The number of maternity care hospitals in underserved areas has been falling since 2004 because of business losses steming from low birth rates, inadequate insurance payments for obstetric services, and the shortage of obstetricians. However, the proportion of pregnant women at high risk in Korea has been increasing for decades because of the delay of marriage and the greater number of older pregnant women. High-risk pregnancies tend to lead to pregnancy complications and are associated with high-risk deliveries. An insufficient maternity care system for highrisk pregnant women in Korea has resulted in an increase in maternal mortality. The Ministry of Health and Welfare has supported the establishment of maternity care centers in underserved areas and regional perinatal centers to reduce maternal mortality. Even though the regional perinatal centers are a good system for reducing maternal mortality, they are limited in scope, in that they are not being established quickly on a nationwide scale to detect high-risk pregnancies earlier. This review briefly describes the current maternity care system for high-risk pregnancies and proposes a direction for the development of a health care delivery system between the regional perinatal centers and the maternity care system in underserved areas.