Background: Stillbirth is a significant obstetric tragedy with profound health, psychological, and social implications. The majority of stillbirths are preventable with appropriate care and interventions. This study was designed to determine the prevalence of stillbirths and identify the associated maternal and fetal factors in a tertiary care hospital in Amritsar, Punjab, India.

Methods: An epidemiological, hospital-based, observational study was conducted at Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar, from January 1 to December 31, 2024. All deliveries (n = 5,892) during the study period were included, with cases delivering stillbirth after 28 weeks of gestation and with a birth weight of 1,000 grams or greater. Data were collected through interviews, medical records, and delivery notes. The ReCoDe Classification was used to identify the cause of stillbirths. Descriptive statistics and Chi-square tests were used to identify significant associations (p < 0.05).

Results: The prevalence of stillbirth was 43.1 per 1,000 total births (254 stillbirths out of 5,892 deliveries). Maternal age 20-30 years (55.1%), residence in a rural area (67.7%), primigravida (67.7%), low income (<Rs. 10,000 per month; 17.3%) and poor antenatal care were significantly associated with a higher likelihood of stillbirth (p < 0.05). Maternal complications (51.5%), placental abnormalities (19.2%), amniotic fluid abnormalities (11.8%) foetal growth abnormalities (8.6%), umbilical cord abnormalities (1.18%) were identified contributors to the poor outcomes.

Conclusions: Stillbirths remain a major health concern in low-resource settings, reflecting gaps in maternity care and health education. Improvement in antenatal care, high-risk pregnancy identification, patient education, and delivery preparedness are essential strategies to reduce the stillbirth rate. An effective health policy should aim to address these risk factors and provide comprehensive care to all pregnant women, especially in the vulnerable groups.