Management of the critically ill obstetric patient

From 2006 to 2008, 261 women in the United Kingdom died either as a direct or indirect result of pregnancy. More than half of these received critical care input. The support required varied from observation and supportive management to multi-organ support. In many women death occurred despite optimal care, but in a number substandard care was identified when the cases were reviewed as part of the Confidential Enquiry into Maternal Deaths. An understanding of the different types of organ support and treatment that are available in a critical care setting and when these are indicated is therefore crucial for medical professionals caring for these unwell obstetric patients.Described here are the technical aspects of organ support that can be utilized in a critical care setting and the alterations in physiology that occur in pregnancy which influence the use of each treatment modality. Also highlighted in more detail are conditions that are common or life threatening in pregnancy and key points about management of these conditions when they mandate critical care support.