Critical Care in Pregnancy

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


Early antibiotic therapy for sepsis is recommended to reduce mortality.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Recommendation Grading




Critical Care in Pregnancy

Authoring Organization

Publication Month/Year

April 1, 2019

Last Updated Month/Year

January 10, 2023

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Adult

Health Care Settings

Ambulatory, Childcare center, Hospital

Intended Users

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



Diseases/Conditions (MeSH)

D011247 - Pregnancy, D003422 - Critical Care


postpartum, Critical care in Pregnancy, puerperium