Background: Perinatal mortality reflects maternal health as well as antenatal, intrapartum and newborn care, and is an important health indicator. Different classification systems of perinatal deaths have been developed, but due to lack of data, few systems have been applied on perinatal deaths in developing countries. This study aimed at classifying causes of perinatal deaths in order to identify possible areas of prevention of such deaths.

 Methods: A total of 1958 stillbirths and early neonatal deaths above 500 g between July 2000 and October 2010 registered in the Medical Birth Registry and neonatal registry at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania were studied. The deaths were classified according to Neonatal and Intrauterine deaths Classification according to Etiology (NICE).

 Results: Overall perinatal mortality was 57.7/1000, of which 1219 (35.9/1000) stillbirths and 739 (21.7/1000) early neonatal deaths. Major causes of perinatal mortality were unexplained asphyxia (n=425, 12.5/1000), obstetric complications (n=303, 8.9/1000), maternal disease (n=287, 8.5/1000), unexplained antepartum stillbirths after 37 weeks of gestation (n= 219, 6.5/1000), and unexplained antepartum stillbirths before 37 weeks of gestation (n=184, 5.4/1000). Among the obstetric complications, obstructed/prolonged labour was the leading condition (251/303, 82.8%). With respect to maternal disease, preeclampsia/eclampsia was the leading condition (253/287, 88.2%). After excluding women who were referred for delivery at KCMC due to medical reasons, perinatal mortality was reduced to 45.6/1000. This reduction was mainly due to fewer deaths from obstetric complications (from 8.9 to 2.1/1000) and maternal disease (from 8.5 to 5.5/1000).

Conclusion: The distribution of causes of death in this population suggests a large potential for prevention. Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care, monitoring of labour for fetal distress, and proper newborn resuscitation are all important in order to improve perinatal outcomes.