Integrating Critical Care Competencies into Obstetrics: A Call for Specialized Training

by Ana Collins-Smith, MD

Issue 36 | Volume 1

Critical care in obstetrics is a vital component of maternal and fetal healthcare, bridging the gap between standard maternity services and high- intensity medical intervention. As maternal mortality and morbidity continue to pose significant global challenges— especially in low- and middle-income countries—effective critical care infrastructure for pregnant and postpartum women becomes not only a clinical priority but also a public health imperative1. The complexities of pregnancy physiology, combined with the possibility of sudden and severe complications, necessitate a specialized approach that integrates obstetric knowledge with critical care expertise.

Pregnancy places unique physiological demands on a woman’s body, affecting nearly every organ system. These changes can mask or mimic signs of critical illness, complicating diagnosis and delaying treatment. Conditions such as preeclampsia, hemorrhage, sepsis, and cardiomyopathy can escalate rapidly, causing a life-threatening emergency2. Without timely recognition & intervention, both maternal and fetal outcomes are often severely compromised. Critical care in obstetrics ensures that patients experiencing such complications receive rapid, specialized treatment in settings equipped with both intensive monitoring and obstetric support.

One of the core aspects of obstetric critical care is its multidisciplinary nature. Optimal outcomes often depend on seamless collaboration between obstetricians, anesthesiologists, intensivists, neonatologists, and nursing staff3. This team-based approach enables precise decision-making and individualized care, tailored to the dynamic needs of mother and child. Moreover, specialized training for clinicians in maternal-fetal medicine and obstetric critical care equips them with the skills to manage complex cases such as ARDS or multi-organ dysfunction in peripartum sepsis.

Beyond emergency response, critical care in obstetrics plays a preventive role. High-risk pregnancies—such as those involving pre-existing heart disease, diabetes, or autoimmune conditions—benefit from early identification and close monitoring, often in high- dependency units. This anticipatory model reduces the likelihood of escalation to full-blown critical illness and improves long-term health outcomes for both mother and baby4,5. Additionally, the presence of dedicated obstetric critical care services enhances the healthcare system’s ability to adapt during crises, such as the COVID-19 pandemic, which disproportionately affected pregnant individuals.

Equity in access to obstetric critical care remains a pressing global issue6. In many parts of the world, the absence of specialized facilities and trained personnel leads to preventable maternal deaths. However, the United States has the opportunities for obstetrical providers to receive additional training in critical care, which is an essential steps toward reducing disparities in access.

In summary, critical care in obstetrics is not just about managing emergencies—it is a cornerstone of comprehensive maternal health. By recognizing the unique challenges of critical illness in pregnancy and responding with specialized, multidisciplinary care, healthcare systems can significantly reduce maternal and neonatal mortality. As the field continues to evolve, additional training for obstetrical providers within the realm of critical care is needed to combat the rising maternal mortality and morbidity.

REFERENCES:

  1. Joseph KS, Lisonkova S, Boutin A, Muraca GM, Razaz N, John S, Sabr Y, Chan WS, Mehrabadi A, Brandt JS, Schisterman EF, Ananth CV. Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance? Am J Obstet Gynecol. 2024 Apr;230(4):440.e1-440.e13. doi: 10.1016/j. ajog.2023.12.038. Epub 2024 Mar 12. PMID: 38480029.
  2. ACOG Practice Bulletin No. 211: Critical Care in Pregnancy. Obstet Gynecol. 2019 May;133(5):e303-e319. doi: 10.1097/ AOG.0000000000003241. PMID: 31022122.
  3. Leovic MP, Robbins HN, Starikov RS, Foley MR. Multidisciplinary obstetric critical care delivery: The concept of the “virtual” intensive care unit. Semin Perinatol. 2018 Feb;42(1):3-8. doi: 10.1053/j. semperi.2017.11.002. Epub 2018 Jan 5. PMID: 29310986.
  4. Leckcivilize A, McNamee P, Cooper C, Steel R. Impact of an anticipatory care planning intervention on unscheduled acute hospital care using difference-in-difference analysis. BMJ Health Care Inform. 2021 May;28(1):e100305. doi: 10.1136/ bmjhci-2020-100305. PMID: 34035049; PMCID: PMC8154976.
  5. Martin CM, Sturmberg JP, Stockman K, Hinkley N, Campbell D. Anticipatory Care in Potentially Preventable Hospitalizations: Making Data Sense of Complex Health Journeys. Front Public Health. 2019 Jan 28;6:376. doi: 10.3389/fpubh.2018.00376. PMID: 30746358; PMCID: PMC6360156.
  6. Kroelinger CD, Brantley MD, Fuller TR, Okoroh EM, Monsour MJ, Cox S, Barfield WD. Geographic access to critical care obstetrics for women of reproductive age by race and ethnicity. Am J Obstet Gynecol. 2021 Mar;224(3):304.e1-304.e11. doi: 10.1016/j. ajog.2020.08.042. Epub 2020 Aug 21. PMID: 32835715; PMCID: PMC9199012.

Authors

Ana Collins-Smith, MD
Member (Fellow), SOCCA
UTMB
Galveston, TX