Background: The objective of this study was to determine the incidence of SB/END and the associated factors among women delivering at KCMC. Methodology: A retrospective immediate intrauterine fetal deaths (IUFD), intrapartum stillbirths (IS), and early neonatal deaths (END) within 24 hours of life admitted to a tertiary hospital in Moshi, Tanzania. Data was abstracted from maternal and infant charts. Key care providers were interviewed using a standardized questionnaire. Result: There were 75 stillbirths (SB) and 25 early neonatal death (END) making a total of 100 perinatal deaths among 2822 babies delivered during the eight months period. Thus SB, END and perinatal mortality rate we 26.6, 8.86 and 35.4 per 1000 respectively. The majority of the women 63% who experience SB or END were referred71% mostly started clinic in the second trimester. Most of the deaths in this study were observed among women aged below 35 years. Term babies contributed 28% (n=7) of the death, compared to 60% (n=15) preterm and 12% (n=3) postdate for END. An Apgar score less than or equal to 7 was recorded in 56% (n=14) of the babies by the 5th minute of life. It was also observed that only 36% of the partograph were completed Fetal distress was the highest with 30.9% (n=17) most probable cause of intrapartum SB followed by prolonged or obstructed labor with 27.3% (n=15), hypertensive disorders in pregnancy 20% (n=11). 6% of the women who experienced SB or END were HIV positive, with only 2% having VDRL being reactive and large number 39% were not tested for VDRL.6 Conclusion: The SB rate and END rate was 26.6 and 8.86 per 1000 live birth respectively, which were lower than Tanzanian national rates. The intrapartum SB rate at KCMC without referral is 2.8 per 1000 live birth indicating good obstetric care. Majority of the SB and END (n= 63) occurred in mothers who were referred and similarly a higher number (n=62) were already in labor on admission.