Management of the critically ill obstetric patient

In the United Kingdom only one-third of cases ending in maternal deaths are admitted to intensive care facilities. This situation can be improved by better interdisciplinary communication, faster referral and more staffed beds. Standardized mortality ratios are lower than expected based on illness severity scores. The most common conditions requiring intensive care support are haemorrhage, pre-eclampsia and eclampsia, sepsis and cardiac disease. Understanding of the physiological changes that take place in pregnancy is necessary for good critical care management. The management of the acute respiratory distress syndrome, the systemic inflammatory response syndrome and hypovolaemic shock are all discussed. Effects of this management and the drugs used on the fetus must also be taken into account.