Objective: Analysis of stagnation of perinatal mortality level in the CR in 2000–2004. Design: Retrospective nationwide epidemiological study of selected indicators of perinatal care level. Settings: Institute for the Mother and Child Care, Prague, Czech Republic. Methods: Comparison of selected indicators of perinatal care and conditions for such care during years period 2000-2002 and 2003–2004. Results: Stagnation of perinatal mortality in the Czech republic since 2000 has been the result of two opposite process. On one side it is the continuous increase of newborns of low birth weight as a result of not only biological but also demographic and socio-economic risk factors, which create unfavorable envirement for provision of perinatal care. On the other side it is the improved professional care observed in two areas (prenatal diagnosis of congenital malformations and intensive care in newborns of extremely low birth weight). During 2003–2004 we were still able to observe odds of improvement of professional care against the deteriorating conditions which led to further decrease of perinatal mortality by 0.27%0 on average. However, there is a danger that negative factors will prevail in the near future, because reserves for the further improvement of professional care are exhausted and analyzed unfavorable factors are continuously on the rise. This could lead to an increase of the curently low perinatal mortality level. Conclusions: Stagnation of perinatal mortality in the Czech Republic during the last five years in a range of 4.0–4.4 %0 is a result of two opposite processes. On one side it is due to improved level of professional care in prenatal diagnosis, and due to centralized intensive care of newborns of extremely low birth weight. However, the reserves in those two areas are already exhausted. On the other side there are the deteriorating conditions (demographic and social) for such care, which are continuously on rise. While the first process has been prevailing until now with the resulting minimal decrease of perinatal mortality by 0.4%0, there is a danger that the ballance will change in the near future.

        Key words: perinatal mortality, specific early neonatal mortality, newborns of extremely low birth weight, prenatal diagnosis of congenital malformations, unfavourable conditions for perinatal care