Scientific Reviews Critical illness in pregnancy: An overview

Critically ill obstetric patients are significantly different from the average patient admitted to the medical intensive care unit (ICU). They present a challenge to the critical care physician due to their unique physiology and the specific medical disorders that occur during pregnancy and the peripartum period. The physiologic changes that occur in the pregnant state in several systems, including the cardiovascular, respiratory, renal, hematologic, and endocrine systems, stress the reserve of the body and may compromise responses needed to combat disease state. Furthermore, in addition to the common admitting diagnoses to a medical ICU, these patients present with disorders peculiar to pregnancy, including peripartum hemorrhage, pregnancyinduced hypertensive disorders, liver failure, embolic disorders, and puerperal infections (1). The challenges faced in the treatment of this patient population are even greater due to the fact that two lives are endangered simultaneously. In this article, we give an overview of the critical illnesses that afflict the obstetric patient. A comprehensive list of the conditions that may require admission to the ICU in pregnancy or within 6 wks of delivery is featured in Table 1.