Introduction. The existing regulatory legal acts in Russian Federation allow the creation of perinatal centers both as independent medical organizations and as structural divisions within medical organizations. Currently, there are no recommendations on the territorial planning of 3rd level obstetric hospitals, taking into account the medical and organizational structure of the perinatal center, based on scientific research. Goal. To determine the impact of the medical and organizational structure of the perinatal center on maternal mortality in Russian regions. Materials and methods. 2023rd maternal mortality in Russia for in 85 regions is presented according to Rosstat, in 4 new territories – according to operational data from the Russian Ministry of Health. Information about the medical and organizational structure of perinatal centers was obtained from the questionnaires of medical organizations participating in the federal project "Protection of Motherhood and Childhood" and the Federal Registry of Medical Organizations. The Mann-Whitney test was used to assess the differences. Results. In 2024, there were no perinatal centers in 8 regions of the Russian Federation (regions were excluded from the study), 47 had perinatal centers that were part of multidisciplinary adult hospitals (sample 1), and 34 regions (sample 2) had perinatal centers represented only by independent medical organizations or structural divisions of children's hospitals. Maternal mortality in 2023 in the selected regions ranged from 0 to 83.1 per 100,000 live births. A high dependence (P=0.0083) of low maternal mortality in the region on the presence of at least 1 perinatal center in the structure of a multidisciplinary adult hospital was obtained. Discussions. The low maternal mortality rate in regions with “multi–specialty adult hospital - perinatal center” complexes is explained by the possibility of organizing better medical care for patients requiring the involvement of specialized physicians, including surgical interventions, resource-intensive research and high-tech life-saving technologies. Conclusion. The presence of the “multidisciplinary adult hospital – perinatal center” complex helps to reduce maternal mortality in the region. According to the variety of clinical and organizational factors affecting maternal mortality, further research is required to create recommendations for optimal obstetric hospitals’ planning.