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The resolution expires in January and the 15-member council is aiming to extend approval for those operations on Thursday.
But Moscow, an ally of al-Assad, objects to a proposal by Germany, Belgium and Kuwait to add a fifth crossing from Turkey and extend cross-border operations for a year.
Russia's UN ambassador Vassily Nebenzia told reporters the proposal does not "reflect realities."
He said a rival resolution by Russia, supported by China, proposes keeping open only two crossings from Turkey and extending the operations for only six months.
The proposal would close a crossing from Iraq into Kurdish-held areas in the north-east. Turkey recently invaded the north-east, targeting Kurdish militias that Ankara regards as terrorists.
"We have to recognize that things are changing," Nebenzia said.
But British ambassador Karen Pierce countered that "things aren't changing." She stressed that "4 million" people's lives are at risk during winter and "this is not the time to be playing around with numbers and figures."
She added that the council should follow the guidance of the UN's emergency relief coordinator Mark Lowcock, who said on Wednesday that the resolution's extension is "critical."
German ambassador Christoph Heusgen said he was not "impressed by any veto threats" ahead of Thursday's vote.
Last year, Russia and China abstained in the council vote to extend cross-border aid deliveries.
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