Background: The recently published European Perinatal Health Report showed wide variability in perinatal mortality rates between European countries. We investigated the gestational age patterns of mortality in order to better understand differences between low versus high mortality countries. Setting: The Euro-Peristat project developed a list of valid and reliable indicators for monitoring and evaluating perinatal health, including fetal and neonatal mortality. Data from 2004 on 29 countries/regions were analyzed. Results: The fetal mortality rate ranged from 2.6 per 1000 births in Slovakia to 9.1 in France (weighted average of 5.4 per 1000 births) and the neonatal mortality rate ranged from 1.6 per 1000 live births in Cyprus to 5.7 in Latvia (weighted average of 3.0 per 1000 live births). In some countries, fetal mortality rates declined dramatically after excluding extremely preterm births (< 28 weeks), while elsewhere rates stayed stable. The exclusion of the extremely preterm births hardly influenced the variability in neonatal mortality rates, although a large decline was observed for the Netherlands, where active intervention is very conservative before 26 weeks of pregnancy. We did not find that countries with low mortality rates had higher proportions of extremely preterm births (which could be considered less preventable) and lower proportions of deaths among term or near term births. Conclusions: Registration differences are still important contributors to variability, but these differences do not explain the variability between countries which persists after removing extremely preterm births. There were different levels and patterns of fetal and neonatal mortality between European countries.