During your call duty, a healthy 40-year-old primigravida with a spontaneous dichorionic pregnancy presents, accompanied by her husband, to the obstetric emergency assessment unit of your hospital center at 33+1 weeks’ gestation with new-onset abdominal pain and vomiting after a two-day history of nausea and general malaise. She has no obstetric complaints, and fetal viabilities are ascertained upon presentation. Her face appears yellow tinged relative to her last clinical visit one week ago. You recall that routine prenatal laboratory investigations, aneuploidy screening, morphology surveys of the male fetuses, and serial sonograms have all been unremarkable.

Key Learning Points

1. 1. Critical illness in pregnancy is relatively uncommon; however, it carries a significant amount of morbidity and mortality when it does occur. The majority of patients will be admitted to the intensive care unit in the post-partum period.

2. 2. Recent advances in the management of common direct obstetric causes of maternal critical illness have improved outcomes. Unfortunately, however, we have not seen similar advances in treating the indirect causes.

3. 3. Managing this unique cohort of patients is challenging and requires an in-depth knowledge of both maternal physiological adaptations to pregnancy and how these may affect the course of the patient’s illness.

4. 4. In obstetric emergencies, the main priority must be to resuscitate the mother, which, in turn, will help resuscitate the fetus.