Pregnant women may require Intensive Care Unit (ICU) at any stage of pregnancy for “obstetric” or “non-obstetric” causes. Many clinical situations can develop during pregnancy, such as hypertensive diseases, bleeding, venous thromboembolism, endocrine diseases, asthma, epilepsy, infection, and sepsis, which are common and require special management, however may not be critical. Most pregnancies with these complications have uneventful outcomes for both mother and fetus. Of 1-3% pregnancies with critical diseases require ICU care. Obstetric bleeding and hypertensive diseases are responsible for 55% of ICU admissions. However, the growing fetus is completely dependent on the mother for oxygenation, nutrition, and removal of other waste products. This “second guest” is always considered in the management of the pregnant patient. Optimal management of the mother often constitutes the best treatment for the fetus. It mostly involves multidisciplinary treatment by obstetricians, pediatricians, and anesthesiologists. During the pregnancy follow-up, delivery of the fetus may be necessary for maternal or fetal indications and should be planned. In this article, the determination of the physiological goals of the pregnant patient in the ICU, the general care principles, the follow-up of the treatment, and the follow-up of the fetus during all these stages will be discussed.