Introduction. А three-level model of the obstetric medical care system has been formed in Russia. The leading role in the system performs perinatal center. In regions with at least one perinatal center, which is part of a multidisciplinary adult hospital, the maternal mortality is significantly lower than in regions without one (data were obtained in 2023). Goal. To determine the optimal medical and organizational structure of perinatal centers in the Russian Federation regions; to determine the needs for their creation or reorganization. Materials and methods. The method of expert assessments was used. The top-level obstetrics organizers of healthcare were chosen as experts (5 employees of the Ministry of Health of the Russian Federation and 5 employees of the FSBI "NMIC AGP named after V.I. Kulakov" of the Ministry of Health of the Russian Federation). The experts evaluated the optimal number of births per 1 perinatal center and its organizational structure on a 10-point scale. The number of births in the region was estimated on the basis of federal statistical reporting forms No. 32 for 2023, and the organizational structure of perinatal centers was based on the data from the Federal Register of Medical and Pharmaceutical Organizations (FRMO). Results. The optimal number of births for one perinatal center is 5,000 births per year (the average expert estimate is 8.8 points); the optimal organizational structure of the only perinatal center in the region is "a part of a multidisciplinary hospital, including adult and children's hospitals" (the average value is 8.8 points); the optimal organizational structure of perinatal centers in regions with several obstetric hospitals of 3 groups (levels), is combination of perinatal centers in children's and adults’ multidisciplinary hospitals (9.8 points). Discussions. The algorithm, based on the results of expert assessments, has been developed to calculate the needs of establishing perinatal centers in the Russian Federation in order to reduce maternal mortality. The algorithm was applied in 89 regions of the Russian Federation. In 34 regions, the number and organizational structure of perinatal centers are optimal and do not require changes. In 15 regions, existing obstetric hospitals of 3rd level need to be reorganized (in 3, perinatal centers need to be reorganized into complexes consisting of multidisciplinary children and adult hospitals, independent perinatal centers in 12 regions need to be combined with multidisciplinary adults’ hospitals). In 40 regions of the Russian Federation, there is a need to create 58 new obstetric hospitals of the 3rd level. Conclusion. The algorithm obtained on the basis of a scientific approach makes it possible to determine the optimal number and organizational structure of perinatal centers in the regions of the Russian Federation and can be used for territorial planning in the field of healthcare.