What are The Most Effective Management Strategies for Obstetric Emergencies in ICU Settings, and How do They Impact Maternal and Neonatal Mortality Rates? : A Systematic Review
Keywords:
Obstetric emergencies, intensive care unit, maternal mortality, neonatal mortality, postpartum hemorrhage, eclampsia, sepsisAbstract
Background: Obstetric emergencies requiring intensive care unit (ICU) admission contribute significantly to maternal and neonatal mortality worldwide, yet optimal management strategies remain heterogenous across settings.
Methods: This systematic review synthesized 80 studies (1990-2025) examining management strategies for obstetric emergencies in ICUs. Outcomes included maternal mortality, neonatal mortality, and effectiveness of interventions.
Results: Hypertensive disorders (42.96% in Africa) and hemorrhage (24.15%) were the leading admission causes. Multidisciplinary team approaches, early intervention (<6 hours for hemorrhage), and protocolized care consistently improved outcomes. Whole blood transfusion reduced transfusion volumes versus component therapy (2,607 mL vs. 4,683 mL, p=0.03) with zero maternal deaths. The non-pneumatic antishock garment combined with balloon tamponade eliminated hemorrhage-related mortality (0% vs. 3 deaths). Continuous renal replacement therapy reduced sepsis mortality by 35%. Skills training for postpartum hemorrhage reduced maternal mortality from 75% to 0%. Maternal mortality ranged from 0%-41.2%, with African centers reporting 30.69% versus 3.03% in dedicated obstetric ICUs. Neonatal mortality ranged 4.2%-52%. Critical timing factors included ICU admission <24 hours from symptom onset and delivery before critical deterioration.
Discussion: Effective management requires condition-specific, early, multidisciplinary approaches. Resource disparities explain much outcome variation, with unbooked status and delayed referral as key modifiable risk factors. Standardized protocols, early warning systems, and uterine-conserving techniques show strongest evidence.
Conclusion: Early, protocol-driven, multidisciplinary ICU management significantly reduces maternal and neonatal mortality in obstetric emergencies. System strengthening and skills training are as crucial as technological interventions.
References
I. Lataifeh, Z. Amarin, F. Zayed, et al (2010) Indications and outcome for obstetric patients' admission to intensive care unit: A 7-year review. Journal of Obstetrics and Gynaecology Research. https://doi.org/10.3109/01443611003646298
Nusrat Noor, Rabia Anwar, Khan Muhammad Yaqub, et al (2020) Study of Obstetric Admissions to the Intensive Care Unit at PNS Shifa. https://doi.org/10.37939/jrmc/vol24.iss1.12
A. Aldawood (2011) Clinical characteristics and outcomes of critically ill obstetric patients: a ten-year review. Annals of Saudi Medicine. https://doi.org/10.4103/0256-4947.84631
Betty Anane-Fenin, E. Agbeno, Joseph Osarfo, et al (2021) A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country. PLoS ONE. https://doi.org/10.1371/journal.pone.0261974
S. Al-Suleiman, H. Qutub, J. Rahman, M. S. Rahman (2006) Obstetric admissions to the intensive care unit: a 12-year review. Archives of Gynecology and Obstetrics. https://doi.org/10.1007/s00404-004-0721-z
N. Ashraf, S. Mishra, P. Kundra, et al (2014) Obstetric Patients Requiring Intensive Care: A One Year Retrospective Study in a Tertiary Care Institute in India. Anesthesiology Research and Practice. https://doi.org/10.1155/2014/789450
H. Yi, S. Jeong, S. Kim, et al (2018) Indications and characteristics of obstetric patients admitted to the intensive care unit: a 22-year review in a tertiary care center. Obstetrics & Gynecology Science. https://doi.org/10.5468/ogs.2018.61.2.209
D. Vásquez, E. Estenssoro, H. Canales, et al (2007) Clinical characteristics and outcomes of obstetric patients requiring ICU admission. Chest. https://doi.org/10.1378/chest.06-2388
Irene Akhideno, Peter Oaikhena Itua, Mojolaoluwa Adeaga, Tochukwu Wisdom Akazie Nneji (2024) Maternal critical care: A 5-year review of the pattern and outcome of obstetrics admission into the intensive care unit (ICU) of a rural South South Nigerian Tertiary Health Care Centre. Journal of critical care. https://doi.org/10.1016/j.jcrc.2024.154640
I. Takai, Z. Ahmed, U. Umar, et al (2020) A 5-year review of obstetrics and gynaecology admission into the intensive care unit of a tertiary hospital in Northern Nigeria. Port Harcourt Medical Journal. https://doi.org/10.4103/phmj.phmj_5_20
M. Muench, A. Baschat, A. Malinow, H. Mighty (2008) Analysis of disease in the obstetric intensive care unit at a university referral center: a 24-month review of prospective data. Journal of reproductive medicine
A. Faponle, A. Adenekan (2012) Obstetric Admissions into the Intensive Care Unit in a Sub-urban University Teaching Hospital. Nepal Journal of Obstetrics and Gynaecology. https://doi.org/10.3126/NJOG.V6I2.6754
Shazia Saaqib, M. Azeem, M. Chohan (2017) Early Versus Late Blood Transfusion in Puerperal Septic Shock Patients with Anemia -a QuasiExperimental Controlled Trial. The International Annals of Medicine. https://doi.org/10.24087/IAM.2017.1.4.121
J. Lalonde, Pierre-Marc Dion, Abigaël Carpentier, et al (2025) Whole blood transfusion in the management of obstetric hemorrhage: A scoping review. Transfusion. https://doi.org/10.1111/trf.70013
Ashish Zarariya, Arya Chaubey, Dr D Harikanth (2023) Non-pneumatic anti-shock garment (NASG) and balloon tamponade decrease maternal mortality and morbidity from Obstetrics Haemorrhage: A prospective observational study. Indian Journal of Obstetrics and Gynecology Research. https://doi.org/10.18231/j.ijogr.2023.083
Snigdha Rai, Sandesh Poudel, S. Adhikari, et al (2024) Impact of Skill Development Training in the Management of Postpartum Hemorrhage. Scholars International Journal of Obstetrics and Gynecology. https://doi.org/10.36348/sijog.2024.v07i12.008
Array Л. Шукевич, Array К. Переделкин, Array В. Григорьев, et al (2010) Продолжительная заместительная почечная терапия при тяжелом акушерском сепсисе. General Reanimatology. https://doi.org/10.15360/1813-9779-2010-2-21
A. Pan, T. Yang, Q. Mei, et al (2017) [Retrospectively analysis on 95 postpartum hemorrhage women treated with obstetrics and gynecology in intensive care unit]. Zhonghua yi xue za zhi. https://doi.org/10.3760/cma.j.issn.0376-2491.2017.29.003
Dr. Shohana Askary, Dr. Roksana Begum, Dr. Zinath Rehena, et al (2024) Identify of Preoperative and Postoperative Complication of Planned Management and Emergency Management of Patients with PAS Disorder. Global academic journal of medical sciences. https://doi.org/10.36348/gajms.2024.v06i05.008
B. Ozumba, L. Ajah, V. Obi, et al (2018) Pattern and Outcome of Obstetric Admissions into the Intensive Care Unit of a Southeast Nigerian Hospital. Indian Journal of Critical Care Medicine. https://doi.org/10.4103/ijccm.IJCCM_297_17
D. Karnad, Vijay Lapsia, A. Krishnan, V. Salvi (2004) Prognostic factors in obstetric patients admitted to an Indian intensive care unit*. Critical Care Medicine. https://doi.org/10.1097/01.CCM.0000128549.72276.00
Sara Oliveira, C. Filipe, N. Husson, et al (2019) Obstetric Admissions to the Intensive Care Unit: A 18-Year Review in a Portuguese Tertiary Care Centre. Acta Médica Portuguesa. https://doi.org/10.20344/amp.11410
Lersten Ivy L, Rodriguez Christina E, Gilroy Jamie R, et al (2021) A Quality Improvement Initiative to Decrease Maternal Morbidity in Placenta Accreta Spectrum with a Standardized Approach: A Single Institution Experience. Annals of Gynecology and Obstetrics. https://doi.org/10.36959/468/475
D. Rattray, C. O'connell, T. Baskett (2012) Acute disseminated intravascular coagulation in obstetrics: a tertiary centre population review (1980 to 2009). Journal of Obstetrics and Gynaecology Canada. https://doi.org/10.1016/S1701-2163(16)35214-8
Keeranmayee Mishra, Chirag Doshi, Charu Chandra, A. A. Mishra (2024) An Observational Study of Obstetric Patients in a Tertiary Care Hospital Requiring Critical Care. Journal of Obstetric and Gynaecological Practices POGS. https://doi.org/10.5005/jogyp-11012-0038
Dipali Prasad, Huma Nishat, B. Tiwary, et al (2018) Review of obstetrical emergencies and fetal out come in a tertiary care centre. International Journal of Research in Medical Sciences. https://doi.org/10.18203/2320-6012.ijrms20181467
W. Pollock, L. Rose, C. Dennis (2010) Pregnant and postpartum admissions to the intensive care unit: a systematic review. Intensive Care Medicine. https://doi.org/10.1007/s00134-010-1951-0
A. Braga, Helder Konrad De Melo, Gabriela Paiva, et al (2026) Advances and Challenges in Obstetric Intensive Care Medicine. Journal of Clinical Medicine. https://doi.org/10.3390/jcm15041487
A Ram Mohan, U. Ihekwaba, E. Jwarah (2013) PM.56 Audit of Care of Critically Ill Pregnant Women. Archives of Disease in Childhood: Fetal and Neonatal Edition. https://doi.org/10.1136/archdischild-2013-303966.138
Ying Lin, Xi Zhu, Fei Liu, et al (2011) [Analysis of risk factors of prolonged intensive care unit stay of critically ill obstetric patients: a 5-year retrospective review in 3 hospitals in Beijing]. Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue. https://doi.org/10.3760/CMA.J.ISSN.1003-0603.2011.08.001
Vishrut M. Mashruwala, Amrita D. Patel (2025) A two year review of indications and outcomes of obstetric admissions to ICU of a tertiary care hospital. International Journal of Reproduction Contraception Obstetrics and Gynecology. https://doi.org/10.18203/2320-1770.ijrcog20253075
M. Özçelik, S. Turhan, O. Bermede, et al (2017) Outcomes of Antepartum and Postpartum Obstetric Admissions to the Intensive Care Unit of A Tertiary University Hospital: An 8-Year Review. Turkish Journal of Anaesthesiology and Reanimation. https://doi.org/10.5152/TJAR.2017.56323
Preetkamal, Ripan Bala, Simran Kaur, M. Nagpal (2019) Obstetrics ICU admissions: learning objectives. International Journal of Reproduction Contraception Obstetrics and Gynecology. https://doi.org/10.18203/2320-1770.IJRCOG20191019
J. Anwari, A. Butt, Mohammed A Al-Dar (2004) Obstetric admissions to the intensive care unit. Saudi Medical Journal
Bandamma Narendra S, A. Shree (2019) A prospective study of spectrum & outcomes of obstetric referral patterns in a tertiary care centre in central Karnataka. Indian Journal of Obstetrics and Gynecology Research. https://doi.org/10.18231/j.ijogr.2019.058
Bharti Parihar, Babli Yadav, Jaya Patel (2020) Critical care management of eclampsia patients - one year study. International Journal of Reproduction Contraception Obstetrics and Gynecology. https://doi.org/10.18203/2320-1770.ijrcog20204945
Liu Yuqi, Guoliang Tan, S. Chengming, Sun Xuri (2017) The ICU Is Becoming a Main Battlefield for Severe Maternal Rescue in China: An 8-Year Single-Center Clinical Experience. Critical Care Medicine. https://doi.org/10.1097/CCM.0000000000002597
A. Gaffney (2014) Critical care in pregnancy--is it different? Seminars in Perinatology. https://doi.org/10.1053/j.semperi.2014.07.002
Alemwork Abie, Molla Getie Mehari, Tenagnework Eseyneh Dagnew, et al (2025) Obstetric admission and maternal mortality in the intensive care unit in Africa: A systematic review and meta-analysis. PLoS ONE. https://doi.org/10.1371/journal.pone.0320254
G. Zanconato, E. Cavaliere, C. Iacovella, et al (2012) Severe maternal morbidity in a tertiary care centre of northern Italy: a 5-year review. Journal of Maternal-Fetal & Neonatal Medicine. https://doi.org/10.3109/14767058.2011.614655
Kadir Arslan, Hale Cetin Arslan, A. Şahin (2023) Evaluation of critically ill obstetric patients treated in an intensive care unit during the COVID-19 pandemic. Annals of Saudi Medicine. https://doi.org/10.5144/0256-4947.2023.10
F. X. Silva, L. Katz, J. Cecatti (2022) Prognostic scores for prediction of maternal near miss and maternal death after admission to an intensive care unit: A narrative review. Health Care for Women International. https://doi.org/10.1080/07399332.2022.2134391
S. Kamal, Vandita Singh, Shashibala Singh (2019) A study of clinical characteristics and outcome of obstetric patients in intensive care and high dependency unit of a tertiary centre of Jharkhand, India. International Journal of Reproduction Contraception Obstetrics and Gynecology. https://doi.org/10.18203/2320-1770.ijrcog20196054
M. Nagpal, Ripan Bala, Simran Kaur (2018) To Improvise Risk Reduction Strategies in Obstetrical ICU Admissions. https://doi.org/10.5005/jp-journals-10055-0044
L. Cussen, K. O'Donoghue (2014) PMM.15 Maternal Admissions to Intensive Care. Archives of Disease in Childhood: Fetal and Neonatal Edition. https://doi.org/10.1136/ARCHDISCHILD-2014-306576.371
Fatima Zahrae Benchekroun, Ilias Jerrar Oulidi, Kaoutar Chafai, et al (2024) Placental Abruption: Unveiling Persistent Challenges and Management Strategies from the Obstetrical Intensive Care Unit Experience in Fes, Morocco. Journal of Medical and Surgical Research. https://doi.org/10.46327/msrjg.1.000000000000259
Fatima Bibi, Shama Chaudhry, Hadia Riaz, et al (2025) Integrating acute pain management protocols in obstetric intensive care: the effect on maternal morbidity in eclampsia and HELLP syndrome. Anaesthesia, Pain & Intensive Care. https://doi.org/10.35975/apic.v29i4.2817
Julien Viau-Lapointe, J. Kfouri, M. Thompson, et al (2024) Outcome reporting in studies on critically ill obstetric patients: A systematic review. Obstetric Medicine. https://doi.org/10.1177/1753495X241302848
Germán A. Monsalve, C. M. Martínez, Tatiana Gallo, et al (2011) Cuidado crítico materno: desenlaces y características de los pacientes de una unidad obstétrica combinada de alta dependencia en Medellín, Colombia. Revista Colombiana de Anestesiología. https://doi.org/10.5554/RCA.V39I2.96
Natasha Sebastian, A. Spence, S. Bouhadoun, H. Abenhaim (2020) Extracorporeal membrane oxygenation in pregnant and postpartum patients: a systematic review. Journal of Maternal-Fetal & Neonatal Medicine. https://doi.org/10.1080/14767058.2020.1860932
J. Lafon, Edward Buga, G. Nethathe (2021) Characteristics and outcomes of obstetric patients with maternal sepsis requiring admission to a South African intensive care unit: A retrospective review. South African Journal of Obstetrics and Gynaecology. https://doi.org/10.7196/SAJOG.1635
S. F. Malfertheiner, D. Brodie, A. Burrell, et al (2022) Extracorporeal membrane oxygenation during pregnancy and peripartal. An international retrospective multicenter study. Perfusion. https://doi.org/10.1177/02676591221090668
S. Gama, M. Sebitloane, K. de Vasconcellos (2019) Outcomes of patients admitted to the intensive care unit for complications of hypertensive disorders of pregnancy at a South African tertiary hospital – a 4-year retrospective review. Southern African Journal of Critical Care. https://doi.org/10.7196/SAJCC.2019.v35i2.001
S. Sarker, Mohammad Habibullah, M. Sardar, et al (2025) Maternal Outcome of Admitted Obstetric Patient in Intensive Care Unit of Dhaka Medical College Hospital, Bangladesh. Journal of Dhaka Medical College. https://doi.org/10.3329/jdmc.v32i2.83434
J. D. de Barros, M. Amorim, Duana Gabrielle De Lemos Costa, L. Katz (2021) Factors associated with severe maternal outcomes in patients with eclampsia in an obstetric intensive care unit. Medicine. https://doi.org/10.1097/MD.0000000000027313
Hayat Elfil, M. Hussein, L. J. Kily, et al (2023) Management and outcomes of pregnant ICU patients with severe COVID-19 pneumonia in Qatar: A retrospective cohort study. Qatar medical journal. https://doi.org/10.5339/qmj.2023.24
N. Kaur, S. Aryal (2016) Pattern of Severe Acute Maternal Morbidity in a Tertiary Care Institute. Journal of Lumbini Medical College. https://doi.org/10.22502/JLMC.V3I2.72
. D. F. Yasmin, Dr. Aklima Akter, Dr. Farida Begum (2021) A Study on Critical Care Obstetrics’ in Eclampsia Patients-ICU Management and Maternal Outcome in Obstetrics and Gynaecology Department, Dhaka Medical College Hospital. Scholars International Journal of Obstetrics and Gynecology. https://doi.org/10.36348/sijog.2021.v04i04.001
Wenting Tang, Jingjin Gong, Liyun Kuang, et al (2015) Clinical characteristics of critically ill obstetric patients in intensive care unit: analysis of 476 cases. Chinese Journal of Perinatal Medicine. https://doi.org/10.3760/CMA.J.ISSN.1007-9408.2015.10.004
M. Stokes, Amber Olson, C. Algeo, et al (2022) Clinical and Sociodemographic Characteristics Associated with Emergency Peripartum Hysterectomy due to Puerperal Sepsis in Malawi. International Journal of MCH and AIDS. https://doi.org/10.21106/ijma.535
W. Andonotopo, M. A. Bachnas, J. Dewantiningrum, et al (2025) Amniotic Fluid Embolism: a comprehensive review of diagnosis and management. Journal of Perinatal Medicine. https://doi.org/10.1515/jpm-2025-0161
K. Knight, Laura G. Duncan, M. Szilvási, et al (2020) Reproductive (In)Justice: 2 Patients With Avoidable Poor Reproductive Outcomes. Obstetric Anesthesia Digest. https://doi.org/10.1097/01.aoa.0000652764.95394.44
Elena Fatnic, Nikole Lee Blanco, Roman Cobiletchi, et al (2023) Outcome predictors and patient progress following delivery in pregnant and postpartum patients with severe COVID-19 pneumonitis in intensive care units in Israel (OB-COVICU): a nationwide cohort study. The Lancet Respiratory Medicine. https://doi.org/10.1016/S2213-2600(22)00491-X
M. Sitter, U. Pecks, M. Rüdiger, et al (2021) P 027 Pregnant and postpartum women requiring intensive care treatment for COVID-19 – first data from the CRONOS-registry. Zeitschrift für Geburtshilfe und Neonatologie. https://doi.org/10.1055/s-0041-1739791
M. Escobar, Paula Andrea Fernández Pérez, J. Carvajal, et al (2019) Impact of nonpneumatic antishock garment in the management of patients with hypoperfusion due to massive postpartum hemorrhage. Journal of Maternal-Fetal & Neonatal Medicine. https://doi.org/10.1080/14767058.2019.1568982
A. A. Nikulin, R. E. Lakhin, A. V. Shchegolev (2024) Comparative analysis of the effectiveness of some intensive care methods in pregnant women with severe and extremely severe forms of coronavirus infection. Public health of the Far East Peer-reviewed scientific and practical journal. https://doi.org/10.33454/1728-1261-2024-4-23-30
Ehab Hassanin Mohammad, A. E. A. Sedek, A. Edrees (2023) Radical versus conservative management of placenta previa accreta. Al-Azhar International Medical Journal. https://doi.org/10.58675/2682-339x.2034
Dr. Muhammad Saeed (2024) Characteristics of Critically ill Obstetric Patients Admitted to the ICU at a Tertiary Care Centre. MedERA - Journal of CMH LMC and IOD. https://doi.org/10.61982/medera.v5i2.114
Celestine Osita John, Justina Omoikhefe Alegbeleye, Ijeoma Chioma Oppah (2022) A Five-year Review of the Pattern and Outcome Obstetric Admissions into the Intensive care unit of a University Teaching Hospital in Southern Nigeria. International Journal of Science and Research Archive. https://doi.org/10.30574/ijsra.2022.5.2.0073
Amaan Ali, R. Lamont (2019) Recent advances in the diagnosis and management of sepsis in pregnancy. F1000Research. https://doi.org/10.12688/f1000research.18736.1
Jennifer A Walker, Natalie Jackson, Sudha Ramakrishnan, et al (2025) Clinical Scores of Peripartum Patients Admitted to Maternity Wards Compared to the ICU: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. https://doi.org/10.3390/jcm14145113
E. J. MacDonald, S. Lepine, M. Pledger, et al (2020) Preeclampsia Causing Severe Maternal Morbidity—A National Retrospective Review of Preventability and Opportunities for Improved Care. Obstetric Anesthesia Digest. https://doi.org/10.1097/01.aoa.0000693672.64079.aa
Catherine P. Marudo, Arya Kermanshah, Daniel Montes de Oca, et al (2025) Standby Extracorporeal Membrane Oxygenation Use in Obstetric Patients: A Systematized Review. Journal of Cardiothoracic and Vascular Anesthesia. https://doi.org/10.1053/j.jvca.2025.03.037
Kkc Chan, N. Leung, A. Lau, K. K. Chan (2010) Clinical characteristics and outcomes of obstetric patients admitted to the Intensive Care Unit: a 10-year retrospective review. Hong Kong medical journal = Xianggang yi xue za zhi
L. Zieleskiewicz, A. Chantry, G. Duclos, et al (2016) Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy. Anaesthesia Critical Care & Pain Medicine. https://doi.org/10.1016/j.accpm.2016.06.005
D. Shrestha, S. Aryal, S. Baniya (2018) Evaluation of Clinical Characteristics and Outcomes of Obstetric Patients Admitted to Intensive Care Unit: A case control study. Journal of Lumbini Medical College. https://doi.org/10.22502/jlmc.v6i1.167
M. Heavner, M. Cucci, Brooke Barlow, et al (2023) Caring for two in the ICU: Pharmacologic management of pregnancy‐related complications. Pharmacotherapy. https://doi.org/10.1002/phar.2837
Caitlin Luebcke, Beth E. Smith, Kathleen Abrahamson (2022) An Integrated Review of Obstetric Admissions in the Intensive Care Unit. Dimensions of critical care nursing : DCCN. https://doi.org/10.1097/DCC.0000000000000521
Jan L Keizer, J. Zwart, R. Meerman, et al (2006) Obstetric intensive care admissions: a 12-year review in a tertiary care centre. European Journal of Obstetrics, Gynecology, and Reproductive Biology. https://doi.org/10.1016/J.EJOGRB.2005.12.013
A. Tempe, L. Wadhwa, Shally Gupta, et al (2007) Prediction of mortality and morbidity by simplified acute physiology score II in obstetric intensive care unit admissions. Indian Journal of Medical Sciences. https://doi.org/10.4103/0019-5359.31151
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Landong Sijabat, Raka Jati Prasetya, Mutia Juliana (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
