The evolution of a perinatal center over the past 12 years was reviewed. Factors in obstetric practices, maternal morbidity, and perinatal mortality were evaluated. The reduction in conditions leading to uteroplacental insufficiency (toxemia, hypertension, high parity) has been the most significant result. This in turn has led to a decrease in deaths from abruption, asphyxia, and respiratory distress syndrome (RDS). The practice of referring high-risk mothers to a perinatal center for delivery can continue to reduce perinatal mortality significantly.