Elevation of the diaphragm in pregnancy leads also to the elevation of the heart, and cardiac index increases in 12 % of pregnant women. Left lateral position may help to increase the cardiac output of the pregnant patient about 25 % by eliminating the compression on the inferior vena cava. Cardiac rate in a term pregnant woman is between 80 and 95 [11]. Systemic blood pressure is lowest in the second trimester and increases gradually and reaches the level prior to pregnancy in the term period. The total blood volume increases about 50 % in the 34th week of pregnancy [12, 13]. Following acute bleeding, hypoxia leads to uterine artery vasoconstriction and a 10–20 % decrease in uterine perfusion. In terms of respiratory functions, ventilation rate increases 40 %, vital capacity increases around 300 cm³, expiratory reserve volume decreases around 200 cm³, and functional residual capacity decreases around 200 cm³ [14]. During pregnancy, dilution of the blood induces anemia with a hematocrit level of 32–34 % and white blood cell count of 18,000/mm³.

Trauma is a serious problem in 6–7 % of pregnant women. Minor trauma is valid in later stages of pregnancy, whereas major trauma can lead to maternal and fetal mortality. For this reason, trauma in pregnancy requires a team approach where the emergency doctor is accompanied by a surgeon, gynecologist, anesthesiologist, trauma nurse, and an intensive care physician. The trauma etiology in trauma is motor vehicle accidents, falls from a height, and assaults [15–17]. Petrone et al. [18] analyzed 321 consecutive cases with abdominal injuries during pregnancy, where 91 % were injured with blunt and 9 % penetrating trauma. Helton et al. [19] reported that 8 % of pregnant women were assaulted in a single pregnancy and 15 % in all pregnancies. Burns in pregnancy are extremely rare and requires hospital admission in 0.1 % of all pregnancies [13].

Penetrating injuries of the uterus end up with 60–80 % fetal injury and 40–70 % fetal mortality [20]. In their study during the Lebanese civil war, Awwad et al. [21] reported 89 % fetal injury rate and 66 % maternal mortality with firearm injuries. Ablatio placenta rate is 50 % following major blunt trauma and 1–5 % following minor blunt trauma. Uterine rupture is a rare (0.6 %) but life-threatening complication of trauma [22]. In case of a need for blood or blood products, blood bank should not be the choice; instead crystalloids and colloids should be preferred. Esposito et al. [23] reported a 7 % emergency laparotomy rate following blunt abdominal trauma in pregnancy. In the presence of uterine trauma, the likelihood of fetus and placenta injury is quite high, which brings up the decision regarding the continuity of fetal presence (Table 16.6).