ปัจจัยที่มีความสัมพันธ์กับภาวะขาดออกซิเจนของทารกในมารดาคลอดครบกำหนด:  การศึกษาย้อนหลังแบบมีกลุ่มควบคุม

Nongyao Uatrongjit; Kanistha Sutaman; Kanistha Sutaman; Tanakon Chairaj; Manassawan Kongnakwong

Authors

Nongyao Uatrongjit Department of Obstetrics and Gynecology, Nakornping Hospital
Kanistha Sutaman Medical Education Center, Nakornping Hospital
Kanistha Sutaman Medical Education Center, Nakornping Hospital
Tanakon Chairaj Medical Education Center, Nakornping Hospital
Manassawan Kongnakwong Medical Education Center, Nakornping Hospital

Keywords:

birth asphyxia, term neonates, Prediction score, Risk factor

Abstract

Introduction: Birth asphyxia remains a major public health problem and continues to exceed the national benchmark at Nakornping Hospital, Thailand.

Objective: To identify maternal factors associated with birth asphyxia in term neonates and to develop and validate a statistical model for predicting the risk of birth asphyxia.

Methods: A retrospective case–control study was conducted using medical record data from January 1, 2020, to March 31, 2025. Mothers who delivered term neonates with birth asphyxia were included as cases, and term neonates without birth asphyxia were selected as controls at a 1:2 ratio, matched by delivery date. Multivariable logistic regression analysis was used to identify significant risk factors and to develop a prediction model.

Results: A total of 291 mothers were included, with 97 index cases (33.33%) and 194 control-cases (66.67%). Maternal age, gravidity, gestational age, hematocrit level, number of antenatal care visits, and birth weight were not significantly different between groups. However, the mode of delivery differed significantly. Significant maternal and intrapartum risk factors for birth asphyxia were maternal fever (AOR 10.55, (95% CI 1.08-102.82, p = 0.043), abnormal fetal heart rate pattern (AOR 7.27, (95% CI 3.55-14.88, p < 0.001), meconium-stained amniotic fluid (AOR 6.30, (95% CI 2.53-15.67, p < 0.001), instrumental delivery (AOR 4.68, (95% CI 1.47-14.87, p = 0.009), and maternal diabetes AOR 3.26, (95% CI 1.14-9.35, p = 0.028). The developed model demonstrated good predictive performance with an accuracy of 79.68% (AUC = 0.7968). The risk scoring model showed a positive likelihood ratio of 16 (95% CI 3.75–68.18), specificity at 98.97% (95% CI 97.81–100.13), and sensitivity at 16.49% (95% CI 9.73–25.40). The optimal cut-off score was 3 points, and the model AUC was 0.751, indicating consistency between observed and predicted outcomes.

Conclusion: Maternal fever, abnormal fetal heart rate, meconium-stained amniotic fluid, instrumental delivery, and maternal diabetes were significant predictors of birth asphyxia among term neonates. The prediction model demonstrated moderate discriminatory ability and may be useful for identifying high-risk pregnancies.

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