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Trauma (motor vehicle accidents, falls, direct assaults to the maternal abdomen, other causes) complicate approximately 7% of all pregnancies (Speichinger & Holschneider, 2013). The most common causes of fetal death are maternal death and abruptio placentae. While motor vehicle accidents account for most injuries, physical abuse is another cause. Stabilizing the mother’s condition is key and takes priority; protecting the fetus from unnecessary drug and radiation exposure is also important. Fetal heart rate and uterine contractions should be monitored after the trauma, for a minimum of 4 hours and up to 48 hours. Frequent uterine contractions, vaginal bleeding, abdominouterine tenderness, postural hypotension, and fetal heart rate abnormalities require further evaluation.

• Because intravascular volume increases up to 8 L in pregnancy, losses of up to 35% of the blood volume can occur without typical signs of hypovolemia and shock (Burlew & Moore, 2015). Pregnant patients may desaturate more rapidly and require oxygen supplementation to prevent maternal and fetal hypoxia during evaluation and treatment. The patient is positioned in the left lateral decubitus position or tilted on a backboard to the left to avoid venocaval compression. Evaluation of the mother by a member of the obstetric team while resuscitation continues may optimize fetal outcomes. Ultrasound of the abdomen can be used to identify abdominopelvic trauma and status of the fetus. Radiography must be considered from a risk-benefit standpoint; X-rays should be limited to the clinically necessary and the pelvis shielded with a lead apron when possible.