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Abstract Background Point-of-care ultrasound (POCUS) has gained popularity as a bedside diagnostic imaging modality. In obstetrical populations, particularly in acute care settings, POCUS serves as a valuable complement to clinical assessment. Despite its many applications, only a few have been defined and validated in the obstetric population. This scoping review aims to delineate literature on the diagnostic applications of POCUS in obstetric anesthesia and critical care. Methods This review will adhere to the Joanna Briggs Institute methodology for scoping reviews, as updated by Arksey and O’Malley and in stages elaborated by Levac et al. Relevant literature will be identified using Medical Subject Headings (MeSH), keyword, and proximity searches and combined using Boolean operators in PubMed, Embase, and Web of Science from January 1, 2000, to the present. Two independent reviewers will screen literature against predefined eligibility criteria in abstract and full-text forms. A third reviewer will be consulted if consensus cannot be reached. Data extraction will be systematic, focusing on pre-specified variables aligned with the review’s aims. Descriptive statistical and thematic analysis will follow data extraction, with findings presented in graphical and tabular forms. The reporting will follow Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Conclusion This review will present the scope of the current literature on diagnostic POCUS in obstetric anesthesia and critical care, highlighting both strengths and gaps in existing knowledge. The insights gained will support future research, knowledge synthesis, and development of educational programs. The findings will be disseminated through peer-reviewed journal publications, conferences, and social media platforms. Systematic review registration Not applicable.

Purpose: To synthesise evidence for the incidence of intensive care unit (ICU) admission, characteristics and mortality of pregnant and postpartum women with a focus on differences between high-income countries (HICs) and low-middle-income countries (LMICs) and report changes in reported findings since the last review by Pollock et al. (2010). Methods: We searched Ovid Medline, EMBASE, and CINAHL (2010–2023), following best practice guidelines for abstract screening for large-evidence systematic reviews. Patient and study characteristics of extracted studies were analysed descriptively. Multivariable meta-regression analysis, employing mixed-effects models, was conducted for assessing ICU admission and mortality. Studies reviewed by Pollock et al. were included to perform an overall analysis, including each study period and geographic region in a model. Results: Seventy-one eligible studies reported data on 111,601 women admitted to ICU, with 41,291,168 deliveries reported in 65 studies. Fifty-six studies were retrospective. Case definitions, admission criteria, and causes of mortality reported were heterogeneous. The pooled ICU admission rate was 1.6% (95% confidence interval [CI] 1.28–1.99; I2 = 99.8%), 0.4% (95% CI 0.32–0.48, I2 = 99.9%) in HICs versus 2.8% (95% CI 0.65–6.4, I2 = 99.9%) in LMICs (p < 0.0001). The pooled ICU mortality rate among 140,780 admissions reported in 63 studies was 6.5% (95% CI 5.2–7.9; I2 = 98.7%), with mortality in HICs 1.4% (95% CI 0.8–2.1, I2 = 98.04%) lower than LMICs 12.4% (95% CI 8.1–17.5, I2 = 98.9%) (p < 0.0001). Multivariable meta-regression analysis found a significant association between the ICU admission rates (p = 0.0001) and mortality (p = 0.0003) with geographic region (HIC vs LMIC). Compared to the earlier study of Pollock et al. in 2010, there was an increase in reported studies (71 vs 40 in Pollock et al. study) and reported admissions (111,601 vs 7887 Pollock et al. study), particularly from LMICs'. Conclusions: Mortality for critically ill peripartum women is substantial and the gap in reported ICU admissions and mortality for critically ill peripartum women between HIC and LMICs remains unacceptably high. The reports are often small and heterogeneous using many case definitions. Reporting standards focusing on critical care processes and outcomes and large multinational prospective studies are necessary to better understand and mitigate maternal and child health challenges as sustainable development goals in LMICs and HICs. [ABSTRACT FROM AUTHOR]

The article discusses the critical need to address maternal sepsis as a prominent cause of maternal morbidity and mortality worldwide. Topics include the background of maternal sepsis, detailing its impact on pregnant and postpartum women; diagnostic approaches to improve early detection and outcomes; and management strategies within obstetric critical care, emphasizing timely intervention and multidisciplinary care.

Background: Point-of-care ultrasound (POCUS) has gained popularity as a bedside diagnostic imaging modality. In obstetrical populations, particularly in acute care settings, POCUS serves as a valuable complement to clinical assessment. Despite its many applications, only a few have been defined and validated in the obstetric population. This scoping review aims to delineate literature on the diagnostic applications of POCUS in obstetric anesthesia and critical care. Methods: This review will adhere to the Joanna Briggs Institute methodology for scoping reviews, as updated by Arksey and O'Malley and in stages elaborated by Levac et al. Relevant literature will be identified using Medical Subject Headings (MeSH), keyword, and proximity searches and combined using Boolean operators in PubMed, Embase, and Web of Science from January 1, 2000, to the present. Two independent reviewers will screen literature against predefined eligibility criteria in abstract and full-text forms. A third reviewer will be consulted if consensus cannot be reached. Data extraction will be systematic, focusing on pre-specified variables aligned with the review's aims. Descriptive statistical and thematic analysis will follow data extraction, with findings presented in graphical and tabular forms. The reporting will follow Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Conclusion: This review will present the scope of the current literature on diagnostic POCUS in obstetric anesthesia and critical care, highlighting both strengths and gaps in existing knowledge. The insights gained will support future research, knowledge synthesis, and development of educational programs. The findings will be disseminated through peer-reviewed journal publications, conferences, and social media platforms. Systematic review registration: Not applicable. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy-related acute kidney injury (PRAKI) causes substantial maternofoetal health burden in developing countries. The causes of PRAKI are diverse, important ones being haemorrhage, sepsis and preeclampsia in developing countries. Methods: A retrospective study was conducted in the department of Obstetrics and Gynaecology, and Nephrology in an Indian tertiary care hospital from 2017 to 2019. All patients admitted to Obstetric Critical Care Unit (CCU-Obs) who were pregnant or less than 42 days postpartum, with acute kidney injury and required haemodialysis were enrolled in the study and analysed for risk factors and causes of PRAKI. Results: PRAKI occurred in 6.21% admissions in CCU-Obs and 37.42% of these patients required dialysis. Majority were unbooked (85.9%) and referred (65.6%) from other hospitals; 57.8% patients developed AKI postnatally. The main causes for AKI in the current study were prerenal causes (84.4%) like obstetric haemorrhage due to placental abruption and post-partum haemorrhage. Other important causes were severe preeclampsia (23.4%) and sepsis (39%). Many patients had more than one condition leading to AKI. Patients needed 4.98 (average) cycles of dialysis and the average duration of stay in the hospital was 16.89 days. Maternal mortality was seen in a third of the cases, owing to complications of AKI. Preterm delivery was seen in 44%; stillbirth in half the cases and neonatal deaths in a quarter of them. Conclusion: To conclude, the leading causes of PRAKI requiring dialysis were obstetric haemorrhage, sepsis and preeclampsia. Prompt management and timely referral to a higher institute will decrease the incidence of PRAKI and its complications. [ABSTRACT FROM AUTHOR]

Aim: The aim was to examine the outcomes of pregnant women admitted to intensive care unit with coronavirus disease-2019 (COVID-19) infection during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in India. The primary outcome of the study was maternal mortality at day 30. The secondary outcomes were the intensive care unit (ICU) and hospital length of stay, fetal mortality and preterm delivery. Materials and methods: This was a retrospective multicentric cohort study. Ethical clearance was obtained. All pregnant women of the 15--45- year age admitted to ICUs with SARS-CoV-2 infection during 1st March 2020 to 31st October, 2021 were included. Results: Data were collected from nine centers and for 211 obstetric patients admitted to the ICU with a confirmed diagnosis of COVID-19. They were divided in to two groups as per their SpO2 (saturation of peripheral oxygen) level at admission on room air, that is, normal SpO2 group (SpO2 > 90%) and low SpO2 group (SpO2 < 90%). The mean age was (30.06 ± 4.25) years and the gestational age was 36 ± 8 weeks. The maternal mortality rate was10.53%. The rate of fetal death and preterm delivery was 7.17 and 28.22%, respectively. The average ICU and hospital length of stay (LOS) were 6.35 ± 8.56 and 6.78 ± 6.04 days, respectively. The maternal mortality (6.21 vs 43.48%, p < 0.001), preterm delivery (26.55 vs 52.17%, p = 0.011) and fetal death (5.08 vs 26.09%, p = 0.003) were significantly higher in the low SpO2 group. Conclusion: The overall maternal mortality among critically ill pregnant women affected with COVID-19 infection was 10.53%. The rate of preterm birth and fetal death were 28.22 and 7.17%, respectively. These adverse maternal and fetal outcomes were significantly higher in those admitted with low SpO2 (<90%) at admission compared with those with normal SpO2. [ABSTRACT FROM AUTHOR]

Background: This study involves two stand-alone tertiary level maternity hospitals with a combined average of 17,000 births per year, and with approximately 300 obstetric high dependency unit (OHDU) admissions annually. Many midwives feel that working in an OHDU does not constitute normal midwifery work and they have voiced concerns regarding their training in this setting. Midwives and nurses from different departments throughout the two hospitals are often asked to care for the OHDU patients. Co-location and expansion of a new OHDU, as well as a discussion around staffing, prompted this questionnaire. Aims: The aim of this study was to formally assess midwives' and nurses' attitudes and confidence working in an OHDU. Methods: After obtaining ethics committee approval, we conducted a survey and collected information on previous training in critical care, level of competence with HDU-related equipment and management of common HDU conditions. Results: In total, 188 staff participated in the survey (38% response rate). The majority (n = 142, 76%) did not feel competent caring for critically ill patients despite almost 40% (n = 69) saying they had experience doing so. Nurses or dual trained midwives were more likely to state they felt competent caring for critically ill patients, with only 2 midwives feeling competent (2.2%) compared to 32 nurses or dual trained staff (34.4%), p < 0.01. One hundred forty-seven (78%) and 136 (72%) respondents felt confident managing major haemorrhage and sepsis respectively. One hundred sixty-nine (89%) respondents would be interested in further training. Conclusions: A greater proportion of nurses and dual trained midwives feel confident caring for ODHU patients. This survey suggests that a mixture of specialty-trained critical care nurses and midwives is required in order to provide a full complement of HDU care to both the antenatal and postnatal women. [ABSTRACT FROM AUTHOR]

Introduction: An admission of a pregnant woman to an intensive care unit (ICU) is considered as an objective marker of maternal near miss. Only a few studies from the Indian subcontinent have reported on the ability of ICU scoring systems in predicting the mortality in obstetric patients. Methods: A prospective analysis of all critically ill obstetric patients admitted to the critical care department was done. Results: In the period between April 2013 and September 2017, there were 101 obstetric admissions to the critical care ICU. Of these, 82 patients (81.2%) were discharged from the hospital, 18 patients (17.8%) died, and one left against medical advice. The common diagnoses seen in these patients were cardiac failure (n = 39; 38.6%); pregnancy-induced hypertension (n = 26; 25.7%); acute respiratory distress syndrome (n = 20; 19.8%); intra-abdominal sepsis (n = 19; 18.8%); tropical diseases (n = 19; 18.8%); and tuberculosis (n = 13; 12.9%).When we compared the survivors with the nonsurvivors, a higher severity of illness score and a low PaO2/FiO2 were found to increase the odds of death. The area of distribution under the receiver operator characteristic curve was 0.726 (95% confidence interval [CI] = 0.575-0.877), 0.890 (95% CI = 0.773-1.006), 0.867 (95% CI = 0.755- 0.979), and 0.850 (95% CI = 0.720-0.980) for the PaO2/FiO2, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation (APACHE) II score, respectively, for predicting mortality. The standardized mortality ratio was better with SAPSII than with APACHE II. Conclusions: Cardiac dysfunction is a leading cause of ICU admission. Obstetric patients frequently require ventilatory support, intensive hemodynamic monitoring, and blood transfusion. The APACHE II score is a good index for assessing ICU outcomes. [ABSTRACT FROM AUTHOR]

The critically ill obstetric patient presents unique challenges. However, the general code of conduct, legal processes, and ethical principles continue to apply. Professionals need to keep themselves informed about the requirements of provisions within the legal framework. [ABSTRACT FROM AUTHOR]

Hypertensive disorders of pregnancy can be classified as chronic hypertension (present before pregnancy), gestational hypertension (onset after 20 weeks of pregnancy), and preeclampsia (onset after 20 weeks of pregnancy, along with proteinuria and other organ dysfunction). Preeclampsia and related disorders are a major cause of maternal and fetal morbidity and mortality. Preeclampsia is believed to result from an angiogenic imbalance in the placenta circulation. Antenatal screening and early diagnosis may help improve outcomes. Severe preeclampsia is characterized by SBP ≥160 mm Hg, or DBP ≥110 mm Hg, thrombocytopenia (platelet count <100 x 109/L), abnormal liver function, serum creatinine >1.1 mg/dL, or a doubling of the serum creatinine concentration in the absence of other renal diseases, disseminated intravascular coagulation, pulmonary edema, new-onset headache, or visual disturbances. Severe preeclampsia or eclampsia (preeclampsia with seizures) needs ICU management and is the main cause of morbidity and mortality. Severe hypertension can also result in life-threatening intracranial hemorrhage. Blood pressure control, seizure prevention, and appropriate timing of delivery are the cornerstones of the management of preeclampsia. Besides intravenous antihypertensive drugs, intravenous magnesium sulfate is the drug of choice to prevent or treat seizures, when preparing for urgent delivery. At present, delivery remains the most effective treatment for preeclampsia, and organ dysfunction rapidly recovers after delivery. Novel therapeutic interventions are under development to reduce complications. [ABSTRACT FROM AUTHOR]

Although no scoring system is as yet fully validated for predicting maternal outcomes in critically ill obstetric patients, prognostication may be done objectively using severity predicting models. General critical care scoring systems which have been studied in obstetric patients are outcome prediction models (Acute Physiology and Chronic Health Evaluation [APACHE] I-IV, Simplified Acute Physiology Score [SAPS] I-III, Mortality Probability Model [MPM] I-IV) and organ dysfunction scores (Multiple Organ Dysfunction Score [MODS], Logistic Organ Dysfunction Score [LODS], Sequential Organ Failure Assessment [SOFA]). General critical care scoring systems may overpredict mortality rates in obstetric patients secondary to an altered physiology of organ systems during pregnancy. Obstetric prediction models were developed keeping in mind the physiological characteristics of obstetric population. They are Modified Early Obstetric Warning System (MEOWS), Obstetric Early Warning Score (OEWS), Maternal Early Warning Trigger (MEWT), and disease-specific obstetric scoring systems. The APACHE II model and MPM II are most often used scoring systems for predicting maternal mortality. The SOFA model is the best predictive model for sepsis in obstetrics. APACHE II and SAPS are more useful for nonobstetric population. Recent studies have also underscored the applicability of the OEWS in intensive care unit (ICU) settings with results comparable to the more elaborate APACHE II and SOFA scores. The Early Warning System helps in identifying acutely deteriorating pregnant and postpartum women in non-ICU settings who may require critical care. Fetal outcomes are largely dependent upon maternal outcomes. Prognostic systems applied to mothers may help in estimation of perinatal mortality and morbidity. [ABSTRACT FROM AUTHOR]

We aimed to describe the availability of 31 distinct services and facilities to diagnose, resuscitate, and treat critically unwell obstetric patients. Using a network of anesthesiologists, intensive care clinicians, obstetricians, critical care nurses, and midwives (MaCriCare) from September 2021 to January 2022, we conducted a descriptive international multicenter cross-sectional survey in centers with obstetric units (OUs) in the WHO Europe Region. The MaCriCare network covers 26 countries and received 1133 responses, corresponding to 2.5 million annual deliveries. The survey identified significant disparities in the availability of the measured 31 services among the OUs, with some services not immediately available and some not available at all. Point-of-care hemoglobin measurements were lacking in 13.8% of OUs. 15.2% of OUs lacked pointof-care lactate measurement, and 11% lacked transfusion services. 23.8% of OUs lacked the ability to administer hypotensive agent infusions in the labor ward. Samebuilding access to cell saver and thromboelastometry was unavailable to 45.5% and 64.4% of OUs, respectively. Access to invasive ventilation was unavailable to 3.4% of OUs, 11.7% were unable to offer same-building access to non-invasive ventilation, and extracorporeal membranous oxygenation was unavailable to 38.3% of the OUs. Critically ill obstetric patients have access to markedly different resources in the WHO Europe Region depending on the OU where they are managed. Consensus on which facilities and services should be universally available is urgently needed. [ABSTRACT FROM AUTHOR]

Introduction: Obstetric patients are a special group of patients whose management is challenged by concerns for fetal viability, altered maternal physiology, and diseases specific to pregnancy. Materials and methods: A prospective analysis of all obstetric patients admitted to the critical care department was done to assess reasons for transfer to the critical care unit (CCU) and the interventions required for management of these patients. Results: Between June 2013 and September 2017, obstetric admission comprised 95 women (5.9%) of the total critical care admissions. There were 77 patients (81.1%) who were discharged from the hospital and 18 patients (18.9%) died. In most of the cases, the primary reasons for shifting the patient to the CCU were severe preeclampsia with pulmonary edema (22.1%), eclampsia (8.4%), acute respiratory distress syndrome (ARDS) (14.7%), and hypovolemic shock in antepartum hemorrhage (APH) and postpartum hemorrhage (PPH) (10.5 and 13.7%, respectively). It was seen that 73 patients (76.8%) required ventilator support, 58 patients (57.4%) required vasopressor support, and intensive hemodynamic monitoring and blood/blood products were transfused in 55 patients (54.5%). The need for ventilator support was more in patients with a lower PaO2/FiO2 and a higher APACHE II score. Patients with a high severity of illness score and a lower PaO2/FiO2 had higher odds of requiring vasopressors. Low hemoglobin at the time of transfer to the CCU and a prolonged hospital stay were found to predict the need for blood transfusion. Conclusion: Obstetric patients are susceptible to critical illnesses but timely management improves the outcome of these young women. [ABSTRACT FROM AUTHOR]

To evaluate obstetric units (OUs) and intensive care units (ICUs) preparedness for severe maternal morbidity (SMM). From September 2021 to January 2022, an international multicentre cross-sectional study surveyed OUs in 26 WHO Europe Region countries. We assessed modified early obstetric warning score usage (MEOWS), approaches to four SMM clinical scenarios, invasive monitoring availability in OUs, and access to high-dependency units (HDUs) and onsite ICUs. Within ICUs, we examined the availability of trained staff, response to obstetric emergencies, leadership, and data collection. 1133 responses were evaluated. MEOWS use was 34.5%. Non-obstetric early warning scores were being used. 21.4% (242) of OUs provided invasive monitoring in the OU. A quarter lacked access to onsite HDU beds. In cases of SMM, up to 13.8% of all OUs indicated the need for transfer to another hospital. The transfer rate was highest (74.0%) in small units. 81.9% of centers provided onsite ICU facilities to obstetric patients. Over 90% of the onsite ICUs provided daily specialist obstetric reviews but lacked immediate access to key resources: 3.4% - uterotonic drugs, 7.5% - neonatal resuscitation equipment, 9.2% - neonatal resuscitation team, 11.4% - perimortem cesarean section equipment. 41.2% reported obstetric data to a national database. Gaps in provision exist for obstetric patients with SMM in Europe, potentially compromising patient safety and experience. MEOWS use in OUs was low, while access to invasive monitoring and onsite HDU and ICU facilities was variable. ICUs frequently lacked resources and did not universally collect obstetric data for quality control. [ABSTRACT FROM AUTHOR]

Introduction: The physiological changes of pregnancy can turn pathological leading to Intensive Care Unit (ICU) admission of mother. The contributory factors to these ICU admissions need to be properly identified so that quality of obstetric services could be improved. Aim: To identify contributory factors to obstetric ICU admission. Materials and Methods: A prospective observational study was conducted in a multidisciplinary ICU of a tertiary care hospital of East Delhi, India. Maternal characteristics of women requiring ICU admission as well as contributory factors to ICU admission were observed and analysed. ‘Contributory factor’ was defined as modifiable component of health system and quality of care covering organisational, personnel and social factors. Descriptive data was tabulated as absolute figures and percentages. Results: Hypertensive disorder of pregnancy was most common primary diagnosis of ICU admission. Massive intraperitoneal haemorrhage leading to Disseminated Intravascular Coagulation (DIC) and multiorgan failure was major cause of death in ICU admitted patients. Delay in referral and lack of transportation were found to be most contributory (84%) in obstetric ICU admission. Conclusion: Social factors are major hurdle in achieving safe motherhood in India. There is a strong need of sensitisation regarding primary obstetric care among illiterate and poor women to decrease obstetric ICU admissions.

Introduction: The physiological changes of pregnancy can turn pathological leading to Intensive Care Unit (ICU) admission of mother. The contributory factors to these ICU admissions need to be properly identified so that quality of obstetric services could be improved. Aim: To identify contributory factors to obstetric ICU admission. Materials and Methods: A prospective observational study was conducted in a multidisciplinary ICU of a tertiary care hospital of East Delhi, India. Maternal characteristics of women requiring ICU admission as well as contributory factors to ICU admission were observed and analysed. 'Contributory factor' was defined as modifiable component of health system and quality of care covering organisational, personnel and social factors. Descriptive data was tabulated as absolute figures and percentages. Results: Hypertensive disorder of pregnancy was most common primary diagnosis of ICU admission. Massive intraperitoneal haemorrhage leading to Disseminated Intravascular Coagulation (DIC) and multiorgan failure was major cause of death in ICU admitted patients. Delay in referral and lack of transportation were found to be most contributory (84%) in obstetric ICU admission. Conclusion: Social factors are major hurdle in achieving safe motherhood in India. There is a strong need of sensitisation regarding primary obstetric care among illiterate and poor women to decrease obstetric ICU admissions. [ABSTRACT FROM AUTHOR]

Reduction in the maternal mortality ratio (MMR) continues to be a worldwide challenge. With repeated analytical studies done over decades, it has become possible to identify the significant contributors to this challenge. Right from low socioeconomic status to the availability of recent technological advances, many factors need attention and prioritization. Obstetric hemorrhage remains an important cause followed by hypertensive disorders of pregnancy and sepsis. In this issue of IJCCM, Miglani et al. have highlighted the various levels of the delays, which are significant contributors to the high MMR. In other preventive strategies, efforts will be needed to improve patient education, infrastructure, availability of trained manpower, blood storage facilities, timely referrals, transport facilities, etc., at peripheral levels. In the tertiary care centers, there is an increased need for trained manpower in critical care, the obstetric medical emergency team as a new concept, aggressive teamwork in intensive care unit (ICU) and operation theaters, the use of advanced technologies and newer drugs, etc. It will remain a tough challenge to reduce global MMR to 70 per 100,000 live births, as per plans by the United Nations, by the year 2030. [ABSTRACT FROM AUTHOR]

Background: Critically ill obstetric patients represent a small proportion of intensive care unit (ICU) admissions. Physiological changes of pregnancy along with pregnancy specific diseases may lead to rapid deterioration of the health status of the parturient warranting ICU care. The present study aims to study the clinical profile and outcomes of the obstetric patients requiring ICU care. Study design and settings: Prospective observational study in the multidisciplinary ICU of a tertiary care teaching hospital conducted for a period of 2 years. Materials and methods: Demographic details, indication for ICU admission, severity of illness scores, interventions, complications and outcomes of the consecutive obstetric patients transferred to ICU were studied. Results: Ninety-one patients were admitted (26 per 1000 deliveries) to the ICU. Majority of them were postpartum (84.6%) and unbooked or referred (63.8%). Hypertensive disorders (24.2%) and obstetric hemorrhage (23.1%) were the major cause for admission to ICU. Forty three patients (47.3%) underwent cesarean delivery. Mechanical ventilation (54.9%), blood transfusion (46%), vasopressor therapy (22%) and dialysis (9.9%) were the various interventions provided in the ICU. Patients with sepsis had high mortality accounting for one third of ICU mortality. The ICU mortality rate was 9.9%. Conclusion: The present study showed a clinical profile and outcomes similar to the current scenario of critically ill obstetric patients nationwide. Further studies with a larger sample size may provide a better insight in this population. [ABSTRACT FROM AUTHOR]

Aims: There is limited published information regarding intensive care unit (ICU) led rapid response team (RRT) calls to obstetric patients. We examined the characteristics of RRT calls to obstetric patients at a tertiary teaching hospital. Methods: Details of calls to pregnant and postpartum patients between October 2010 and June 2014 were obtained from the hospital RRT database. Each was retrospectively examined for data on patient demographics, call trigger, interventions and outcomes. Local obstetric‐specific escalation practices (Code Pink/Green) for obstetrical concerns (not mandating maternal instability/involvement of the ICU team), were excluded. Results: There were 106 RRT calls logged during 43 months, and 97 had data available for analysis. Women currently pregnant accounted for 33% of calls and postpartum women 67%, with nearly half of these occurring more than 24 h post‐delivery. The most common reason (29% of calls) for calling the RRT was hypotension, followed by ‘concern about patient’ (21%) and decreased Glasgow Coma Score (GCS) (17%). An escalation in the environment of care occurred after 32% of calls, with approximately 11% of calls necessitating direct ICU admission. Twenty‐three percent of all calls were to women who had an ICU admission during their hospital stay. Among the cohort who received an RRT call, there was one maternal and three neonatal deaths. Conclusion: At our institution generic RRT calls are called to both pregnant and postpartum women, and frequently result in an escalation in the care environment. Further study is required to understand better the specific needs of this important population. [ABSTRACT FROM AUTHOR]

Highlights from the article: • A true decrease in the need for ICU admission, which would be related to a reduced absolute number of patients with severe disease involving organ failure, suggesting better overall care and prophylaxis of degradation. In addition, patient and staff satisfaction may be increased due to reduced stress related to ICU activities (light, noise...), mother-neonate separation and need for intra-hospital transport [7], [21]. 18 D.R. Karnad, V. Lapsia, A. Krishnan, V.S. Salvi, Prognostic factors in obstetric patients admitted to an Indian intensive care unit, Crit Care Med, 32, 6 2004, 1294-1299.

Pulmonary hypertension has been traditionally classified in two categories: primary or secondary pulmonary hypertension, based on associated causes or risk factors; although, during the Second World Symposium in Pulmonary Hypertension held in Évian-les-Bains, France, in 1998, a new classification was developed, with the objective to individualize the different categories of pulmonary hypertension sharing pathologic features, hemodynamic characteristics and similar treatment and nowadays this classification includes five well distinguished types of pulmonary hypertension. We relate the case of an obstetric patient with severe pulmonary hypertension at high altitude, fortunately with favorable evolution. Patients with congenital cardiac disease can become symptomatic in front of a stressful event such as pregnancy. This is one of the few cases in literature about congenital cardiac disease with severe pulmonary hypertension in an obstetric patient. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension has been traditionally classified in two categories: primary or secondary pulmonary hypertension, based in associated causes or risk factors; although, during the Second World Symposium in Pulmonary Hypertension held in Evian (France, 1998), a new classification was developed, with the objective of individualize the different categories of pulmonary hypertension sharing pathologic features, hemodynamic characteristics and similar treatment and nowadays this classification includes five well distinguished types of pulmonary hypertension. We relate the case of an obstetric patient with severe pulmonary hypertension at high altitude, fortunately with favorable evolution. Patients with congenital cardiac disease can become symptomatic in front of a stressful event such as pregnancy. This is one the few cases in literature about congenital cardiac disease with severe pulmonary hypertension in an obstetric patient, with a favorable evolution of the maternal fetal couple. [ABSTRACT FROM AUTHOR]

Institutional policies restricting pregnant providers from caring for patients receiving inhaled epoprostenol exist across the nation based on little to no data to substantiate this practice. Over the last 2 decades, the use of inhaled pulmonary vasodilators has expanded in patients with cardiac and respiratory disease providing more evidence for the safety of these medications in obstetrical patients. We propose a thoughtful consideration and review of the literature to remove this restriction to reduce the need to reveal early pregnancy status to employers, to alleviate undue stress for pregnant caregivers who are exposed to patients receiving epoprostenol, and to ensure safe, equal employment, and learning opportunities for pregnant providers., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

In this article, we discuss some of the more common obstetric-related conditions that can lead to critical illness and require management in an ICU. These include the hypertensive disorders of pregnancy, postpartum hemorrhage, hemolysis, elevated liver enzymes, and low platelet syndrome, acute fatty liver of pregnancy, amniotic fluid embolism, and peripartum cardiomyopathy. We also discuss pulmonary embolism and Covid-19. Despite not being specific to obstetric patients, pulmonary embolism is a common, life-threatening diagnosis in pregnancy with particular risks and management aspects. Covid-19 does not seem to occur with higher frequency in pregnant women, but it leads to higher rates of ICU admissions and mechanical ventilation in pregnant women than in their nonpregnant peers. Its prevalence during our current global pandemic makes it important to discuss in this article. We provide a basis for critical care physicians to be engaged in informed conversations and management in a multidisciplinary manner with other relevant providers in the care of critically ill pregnant and postpartum women., Competing Interests: ACKNOWLEDGMENTS Dr. Ghada Bourjeily has this grant funding number: NHLBI R01-HL130702Dr. Corrina Oxford-HorreyDr. Kelly Griffin has no funding to declare. Disclosure The authors have nothing to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)