Globally, the hatch success of leatherback sea turtles (Dermochelys coriacea) is much lower than any other sea turtle species. Causes of embryonic mortality, a contributing factor to the low hatch success of the species, are poorly understood. Muscle necrosis, renal mineralization, and bacterial pneumonia are prevalent among embryos and hatchlings in St. Kitts, where hatch success is much lower (<∼ 20%) than the global average (∼ 50%), yet the significance of these conditions in the wider region is unknown. The objective of this study was to describe the pathology of hatchlings and embryos in Grenada as a comparison population for St. Kitts. In 2017, 20 hatchlings, 6 pipped hatchlings, 35 late stage embryos, and 5 early stage embryos were sampled for comprehensive postmortem examination from 12 leatherback nests on Levera Beach, Grenada and 2 nests on St. Kitts. Pathology affected 71% of nests and 44% of individuals from Grenada and 100% of nests and 56% of individuals from St. Kitts. Lesions observed in both populations included skeletal muscle degeneration and necrosis (19%), bronchopneumonia (8%), and renal tubular degeneration (5%) while chorioallantoitis (17%) and mycotic dermatitis (5%) were only observed in Grenada. Gonads were histologically classified as female in all instances (n = 60), suggestive of high incubation temperatures in nests at both locations. Further study is needed to find interventions that reduce the prevalence of perinatal pathology and to identify the basis for the large proportion of eggs that fail to develop as well as embryos that die without significant pathology.