- Obstetric morbidity

- Gynaecological morbidity and,

- Contraceptive morbidity

PERINATAL MORTALITY
It is defined as deaths among foetuses weighing 1000g or more at birth (28
weeks gestation) who die before or during delivery or within the first 7 days of
delivery. The perinatal mortality rate is expressed in terms of such deaths as per
1000 total births. According to WHO, the limit of viability is brought down to a
fetus weighing 500g (gestational age 22 weeks) or body length(25 cm crown-
heel) or more. However, for international comparisons, only death of foetuses or
infants weighing ≥1000g at birth should be included as in the developing
countries many such deaths are under reported.
The important causes of antepartum deaths are
- Chronic hypoxia (30%)
- Pregnancy complications (30%)
- Congenital malformations (15%)
- Infection (5%)
- Unexplained (20%)
Predisposing factors of perinatal mortality: many factors influence the
perinatal survival and these are briefly discussed below-
Epidemiological: Age over 35 years, teenagers, parity above 5, low
socioeconomic condition, poor maternal nutritional status—all adversely affect
the pregnancy outcome.
 Medical disorders: Anemia (Hb < 8 g/dL), hypertensive disorders of
pregnancy, diabetes mellitus, syphilis, acute fever (malaria) and infection (HIV)
are often associated. Perinatal deaths increase due to hypoxia, intrauterine
growth restriction, prematurity, congenital malformations and infection.
 Obstetric complications:
(a) Antepartum hemorrhage particularly abruptio placenta is responsible for
about 10% of perinatal deaths due to severe hypoxia.
(b) Preeclampsia-eclampsia is associated with high perinatal loss either due to
placental insufficiency or prematurity—spontaneous or induced.
(c) Rh isoimmunization
 (d) Cervical incompetence—Premature effacement and dilatation of cervix
between 24 and 36 weeks is responsible for significant perinatal deaths from
prematurity