Caring for Two: Management of the Critically Ill Cardiac Patient During Pregnancy

Critical cardiac illness in the setting of pregnancy presents a unique and complex challenge requiring multidisciplinary expertise and coordination. Physiologic changes of pregnancy can unmask or exacerbate underlying cardiac disease, placing both patient and fetus at significant risk. This review provides a comprehensive approach to the management of critically ill pregnant individuals with cardiac disease within the cardiac intensive care unit. We discuss the nuances of hemodynamic monitoring, mechanical ventilation strategies, and pharmacotherapy tailored to the pregnant state. Special emphasis is placed on cardiac arrest management, as well as the diagnosis and treatment of acute cardiac conditions such as acute coronary syndromes, heart failure, cardiogenic shock, and valvular heart disease. Practical considerations for fetal monitoring, delivery planning, and postpartum care are also highlighted. This review aims to equip cardiac intensivists, obstetricians, anesthesiologists, and maternal-fetal medicine specialists with evidence-based strategies to optimize outcomes for both pregnant individual and fetus.