, one assessing the outcome of uterine rupture and one assessing the exposure of planned mode of delivery. In Nova Scotia we found disparities in planned vaginal deliveries and successful vaginal deliveries by body mass index (BMI). Our study team has partnered with a provincial health program to implement an evidence-based clinical decision support tool across Nova Scotia.

Learning Objectives

At the completion of this talk, attendees will be able to:

• Understand the historical and recent evidence informing clinical decision making regarding planned mode of delivery following a previous cesarean delivery;
• Learn to apply internal validation studies in large, routinely collected database analyses;
• Describe and understand the limitations of study findings on disparities in planned and actual mode of delivery by BMI;
• Understand the process of implementing an evidence-based clinical decision support tool addressing planned mode of delivery following a previous cesarean.

Speaker Bio

Dr. Azar Mehrabadi (PhD) is a perinatal Epidemiologist with expertise in maternal, fetal and newborn health research. Dr. Mehrabadi has been Assistant Professor in the Departments of Pediatrics and Obstetrics & Gynaecology, Dalhousie University, since 2019. She completed a PhD at the University of British Columbia School of Population and Public Health in 2014 and from 2014 to 2019, she was a postdoctoral fellow at 9I制作厂免费鈥檚 Department of Epidemiology, Biostatistics and Occupational Health. She is currently conducting research using data from Canada and the United Kingdom on obstetrical care and maternal and perinatal-neonatal outcomes, the effects of the social determinants of health on birth outcomes, and trends in medication use in pregnancy and postpartum in Nova Scotia.