Critical care in pregnancy relies predominantly on recommendations from nonpregnant adult critical care with only limited research available for obstetric critical care specifically. The purpose of this document is to review available evidence, propose strategies for obstetric-related critical care, and highlight the need for additional research. Much of the review will, of necessity, focus on general principles of critical care, extrapolating when possible to critical care in pregnancy and the puerperium. This Practice Bulletin is updated to include information about unique issues to pregnancy when conditions such as sepsis or acute respiratory distress syndrome (ARDS) are encountered and the obstetrician's role in the management of the critically ill pregnant woman, which is dependent upon the care setting and the intensive care unit (ICU) model used. The role of the tele-intensive care unit in the care of critically ill pregnant women also is explored.