Achievements in modern medicine, allowed since 2012, significantly reduce perinatal mortality in the Russian Federation. Despite the impressive rate of decline in perinatal mortality, there are still quite a few deaths that could be prevented. Causes and mechanisms of death in the perinatal period, starting from the 22nd week of intrauterine fetal development, on the 7th day after birth, are significantly different from the tanatogenesis in a patient living more than 7 days. Our work presents perinatal mortality rates in the Russian Federation for the period from 2010 to 2016 and formulates recommendations for the consistent implementation of all stages of an autopsy of the deceased in the perinatal period in full. Issues of approaches to pathoanatomical research, principles of diagnosis formulation and correct registration of medical documentation in stillbirth and in cases of death in the early neonatal period were discussed. The main criteria that allow differential diagnostics between antenatal intrapartum fetal death and the death of a child in the early neonatal period are considered. In addition, we have developed a classification of pathoanatomical diagnosis, taking into account the characteristics of the perinatal period and the interaction in the “mother-placenta-fetus” system. The authors note that in the case of a fatal outcome in the perinatal period, the final pathoanatomical diagnosis, in addition to the generally accepted headings, should take into account the mother's condition (pathology of pregnancy, childbirth), as well as the pathology of the afterbirth.