Blunt trauma is responsible for non-obstetric fatalities during pregnancy, specifical intimate partner violence and motor vehicle collisions. Fetal mortality is 2.8 times higher in unrestrained or improper positioning of seatbelts in pregnant trauma patients. Emergency physicians must educate and encourage proper usage and placement of seatbelts among pregnant patients. Additionally, women of childbearing age should be screened for intimate partner violence in the emergency department. The first priority of management of the pregnant trauma patient is to attend to the mother. Intravenous fluids, supplemental oxygen, left lateral positioning, and clinical estimation of gestational age are the cornerstones of care. Avoidance of hypoxia, acidosis and hypotension are of paramount importance and critical actions are necessary to provide optimal maternal resuscitation. Normal vital signs in pregnant patients are highly unreliable as is the physical exam. There are specific anatomical and physiological changes that are unique to the pregnant patient that must be recognized when performing rapid sequence intubation or chest tube thoracostomy, as well as in the interpretation of radiological studies, ECG, and laboratory analysis. Trauma computed tomography studies confer ionizing radiation doses below 50 mGy, whereas levels between 100 and 200 mGy has shown to be teratogenic. Placental abruption, uterine rupture, and preterm labor can occur following even minor trauma, and all patients ≥20 weeks gestation require 6 h of continuous cardiotocodynamometry. Low titer O + blood and TXA may be given during maternal resuscitation in the pregnant trauma patient. In the event of maternal death, or acute cardiopulmonary arrest, maternal survival requires uterine-aortocaval decompression by emergent resuscitative hysterotomy.