The management of acute trauma in the pregnant patient relies on a thorough understanding of the underlying physiology of pregnancy. This issue reviews the evidence regarding important considerations in pregnant trauma patients, including the primary and secondary survey as well as the possibility for Rh exposure, placental abruption, uterine rupture, and the need for a prompt perimortem cesarean section in the moribund patient. Because ionizing radiation is always a concern in pregnancy, the circumstances where testing provides benefits that outweigh risks to the fetus are discussed. Emergency clinicians are encouraged to advocate for trauma prevention, including proper safety restraints for motor vehicles and screening for domestic violence, as these measures have been shown to be effective in reducing morbidity and mortality in this population. Recommendations for monitoring, admission, discharge, and follow-up are also noted.