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Background: Perinatal mortality index is a major indicator of health and health assessment that has a direct impact on infant mortality index. This study aimed to determine the rate and causes of perinatal mortality in Kermanshah District, Iran.Methods: In this cross-sectional study, records of perinatal mortality in Kermanshah District during the years 2011-2014 were extracted. Information, including data about the neonate and the mother, and indicators of pregnancy and childbirth, and the leading cause of death based on International Classification of Diseases-10th (ICD-10) were collected. Data were analyzed using mean and standard deviation for quantitative variables, and amount and percent for qualitative variables via Stata software.Findings: of 1236 perinatal deaths, 56.1% were boys. Most mortality cases were in low and very low birth weight, and the most common underlying mother’s disease was hypertension. The highest perinatal mortality rate was in year 2012 (12.3 per one thousand births), and the lowest in year 2014 (5.7 per one thousand births). The most common cause of perinatal death (87.6%) was related to complaints originated around the time of birth.Conclusion: According to the results, emphasizing adequate care during pregnancy and perinatal period, more accurately identifying and tracking high-risk women with underlying diseases, and prevention of preterm birth and low-birth weight babies can be effective in reduction of perinatal mortalities.