After approximately 24 weeks of gestation, most authorities consider the fetus viable, so for many pregnant patients in the intensive care unit (ICU) care must also be directed to the fetus. Although maternal life should never be jeopardized for the care of this second patient, the critical care physician should be able to recognize signs of fetal distress and collaborate with obstetric and neonatology colleagues to determine optimal therapy for both patients. Fetal distress can be caused by a host of factors; most notably, hypoxemia and hypovolemia are dangerous for the fetus. Fetal tachycardia, late fetal heart rate decelerations, and loss of heart rate variability are signs of significant fetal distress and call for immediate action. These are best identified with the use of the continuous electronic fetal monitor.