But what about the fetus?

Introduction, The obstetrician with a patient in the intensive care unit (ICU) finds that “What about the fetus?” is very common question posed by colleagues in other specialties. Sometimes it is asked explicitly; sometimes it is only implied, as a background to a more specific question, for example “Is that safe for the baby?” This whole issue could probably be generally condensed into one sentence, maybe two: “Don’t worry about the fetus. Keep the mother healthy and the rest will follow.” Obstetricians are used to managing two patients at a time, one of whom (the fetus) is entirely dependent upon the other and not generally accessible to its own interventions. However, colleagues in other specialties may not be accustomed to this type of double perspective and may worry about the myth of maternal–fetal conflict. As a rule, however, the best way to maintain fetal stability is to maintain maternal stability. While the principal goal of intensive care medicine remains unaltered, the presence of the fetus may affect management. For example, in women who are admitted to the ICU because of primary obstetric disorders, delivery may dramatically reverse the pathology. Similarly, cardiopulmonary resuscitation performed in a woman after mid-pregnancy is more effective when the uterus is empty. Aside from these situations, restoring maternal physiology is still key in ensuring the ultimate well-being of the fetus, and the interests of the fetus are not in conflict with those of the mother. In general, the fetus is relatively robust in spite of maternal illness, and any intervention or therapy that preserves or improves the physiological status of the mother is favorable to the fetus.