Complicating approximately 6–7% of pregnancies, trauma is the leading non-obstetrical cause of death. However, there still exist great challenges in the management of pregnant trauma patients. Numerous physiological adaptions occur during pregnancy, which affect the evaluation and treatment of the patient. Obstetric trauma is followed by many maternal and fetal adverse outcomes that need to be considered. Initial treatment should be focused on the pregnant patient: fetal survival usually depends on the well-being of the mother. Because of its complexity and rarity, multidisciplinary approach and up-to-date guidelines need to be established.