The care of an acutely injured woman in her second or third trimester of pregnancy represents a uniquely challenging situation for the trauma care professional. Recent data refute the concept that maternal salvage offers the best protection against fetal demise, and suggests that our current methods of assessing the status of the fetus are both underused and inexact. Ultrasound is emerging as a valuable tool in evaluating both the injured mother and her fetus, and the indications for cesarian section following trauma have been refined. In the postinjury period, complications such as intra-abdominal infections and thromboembolism may also influence the outcome of the pregnancy. A recognition of the mechanisms of injury associated with trauma to this population, especially the apparent increase in violent assaults against the gravid woman, helps to emphasize the need for injury prevention efforts during pregnancy.