OG1.1-3 | Maternal, Perinatal, Stillbirth and Abortion Statistics — Summary & Reflection

KEY TAKEAWAYS

This module has covered the core vital statistics framework for obstetrics and gynaecology:

• Maternal Mortality Ratio (MMR) = maternal deaths ÷ live births × 100,000. India 2018–20 = 97; SDG target <70 by 2030. Maternal death = death within 42 days of pregnancy termination from obstetric or aggravated causes (not accidental).

• Maternal Morbidity spans a spectrum; Maternal Near-Miss = survival of severe organ dysfunction using WHO 2011 organ-dysfunction criteria. Near-miss audits complement mortality data and reveal preventable system failures.

• Perinatal Mortality Rate (PMR) = (stillbirths ≥28 weeks + early neonatal deaths 0–7 days) ÷ total births × 1,000. India 2020 ≈ 26. Neonatal Mortality Rate (NMR) = neonatal deaths ÷ live births × 1,000. India 2020 ≈ 20. SDG NMR target ≤12 by 2030.

• Stillbirth = fetal death at ≥28 weeks or ≥1,000 g. Types: macerated (antenatal, chronic) and fresh (intrapartum, acute). SBR = stillbirths ÷ total births × 1,000.

• Abortion = expulsion before 20 weeks or <500 g. Types by presentation: threatened, inevitable, incomplete, complete, missed, septic, habitual. Legal termination governed by MTP Act (amended 2021).

• Birth rate indices: crude birth rate (per 1,000 total population), general fertility rate (per 1,000 women 15–49), TFR (India ≈ 2.0 at replacement level).

• Applied significance: MDR and perinatal audit translate vital statistics into quality improvement. The three-delays model frames intervention design. PPH is the leading direct cause of maternal death in India (~30% of direct deaths).

REFLECT

Kolb reflection — concrete experience to abstract conceptualisation: Think back to the opening scenario — the 24-year-old woman who died of eclampsia at 32 weeks. Now apply what you have learned. Which delay(s) from the three-delays model likely contributed to her death? Her death enters which vital statistic indicator (with the correct denominator)? Her baby, delivered alive by emergency caesarean but admitted to NICU, is at risk of contributing to which neonatal mortality indicator if he does not survive the first 7 days? Finally, consider: if your hospital's MMR is 180 per 100,000 live births while the state average is 100 — what questions would you ask in a departmental review to understand the gap? How would you know whether the difference reflects genuine excess mortality or a difference in case mix (e.g., a tertiary centre receiving referred high-risk cases)? These questions move you from memorising definitions to using them as diagnostic tools for health system assessment — the competency this module is designed to develop.