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The well-being of the fetus is strongly influenced by the status of the critically ill mother. Understanding basic principles of placental gas exchange is important when caring a pregnant patient in the intensive care unit (ICU). Aside from the few cases in which delivery is the preferred therapy, managing a pregnant patient in ICU should focus primarily on maternal well-being and only secondarily on the effects of interventions on the fetus. If preterm delivery is anticipated, administration of antenatal corticosteroids to the mother will decrease rates of common complications of prematurity of the newborn. The usual rule is to optimize the maternal medical condition and allow the fetus and placenta to take care of themselves. Certain fetal conditions such as severe intrauterine growth restriction may also provide a reason to separate the fetus from the mother.