Beyond the personal tragedy, infant mortality is an important indicator of acommunity's well being.  The Utah Department of Health began a PerinatalMortality Review Program (PMRP) in 1995, the objectives of which were to providetimely and pertinent statewide data on perinatal health, to develop an efficient andpractical review process and to make recommendations for improvement ofpregnancy outcomes.  This manuscript reports the first two years experience ofthis program as well as the initial recommendations of the Program forimprovement of pregnancy outcomes.