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Background. Perinatal committees evaluate deaths by medical audit to improve antenatal and neonatal care. We report data from Troms County from 1976 to 1997. Subjects and methods. Antenatal, neonatal and post neonatal deaths (n=472) at ≥20 weeks of gestation have been evaluated. Data were collected from the Medical Birth Registry of Norway and from medical records. Pregnancy risk factors, mortality rates, causes of deaths, non-optimal care and avoidable deaths were recorded. Results. The death rate (all deaths per thousand total births) declined from 13.8 (1976–80) to 7.7 (1992–97), (p<0.001), due to a reduced death rate in preterms ≥24 weeks (p<0.001) and in those between 500 and 1995 g (p<0.001). Antenatal deaths decreased (p<0.001) due to reduced intrapartum deaths (p<0.001). Prelabor deaths, unexpected intrauterine pre-hospitalization deaths included, did not change. Postnatal deaths declined (p=0.01) due to reduced early neonatal mortality (p=0.002). Deaths from malformations (p<0.001), fetal and neonatal infections (p=0.03) and placental disorders (p<0.001) declined. Non-optimal care (22.5% of deaths, 2.3‰ of total births), avoidable deaths (13.1% of deaths, 1.3‰ of total births), and maternal neglect (7.5% of cases with non-optimal care, 0.6‰ of total births) did not change. Death during transport was rare (n=5), and no deaths occurred at maternity homes. Non-cohabitance, smoking and undiagnosed SGA new borns declined, and the level of education increased in the study population. Conclusion. The improvement is due to a reduction in intrapartum deaths and early neonatal mortality in preterms. A constant high rate of unexpected intrauterine deaths in non-hospitalized patients is a challenge for antenatal health care providers. [ABSTRACT FROM AUTHOR]