Objective To analyze the causes and factors associated with perinatal death in Quanzhou, Fujian Province from 2018 to 2022, so as to provide evidence for formulating targeted intervention strategies.

Methods Data of perinatal death and live birth in 30 hospitals in Quanzhou, Fujian Province were collected from Jan, 2018 to Dec, 2022, and factors associated with perinatal death were analyzed using the chi-square and logistic regress model.

Results A total of 338 325 cases of perinatal newborn were monitored in Quanzhou from 2018 to 2022, and 1 464 cases of perinatal death were detected. The perinatal mortality rate was 4.33‰. Whose mothers living in rural area (OR = 3.956, 95% CI: 3.257 − 4.804), having pregnancy complications (OR = 3.327, 95% CI: 2.639 − 4.194) and with birth defects (OR = 125.297, 95% CI: 61.619 − 254.779) were risk factors for perinatal death (all P < 0.001). Maternal antenatal care was a protective factor for perinatal death (OR = 0.904, 95% CI: 0.880 − 0.929). Top 5 causes of perinatal death were birth defects, umbilical cord issues, maternal issues, placental issues and birth asphyxia, accounting for 81.2% of perinatal deaths.

Conclusion Prevention and control of birth defects in Quanzhou is still challenging. We should take birth defects as the key point of breakthrough, strengthen knowledge dissemination of prevention and control of birth defects to reduce the incidence of birth defects. Meanwhile, perinatal health care management should be improved, high-risk factors of perinatal death should be identified and intervened timely to further reduce perinatal mortality.