Maternal near-miss (MNM) cases are a key tool for assessing the quality of obstetric care and organizing patient routing within the maternity care system. Aim. To assess the dynamics of key MNM indicators in the Russian Federation in 2021– 2024 and the impact of the national MNM monitoring system on maternity care at the federal, regional and hospital levels. Materials and methods. A mixed-design study was conducted, including a retrospective analysis of data from the MNM Register and a cross-sectional questionnaire survey of chief regional obstetricians-gynecologists, using analytical, statistical and sociological methods. Results. In 2021–2024, 34,647 MNM cases were registered; the incidence increased from 6.1 to 8.9 per 1,000 births (about 46%), while mean episode duration decreased from 7 to 3 days. The MNM survival index increased from 17:1 to 79:1; the proportion of cases requiring mechanical ventilation decreased from 15.5 % to 7.6 %, and extracorporeal membrane oxygenation from 1.0 % to 0.1 %. A total of 18,825 telemedicine consultations were conducted for MNM cases. The number of regions with functioning obstetric remote consultation centers increased from 62 of 85 to 83 of 89, and telemedicine consultation capacity was available in all regions. According to chief regional specialists, implementation of the MNM Register was most frequently associated with improved interaction with national medical research centers via telemedicine consultations, the creation of regional MNM monitoring systems, and improved quality of care for patients with MNM. Conclusion. The MNM Register has enabled unified monitoring of MNM cases, federal-level consultative support and improved patient routing, accompanied by better survival indices in maternal near-miss cases.