Preparation for delivery of the critically ill pregnant women begins soon after admission to the intensive care unit. Unless maternal or fetal condition deteriorates, remaining in utero may be more beneficial to the premature fetus. A decision regarding the timing of delivery is based on the impact on maternal and fetal well-being of maintaining the fetus in utero. Maternal or fetal instability may necessitate immediate delivery, and specialist from critical care, obstetrics, neonatology, and anesthesiology should decide on the most appropriate location for labor and delivery. Personnel from affected departments are alerted as soon as possible to facilitate the gathering of necessary equipment and supplies and the attendance of skilled professionals in intrapartum management and neonatal resuscitation.

Spinal cord injuries occur more frequently in women than in the past because of the societal and cultural changes in this country. Female survivors of spinal cord injuries have an improved prognosis for return to independence and societal contribution over their counterparts of 15 to 20 years ago. Because fertility is not affected, it is reasonable to predict that perinatal centers will continue to see an increase in spinal cord-injured patients. The unique nature of the injury makes pregnancy in these women a challenging event. The objectives of care are to prevent the complications associated with pregnancy while supporting independence. A multidisciplinary team approach best serves these patients and provides the best possible outcome for both mother and baby.

Critical care obstetrics is gaining increased recognition as a subspecialty of perinatal medicine. As the specialty continues to expand, many institutions may consider establishing a critical care obstetric service. However, implementing such a service is not feasible for every institution because of space limitations, budgetary constraints, lack of necessary resources, and/or a limited number of critically ill obstetric patients. This article explores strategies for examining the feasibility of establishing a critical care obstetric service, suggests methods of implementation, and offers an alternative when establishing a critical care obstetric service is not feasible.

Complications of pregnancy-induced hypertension (PIH) remain a leading cause of maternal mortality in the United States. The etiology of the disease is not fully understood, but pathologic effects of PIH on maternal organ systems are well documented. Present strategies for management emphasize prevention and control of eclamptic seizure and hypertensive crisis and correction of fluid imbalance. The article reviews current trends in drug therapy for the acute management of PIH. Topics discussed include evaluation of magnesium sulfate as an anticonvulsant, hydralazine versus labetalol for management of hypertension, and the role of colloid osmotic pressure in fluid therapy.