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Background: The perinatal mortality of 70 deaths per 1,000 total births in Uganda is unacceptably high. Perinatal death audits are important for improvement of perinatal care and reduction of perinatal morality. We integrated perinatal death audits in routine care, and describe its effect on perinatal mortality rate at Nsambya Hospital. Methods: This was a retrospective descriptive study conducted from March – November 2008. An interdisciplinary hospital team conducted weekly perinatal death reviews. Each case was summarized and discussed, identifying gaps and cause of death. Local solutions were implemented according to the gaps identified from the audit process. Results: Of the 350 perinatal deaths which occurred, 120 perinatal deaths were audited. 34.2 % were macerated still births, 31.7 % fresh still births and 34.2 % early neonatal deaths. Avoidable factors included: poor neonatal resuscitation skills, incorrect use of the partographs and delay in performing caesarean sections. Activities implemented included: three skills sessions of neonatal resuscitation, introduction of Continuous positive airway pressure (CPAP) for babies with respiratory distress, updates on use of partographs. Perinatal mortality rate was 47.9 deaths per 1000 total births in 2008 after introduction of the audits compared to 52.8 per 1,000 total births in 2007. Conclusion: Conducting routine perinatal audits is feasible and contributes to reduction of facility perinatal mortality rate