This study aimed to provide insight into the causes of stillbirths and early neonatal deaths and identify better intervention strategies. Methods: This was a retrospective study during a 7-year period (January 2003 to December 2009) of all stillbirths and early neonatal deaths at the Nizwa regional referral hospital in AlDakhiliyah region. Oman. Results of a total 27,668 births, there were 244 stillbirths and 157 early neonatal deaths. The perinatal mortality rate (PMR) was 14.49/1,000 births. The period specific rates were 17.23/1.000 in 2003 18.33/1,000 in 2004, 15.20/1,000 in 2005, 12-20/1,000 in 2006, 12, 16/1,000 in 2007 and 1209/1000 in 2008. This decline in the death rate was significant (P = <0.005). The rate rose in 2009 to 15.63/1,000, mostly from an increase in early neonatal deaths (congenital anomalies). The most common identifiable cause of stillbirth was congenital anomalies (18.82%), in which central nervous system anomalies were most common. Other causes include abruptio placentae (13%), cord accidents (12%), and intrauterine growth restriction (IUGR), while the cause remained unknown in 22.59%. Congenital anomalies accounted for 53.50% of early neonatal deaths followed by prematurity (23.56%) and birth asphyxia (5.73%). Extremes of maternal age were related to higher PMRs. Conclusion: An overall improvement in the stillbirths and neonatal death rates was witnessed; however, further improvement is warranted for common avoidable fetal and maternal risk factors. Extra care needs to be provided for women who are at risk of developing complications such as gestational diabetes, pregnancy-induced hypertension, IUGR, etc.