OG1.1-5 | Demographic and Vital Statistics — Practice Quiz

Correct. MMR = maternal deaths divided by live births, multiplied by 100,000. India's MMR for 2018–20 was 97 per 100,000 live births. Using live births (not total births or total population) as the denominator standardises the ratio for the population at obstetric risk.

MMR denominator = live births × 100,000. India 2018–20 = 97; SDG target <70 by 2030.

Incorrect. MMR uses live births in the denominator, not total population or total births, and the multiplier is 100,000 — not 1,000. This distinction is tested frequently in NMC assessments.

Correct. Direct maternal deaths result from obstetric complications of pregnancy, labour, or the puerperium — due to interventions, omissions, incorrect treatment, or a chain of events arising from any of these. Eclampsia is a direct obstetric complication. Pre-existing cardiac disease aggravated by pregnancy is indirect; road traffic accidents and incidental pneumonia are coincidental/non-maternal.

Direct = obstetric cause (APH, PPH, eclampsia, sepsis, obstructed labour). Indirect = pre-existing disease worsened by pregnancy. Coincidental/non-maternal = unrelated cause (accident, incidental infection).

Incorrect. Direct maternal deaths arise from obstetric causes (e.g. haemorrhage, eclampsia, sepsis, obstructed labour). Cardiac disease worsened by pregnancy is an indirect cause. Accidental trauma and incidental infections are coincidental/non-maternal deaths.

Correct. The WHO defines a maternal near-miss as a woman who nearly died but survived a severe life-threatening complication during pregnancy, childbirth, or within 42 days of termination of pregnancy. Near-miss surveillance complements maternal death review by capturing the far more frequent survivors who reached the threshold of severe morbidity.

Near-miss = severe life-threatening complication + survival within 42 days. WHO uses organ-dysfunction markers. Near-miss:death ratio is a facility quality indicator.

Incorrect. A near-miss case, by definition, is a survivor — not a death. ICU admission alone or blood transfusion alone does not qualify; the WHO criteria require organ dysfunction or failure (cardiovascular, respiratory, renal, coagulation, hepatic, neurological, or uterine).

Correct. The WHO perinatal period commences at 28 completed weeks of gestation (corresponding to approximately 1,000 g birth weight) and ends at 7 completed days (168 hours) after birth. The perinatal mortality rate includes both late fetal deaths (stillbirths at ≥28 weeks) and early neonatal deaths (first 7 days).

Perinatal period = 28 completed weeks gestation to 7 completed days after birth. Perinatal mortality rate = (stillbirths ≥28 wks + early neonatal deaths in first 7 days) / 1,000 total births.

Incorrect. The WHO perinatal period starts at 28 completed weeks (not 20 or 22) and ends at 7 days after birth (not 28 days, which defines the neonatal period). Option A uses the abortion gestational threshold, not the stillbirth threshold.

Correct. India and WHO define a stillbirth as the birth of a baby showing no signs of life at or after 28 completed weeks of gestation, with a corresponding weight criterion of ≥1,000 g. A fetus expelled before 20 weeks (or <500 g) is classified as an abortion; 20–28 weeks is a grey zone sometimes called an immature birth.

Stillbirth = no signs of life at or after 28 weeks / ≥1,000 g. Abortion = expelled before 20 weeks or <500 g. The 20–28 week range (immature) is a borderline category.

Incorrect. The Indian/WHO stillbirth threshold is 28 completed weeks / ≥1,000 g. The 20-week / ≥500 g boundary applies to the definition of abortion (fetal loss). Do not confuse the two thresholds.

Correct. The obstetric definition of abortion is expulsion or extraction of a fetus or embryo weighing less than 500 g or before 20 completed weeks of gestation — whichever criterion is met first. This threshold also aligns with the viability boundary used in clinical practice for this context.

Abortion threshold: <500 g or <20 completed weeks (whichever first). Stillbirth threshold: ≥1,000 g or ≥28 completed weeks. These boundaries are frequently tested together.

Incorrect. The 1,000 g / 28-week threshold is the stillbirth definition. The obstetric abortion threshold is 500 g / 20 weeks. Option C's 22-week boundary and option D's 24-week boundary do not correspond to any standard obstetric definition of abortion.

Correct. Group 5 (previous uterine scar, term singleton cephalic, including induced and pre-labour CS) is the single largest contributor to the overall CS rate in most Indian tertiary and district hospitals. The cycle self-perpetuates: every primary CS adds a woman to Group 5 in subsequent pregnancies, and the low rate of trial of labour after caesarean (TOLAC) in India means the majority undergo repeat CS.

Robson Group 5 (previous CS, term singleton cephalic) is the largest driver of high CS rates in Indian hospitals. TGCS audit identifies Group 5 as the primary target for TOLAC counselling to reduce unnecessary repeat CS.

Incorrect. While Groups 1 and 2 are numerically large, the proportionate CS rate from Group 5 (all have a uterine scar) dominates the total CS count in settings with historically rising CS rates. Group 10 covers preterm deliveries, which are a minority of all births.

Correct. Robson Group 6 = all nulliparous women with a singleton breech (regardless of mode of onset). Group 7 = all multiparous women with a singleton breech (including those with a previous uterine scar). Group 8 = all women with a multiple pregnancy. Group 9 = all women with a singleton transverse or oblique lie. Group 10 = all singleton cephalic preterm births.

Robson groups 6 & 7 = singleton breech (6=nullip, 7=multip). Group 8 = multiple pregnancy. Group 9 = abnormal lie. Group 10 = preterm cephalic. Know all 10 group definitions.

Incorrect. The breech groups in Robson are Group 6 (nulliparous, singleton breech) and Group 7 (multiparous, singleton breech). Group 8 covers multiple pregnancies; Group 9 covers abnormal lies (transverse/oblique); Group 10 covers preterm cephalic.

Correct. JSY is a conditional cash transfer scheme launched in 2005 under NHM to promote institutional delivery. It offers financial incentives to pregnant women (and ASHAs who facilitate) for delivering in government health centres, community health centres, or accredited private institutions — with higher incentives in low-performing states (LPS) for BPL/SC/ST women.

JSY (2005, NHM) = conditional cash transfer for institutional delivery. Incentive higher in LPS (low-performing states) and for BPL/SC/ST. ASHA receives incentive too. Complements JSSK (free services).

Incorrect. JSY's primary goal is to shift deliveries away from home into institutions by providing a cash benefit for institutional delivery. It does not incentivise home deliveries (that defeats its purpose) or exclusive breastfeeding (that is Poshan Abhiyan/National Nutrition Mission).

Correct. SUMAN (Surakshit Matritva Aashwasan), launched in 2019, aims to ensure zero preventable maternal and newborn deaths by guaranteeing respectful, dignified, and zero-out-of-pocket care at all public health facilities for pregnant women, mothers up to 6 weeks post-delivery, and sick newborns. It builds on JSSK by adding a rights-based, quality-of-care framework.

SUMAN (2019) = zero out-of-pocket + respectful care at public facilities for pregnant women and newborns. Complements JSSK (which provides free drugs, diet, diagnostics, blood). Together they address cost and dignity barriers.

Incorrect. IFA supplementation is part of Anaemia Mukt Bharat and the routine antenatal package, not a specific goal of SUMAN. SUMAN's focus is on guaranteed, free, respectful maternity care at public facilities — not home deliveries or sterilisation incentives.