This study analyzed perinatal mortality trends at Kathmandu Medical College Teaching Hospital from 2002-2007. It found that the perinatal mortality rate decreased from 30.7 in 2002-2003 to 19.1 in 2003-2005 but slightly increased to 25.5 in 2007. The main causes of perinatal deaths were prematurity (33.3%), intrapartum asphyxia (25%), and congenital anomalies (8.3%). Improving antenatal care, preventing preterm births, better monitoring during delivery, and intensive care for low birth weight infants could help reduce the perinatal mortality rate further.