Management of the critically ill obstetric patient

From 2015 to 2017, 209 women in the United Kingdom died during pregnancy or in the 6-week period postpartum, as a direct or indirect result of the pregnancy, a mortality rate of almost 1 in 10,000. In 44% of cases, care was considered ‘good’, but in 29%, opportunities to improve care were identified that might have altered the outcome in a positive way. The admission rate to intensive care units for women who are pregnant or within the first six postnatal weeks exceeds 1 in 500 maternities, and is more common among women of black ethnic origin, older age, or those with severe obesity. Reasons for admission range from provision of close observation with or without invasive monitoring, to multi-organ support including extracorporeal therapies. An understanding of the types of organ support available, along with their indications and objectives, is important for all medical professionals caring for such women. This review describes the range of critical care organ support modalities available and how the physiology of pregnancy influences their use. Life-threatening conditions are highlighted, together with key management recommendations and the importance of a collaborative multi-disciplinary approach in caring for these women. The unique non-clinical challenges faced by professionals caring for pregnant and recently pregnant women who are critically unwell, from logistical to psychological, are also discussed.