Trauma and Critical Care

The management of critically ill obstetric patients most commonly involves treatment of disease processes that occur as a direct consequence of pregnancy. Although sometimes life-threatening, these conditions are usually reversible. Delivery of the infant often attenuates or ablates the disease process, and the mother typically recovers with supportive and resuscitative measures. Primary obstetric disorders account for 50% to 80% of intensive care unit (ICU) admissions for pregnant patients; approximately 80% of these admissions result from preeclampsia, sepsis, and/or hemorrhage. Trauma accounts for 45% to 50% of all maternal deaths in the United States, and it is the most common nonobstetric cause of maternal death. Other common nonobstetric causes of ICU admission are respiratory failure, endocrine disorders, preexisting autoimmune disease, and thromboembolic disorders. Ethnic minorities and women with low socioeconomic status have the highest rates of morbidity and mortality. Modern medicine has allowed women with complex medical problems such as congenital heart disease and cystic fibrosis to survive into childbearing age, and these patients are at increased risk for complications during pregnancy and have a higher incidence of ICU admission. Among critically ill obstetric patients admitted to an ICU, the most common cause of death is acute respiratory distress syndrome (ARDS), which can complicate both obstetric and nonobstetric disease processes. Critical maternal illness places the fetus at significant risk for morbidity and mortality. Important fetal risk factors include maternal shock, transfusion of blood products, and early gestational age at the time of critical maternal illness.