Pregnant and postpartum women are considered at increased risk for severe COVID-19. However, information about disease progression and management in this population is scarce. This study aims to describe sociodemographic, clinical, and radiological characteristics of pregnant and postpartum women admitted to intensive care due to severe COVID-19, emphasizing respiratory outcomes. This is a retrospective, descriptive cohort study evaluating consecutive admissions of pregnant and postpartum women to an infectious diseases intensive care unit due to confirmed or suspected COVID-19, from May 2020 to June 2022. Numerical variables were described by median and interquartile range (IQR), and categorical variables, by frequency and percentage. Missing data were excluded from the analysis. A total of 101 admissions were recorded (85 pregnant and 16 postpartum women), with most patients in their second or third trimester. Forty-seven women (46.5%) required invasive mechanical ventilation (IMV), most of whom (62.1%) showed at least 50% of lung involvement on CT scans and requiring neuromuscular blocking agents (89.1%). Lethality was 15.8% in the cohort and 34.0% among women who required IMV. Pregnant and postpartum women are at risk of developing severe COVID-19, with high mortality and need for IMV and neuromuscular blocking. They should be prioritized in public health policies addressing COVID-19.