Critical Care in Pregnancy

Publication Date: April 1, 2019
Last Updated: March 14, 2022

Recommendations

Early antibiotic therapy for sepsis is recommended to reduce mortality.
574
Neither necessary medications nor diagnostic imaging should be withheld from a pregnant woman because of fetal concerns, although attempts should be made to limit fetal exposure to ionizing radiation and teratogenic medications when feasible.
574
If efforts to resuscitate a pregnant woman in cardiac arrest have been unsuccessful, resuscitative hysterotomy (eg, perimortem cesarean delivery) is recommended for maternal benefit in women with a uterine size at or above the umbilicus (20 weeks of gestation or more).
574
Consideration of resuscitative hysterotomy should occur as soon as there is a maternal cardiac arrest and preparations should begin in the event that return to spontaneous circulation does not occur within the first few minutes of maternal resuscitation.
574
Survival curves for women and neonates have shown 50% injury-free survival rates with perimortem cesarean delivery as late as 25 minutes after maternal cardiac arrest, so even if delivery does not occur within 4–5 minutes, there still may be benefit and resuscitative hysterotomy should be considered.
574
Intensive care unit admission alone is not adequate as a quality or an epidemiologic marker of maternal morbidity. However, it may be useful for local surveillance and quality assurance activities.
574
Admission to the ICU should take into account objective clinical parameters that reflect instability, the potential for the patient to benefit from high acuity interventions, underlying diagnoses and prognoses, availability of clinical expertise in the current setting, and ICU beds.
574
If a pregnancy is complicated by a critical illness or condition, the woman should be cared for at a hospital with obstetric services, an adult ICU, advanced neonatal care services, and appropriate hospital services such as a blood bank.
574
For cases in which a higher level maternal care facility is required for critically ill women, consideration should be given to transport as soon as the need is identified and the patient is stable for transport.
574
Decisions on fetal monitoring during transport should be individualized based on gestational age, maternal hemodynamic status, and feasibility of intervention in response to abnormalities in the fetal heart rate tracing.
574
When obstetric patients are transferred to the ICU, patient care decisions including mode, location, and timing of delivery ideally should be made collaboratively between the intensivist, obstetrician–gynecologist, and neonatologist, and should involve the patient and her family when possible.
574
Because the risk–benefit considerations for continued pregnancy versus delivery are likely to change as the pregnancy and critical illness progress, the care plan must be reevaluated regularly.
574
Cesarean delivery in the ICU should be restricted to cases in which transport to the operating room cannot be achieved expeditiously and safely, or to a perimortem procedure.
574

Recommendation Grading

Overview

Title

Critical Care in Pregnancy

Authoring Organization

American College of Obstetricians and Gynecologists

Publication Month/Year

April 1, 2019

Last Updated Month/Year

January 10, 2023

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adult

Health Care Settings

Ambulatory, Childcare center, Hospital

Intended Users

Surgical technologist, physician, nurse midwife, nurse, nurse practitioner, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D011247 - Pregnancy, D003422 - Critical Care

Keywords

postpartum, Critical care in Pregnancy, puerperium