Objective: Analysis of causes of unchanging level of national perinatal mortality and identification of potential for its further decrease. Design: Retrospective epidemiological analysis of aggregated data on perinatal care. Setting: Mother and Child Care Institute, Prague 4 – Podolí. Methods: Correlation of selected national aggregated data on the level of perinatal care under current system and under influence of changing conditions for care provision. Results: The analysis of some criteria of perinatal care demonstrated the influence of several contradictory processes: 1) among newborns below 2500 grams the stillbirth increased while the early neonatal mortality decreased; there was also decrease of contribution of congenital malformation in this group, 2) although there were more live born babies under 500 grams, who suffered from high mortality, their contribution to perinatal mortality was compensated by further decrease of early neonatal mortality of newborns weighing 1000–1499 grams, 3) the increasing frequency of low birthweight newborns did not influence the total perinatal mortality due to improved perinatal care. We observed the improvement of results among half of the regional perinatal centres with formerly higher early neonatal mortality figures, which represents the decrease of one of the reserves for further decrease of early neonatal mortality. There is a similar situation in centralisation of preterm deliveries – transfer in utero – which reached its maximum. Up to new we did not succeed in early referral of women with serious pregnancy complications which lead to stillbirth to perinatal centres with lower stillbirth rates. However this represents only small potential for decrease of total perinatal mortality. Conclusion: The 4-year stagnation of national perinatal mortality is a result of contradictory influence of improving level of care on one side and worsening of conditions on the other side. The potential for improvement under current conditions is almost exhausted.

        Key words: perinatal mortality, stillbirth, early neonatal mortality, birthweight, reserves in care