Perinatal Mortality Rate is an important epidemiological indicator of Maternal and Child Health care because of its sensitivity for both maternal and new-born care. To analyse trends of perinatal morbidity and mortality, 4177 deliveries were studied across 18 months in a tertiary care hospital in Karnataka. Fetal growth restriction accounted to more than 50% of the perinatal deaths. Maternal morbidities were associated with up to 40.6% of causes for still birth. Preterm births account to 45.3% of neonatal deaths, sepsis accounting to 20.31%. Early recognition and intervention for these conditions seemed to be the mainstay in improving perinatal outcome.