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 > or = 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 or = 24 weeks (p