Introduction: Perinatal mortality is defined as fetal death after 28 weeks of gestation and newborn death within seven days. Globally, more than 2.6 million stillbirths and over 2.7 million early neonatal deaths are estimated to occur each year. In the year 2015, each day an estimated 7,300 newborns die from complication during pregnancy, child birth and further neonatal causes and 7000 stillbirth, half of this occurs after labor had started. Almost all (98%) takes place in developing countries and the magnitude of perinatal mortality in the study area was 44 per 1000 pregnancy. Objective: The objective of this study was to identify determinants of perinatal mortality in Bahir-dar town governmental health institutions, northwest, Ethiopia: 2019 Methods: Institutional based unmatched case control study was conducted in Bahir Dar town, from 1st March to 30th May, 2019.Cases were stillbirths and early neonatal deaths and controls were live births that were survived the first seven days after delivery. All stillbirths and early neonatal deaths in the selected health institutions were included and two controls per case were selected using systematic sampling method. A total of 459 participants were involved in this study (153 cases and 306 controls) .Pretested, structured questioner with face to face interview was conducted and some data were also extracted using checklist. Multivariable logistic regression analysis was done to analyze the data. A p-value of <0.05 was considered as significant at 95% confidence interval and the strength of association was measured using odds ratio. Results: Antepartum hemorrhage (AOR 2.55,95%CI;1.23-5.26), obstructed labour (AOR 3.11,95% CI; 2.00-8.38), prematurity (AOR 3.29,95% CI;1.86-5.81), first delay (AOR 2.61,95% CI;1.56-4.39) and second delay (AOR 2.75,95% CI;1.49-5.11) were the determinants of perinatal mortality that increase risk of perinatal death. Whereas partograph use (AOR 0.24, 95% CI; 0.14-0.42) and tertiary education (AOR 0.35, 95% CI; 0.17-0.71) were found to be protective factors for perinatal mortality. Conclusion and Recommendation: The determinants of perinatal mortality in the study area was due to medical, obstetric and neonatal complications that are easily identifiable and manageable with the existing health care services whereas health care and maternal behavioral factors were also the important determinants that were associated with the outcome. Partograph use in labour follow up and educating females to tertiary education level is better, first and second delay need to avoided during labour. Keywords: perinatal mortality, case-control, determinants, case mother, control mother, Bahir-dar town