ปัจจัยทำนายการเกิดภาวะขาดออกซิเจนในทารกแรกเกิดในระยะแรกรับ ระยะรอคลอด และระยะคลอด โรงพยาบาลส่งเสริมสุขภาพ ศูนย์อนามัยที่ 1 เชียงใหม่

Kamonchanok Khetwang

Authors

Kamonchanok Khetwang Regional Health Promotion Center 1 Chiangmai

Keywords:

Factors Predicting, Birth Asphyxia, Admission, First Stage of Labor, Second Stage of Labor

Abstract

Birth asphyxia is a severe obstetric complication and a leading cause of neonatal death. This predictive, retrospective case-control study aimed to explore the factors predicting birth asphyxia during admission, first and second stage of labor at the Regional Health Promotion Center 1 Chiangmai. Data were collected from medical records of 1,159 pregnant women (61 cases and 1,098 controls) who gave birth between 2022 and 2025. The participants were selected according to the inclusion criteria. Descriptive statistics, multivariable logistic regression, and AuROC curve were used to analyze the data.

The results revealed that predictors of birth asphyxia during the admission stage included GA < 34 wks (Adj. OR = 37.60, 10.19-138.77), thick meconium-stained (Adj. OR = 30.71, 9.93-94.91), transverse lie (Adj. OR = 20.78, 1.90-227.40), severe preeclampsia (Adj. OR = 15.23, 1.33-174.08), oligohydramnios (Adj. OR = 9.51, 1.51-59.81), FH ≥ 38 cm (Adj. OR = 6.80, 2.82-16.41), APH (Adj. OR = 5.07, 1.28-20.04), ROM ≥ 12 hr. (Adj. OR = 4.10, 1.91-8.81), GDM A1 (Adj. OR = 2.74, 1.23-6.14) and primiparity (Adj. OR = 2.27,: 1.17-4.42) During the first stage included FHR < 110 bpm (Adj. OR = 7.30, 3.44-15.49) and sedation (Adj. OR = 3.36, 1.79-6.33). During the second stage included shoulder dystocia (Adj. OR = 57.14, 14.45-225.91), tight nuchal cord (Adj. OR = 7.92, 1.76-35.68), V/E (Adj. OR = 5.85, 2.19-15.64), C/S (Adj. OR = 3.22, 1.52-6.82) and evening time delivery (Adj. OR = 2.20, 1.07-4.56). The predictive models demonstrated very good discriminative ability, with AuROC values of 0.8620, 0.8056, and 0.8226, respectively.

The results of this study can be used as baseline data in developing clinical practice guidelines to reduce its incidence and improve the quality of maternal and newborn care.

References

Collins KA, Popek E. Birth Injury: Birth Asphyxia and Birth Trauma. Academic forensic pathology. (2018);8(4):788–864. Available from: https://doi.org/10.1177/192536211882148

Gillam-Krakauer M, Gowen Jr CW. Birth Asphyxia. [Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.

World Health Organization. Perinatal asphyxia. [Internet]. [cited 2023 August 08]. Available from: https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/newborn-health/perinatal-asphyxia

กรมอนามัย กระทรวงสาธารณสุข. แนวทางการทบทวนสาเหตุการตายทารกปริกำเนิด Perinatal Death Review Guideline. กรุงเทพฯ : ชุมชนสหกรณ์การเกษตรแห่งประเทศไทย จำกัด; 2564

กรมอนามัย กระทรวงสาธารณสุข. อัตราการเกิดภาวะขาดอากาศในทารกแรกเกิด (Birth Asphyxia Rate) เขตสุขภาพ [อินเทอร์เน็ต]. 2567 [เข้าถึงเมื่อ 14 ต.ค. 2567]. เข้าถึงได้จาก: http://dashboard.anamai.moph. go.th/dashboard/birthasphyxia/index?year=2022

เวชระเบียน โรงพยาบาลศูนย์อนามัยที่ 1 เชียงใหม่. สถิติหน่วยงานห้องคลอด ประจำปี 2565-2568. เชียงใหม่: โรงพยาบาลศูนย์อนามัยที่ 1 เชียงใหม่; 2568

สุธิต คุณประดิษฐ์. การประชุมคณะทำงานขับเคลื่อนและบูรณาการภารกิจด้านการพัฒนาสุขภาพสตรีตั้งครรภ์และเด็กปฐมวัย (MCH Cluster) เขตสุขภาพที่ 1 [อินเทอร์เน็ต]. 2565 [เข้าถึงเมื่อ 2 ส.ค. 2566]. เข้าถึงได้จาก: https://mch.hpc1.go.th/

Ikechebelu JI, Eleje GU, Onubogu CU, Ojiegbe NO, Ekwochi U, Ezebialu IU, et al. Incidence, predictors and immediate neonatal outcomes of birth asphyxia in Nigeria. BJOG: an international journal of obstetrics and gynaecology. 2024;131 Suppl 3:88–100.

Sunny AK, Paudel P, Tiwari J, Bagale BB, Kukka A, Hong Z, et al. A multicenter study of incidence, risk factors and outcomes of babies with birth asphyxia in Nepal. BMC Pediatrics. 2021;21(1):394. doi:10.1186/s12887-021-02858-y

Tegegnework SS, Gebre YT, Ahmed SM, Tewachew AS. Determinants of birth asphyxia among newborns in Debre Berhan referral hospital, Debre Berhan, Ethiopia: a case-control study. BMC Pediatrics. 2022;22(1):165. doi:10.1186/s12887-022-03223-3

Torres-Muñoz J, Fonseca-Perez JE, Laurent K. Biological and Psychosocial Factors, Risk Behaviors, and Perinatal Asphyxia in a University Hospital: Matched Case–Control Study, Cali, Colombia (2012–2014). 2021;9. doi:10.3389/fpubh.2021.535737

Tibebu EA, Desta KW, Ashagre FM, Jemberu AA. Prevalence of birth injuries and associated factors among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021. Crossectional study. PloS one. 2023;18(1). Available from: https://doi.org/10.1371/journal. pone.0281066

Wang Y-W, Chen Y, Ming Y-H, Zhang J-W, Sun K, Zhang J, et al. Epidemiology and region-specific risk factors for low Apgar scores in China: a nationwide study. World Journal of Pediatrics. 2022;18(2):135-141. doi:10.1007/s12519-021-00497-y

Lemma K, Misker D, Kassa M, Abdulkadir H, Otayto K. Determinants of birth asphyxia among newborn live births in public hospitals of Gamo and Gofa zones, Southern Ethiopia. BMC Pediatrics. 2022;22(1):280. doi:10.1186/s12887-022-03342-x

Ye W, Luo C, Huang J, Li C, Liu Z, Liu F. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ (Clinical research ed.). 2022;377. Available from: https://doi.org/10.1136/bmj-2021-067946

Mamo SA, Teshome GS, Tesfaye T, Goshu AT. Perinatal asphyxia and associated factors among neonates admitted to a specialized public hospital in South Central Ethiopia: A retrospective cross-sectional study. PloS one. 2022;17(1). Available from: https://doi.org/10.1371/journal.pone.0262619

Anto EO, Boadu WIO, Ansah E, Tawiah A, Frimpong J, Tamakloe VCKT, et al. Prevalence of preeclampsia and algorithm of adverse foeto-maternal risk factors among pregnant women in the Central Region of Ghana: A multicentre prospective cross-sectional study. PloS one. 2023;18(6):e0288079. Available from: https://doi.org/10.1371/journal.pone.0288079

Atamamen TF, Naing NN, Oyetunji JA, Wan-Arfah N. Systematic literature review on the neonatal outcome of preeclampsia. The Pan African medical journal. 2022;41:82. Available from: https://doi.org/10.11604/pamj.2022.41.82.31413

Gizachew S, Wogie G, Getnet M, Lonsako AA. Magnitude of neonatal asphyxia and its predictors among newborns at public hospitals of Wolaita Zone in Southern Ethiopia, 2023. BMC pediatrics. (2024);24(1):142. Available from: https://doi.org/10.1186/s12887-024-04627-z

Magalhães ALC, Monteiro DLM, Trajano AJB, Souza FM. Proportion and factors associated with Apgar less than 7 in the 5th minute of life: from 1999 to 2019, what has changed?. Ciencia & saude coletiva. 2023;28(2):385. Available from: https://doi.org/10.1590/1413-81232023282.11162022

Tunç Ş, Oğlak SC, Gedik Özköse Z, Ölmez F. The evaluation of the antepartum and intrapartum risk factors in predicting the risk of birth asphyxia. The journal of obstetrics and gynaecology research. 2022;48(6):1370–1378. Available from: https://doi.org/10.1111/jog.15214

Gupta S, Malik S, Gupta S. Neonatal complications in women with premature rupture of membranes (PROM) at term and near term and its correlation with time lapsed since PROM to delivery. Tropical doctor. 2020;50(1):8–11. Available from: https:// doi.org/10.1177/0049475519886447

Chandra SN, Pradeep M, Shashikumara. Maternal and Neonatal Outcomes and the Associated Risk Factors for Premature Rupture of Membranes. Journal of South Asian Federation of Obstetrics and Gynaecology. 2021;12(6):402-407. Available from: https://www.jsafog.com/doi/JSAFOG/pdf/10.5005/jp-journals-10006-1836

Niamrat T, Suwikrom S, Luengmettakul J. Pregnancy Outcomes in Term Pregnancy with Isolated Oligohydramnios. Thai Journal of Obstetrics and Gynaecology. 2023;31(1):48-55.doi:10.14456/tjog.2023.6

Hassan SB, Rana SM, Hanif A, Gilani SA, Afzal S, Fatima W, et al. Risk Factors Associated with Birth Asphyxia: A Case Control Study. Annals of King Edward Medical University. 2022;27(4):508-514. Available from: https:// doi.org/10.21649/akemu.v27i4.4883

Ajibo BD, Wolka E, Aseffa A, Nugusu MA, Adem AO, Mamo M, Temesgen AS, et al. Determinants of low fifth minute Apgar score among newborns delivered by cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: an unmatched case control study. BMC pregnancy and childbirth. 2022;22(1):665. Available from: https://doi.org/10.1186/s12884-022-04999-z

Madathil S, Priyadarshi M, Antony S, Rauf Kk A, John ST. Respiratory Distress in a Newborn with Severe Birth Asphyxia. The Journal of Pediatrics. 2021;237:312-313.doi:10.1016/j.jpeds.2021.06.020

Kelsey JL, Whittemore AS, Evans AS, Thompson WD. Methods in Observational Epidemiology. Oxford University Press. 1996.

Nakaporntham P, Tongswatwong P. Symphysis fundal height measurements in prediction of birthweight. Thai J Obstet Gynaecol [internet]. 2012 May 10 [cited 2026 Jun. 9];18(3):126-33. Available from: https://he02.tci-thaijo.org/index.php/tjog/article/view/1357