One hundred three pregnant women hospitalized following blunt trauma had injuries classified as: major (20%); minor (17%); or insignificant (63%). Maternal mortality related only to the severity of maternal injuries: 24% of women who sustained major injuries died. Pregnancy ended unsuccessfully in 18% of all women with known pregnancy outcome. The incidence of unsuccessful pregnancy was 61% following major injuries and 27% following minor injuries. Insignificant maternal injuries did not affect pregnancy outcome. Fetal survival did not relate to gestational age per se. Pregnancy uniformly ended unsuccessfully in the presence of maternal death, placental injury, uterine injury, and direct fetal injury, and occurred in 80% of women admitted in hemorrhagic shock. An understanding of the ways that the anatomic and physiologic changes of pregnancy alter the nature and frequency of maternal injuries and that maternal response to injury is altered is essential. The best chance for fetal survival is to assure maternal survival.