Introduction:The millennium development goal was setto achieve a reduction of childmortality by two thirdsbythe end of 2015. In Ethiopiaeven if a significant reduction inmortality was seen amongthe post neonatal age children yet the death of newborns in theperinatalage category is still high. This studyestimatedtheperinatal mortality rate andidentifieditsdeterminant factors and causes of deathin West Gojam zone,Amhara region.rnMethods and materials:Outofthe4158pregnant motherswhowere followed in thecohort of this nested case control study,73 cases and 146 controls wereidentified andinterviewed in three districts of the West Gojam zone, from Feb 2011 to Mar 2012.Wealthindexwas used to estimate the wealth difference amongthestudied families.Factors such asbirth spacing,history of abortion and history of perinatalmortality were included ina multiplebinary logistic regression modelto identify risk factors.Physician review method was used toidentify the causes of death from the verbal autopsy data.rnResult:Theperinatal mortality rate was 27.04per 1000 live andstillbirths(95%CI,15.1,38.9).Perinatal mortality was significantly associated withhouseholdwealthand familysize, those with 2-5 and greater than three family members hada lesser risk for perinatalmortality as compared to those with a family size of only two (AOR=0.04,95%CI 0.01-0.38)and (AOR=0.03,95%CI 0.01-0.27 ) respectively.Primiparousmothers indicated a greater riskfor perinatal mortality as compared to those who gave birth to five or more children(AOR=7.89,95%CI 1.46-42.77). In addition women with a previous history of perinatal deathand abortionshowed a higher risk for perinatal mortalitythanthose who had no history ofperinatal mortalityor abortion(AOR=14.29,95%CI 5.28 , 38.67)and(AOR=0.24,95%CI0.1,0.58)respectively.Preterm newborns were more at risk (AOR=17.49,95%CI 1.51,202.78)than the term babies.Twins were also athigher risk for perinatal mortality than thesingletons(AOR=5.09,95%CI1.21,21.4). Home delivery was found to protect againstperinatal death (AOR=0.05 95%CI0.01,0.26)in comparison to the births that took place inhealth facilities.rnConclusion:Findings of this study indicated a high perinatal mortality rate and the increasedrisk that was associated with selected socio-economic and health service related factorssomeof which are amenable tochange. iii