• Keep her away from the husband and do not leave her alone if danger continues.
• Avoid food/drink if she may need urgent surgery or is vomiting.
• Do not press or massage the abdomen.
• Do not use ibuprofen, aspirin, alcohol, or herbal remedies. Do not delay care to obtain medicines.
• If pain relief is needed and she has no allergy or liver disease, paracetamol/acetaminophen is generally the preferred pregnancy pain medicine, but urgent evaluation still comes first.

Immediate management

• ABCDE with ATLS principles. Maternal resuscitation is fetal resuscitation.
• Give high-flow oxygen only if hypoxemic/respiratory compromise, establish 2 large-bore IV lines, monitor BP/SpO₂/ECG, send CBC, group and crossmatch, coagulation profile, fibrinogen, renal panel, and type-and-screen.
• At ≥20 weeks, use 15-30° left uterine displacement during resuscitation. Call obstetrics, anesthesia, trauma surgery.
• Do not withhold indicated CT, surgery, blood products, or other lifesaving maternal treatment because of pregnancy.

Medicines/injections to consider

1. Rh(D) immune globulin / anti-D
   • Give to an unsensitized RhD-negative patient after blunt abdominal trauma, vaginal bleeding, or suspected fetomaternal hemorrhage.
   • Use your local preparation/protocol. A commonly used dose after 12 weeks is 300 micrograms (1500 IU) IM or IV, ideally within 72 hours.
   • Send Kleihauer-Betke or flow cytometry after significant trauma to quantify fetomaternal hemorrhage and calculate additional anti-D dose. Anti-D is not indicated if she is RhD-positive or already alloimmunized.
   • ACOG includes abdominal trauma as an RhIg indication in Rh-negative pregnancy: ACOG Rh guidance.
2. Analgesia
   • Paracetamol/acetaminophen PO or IV for mild pain.
   • For moderate-severe traumatic pain, use titrated opioid analgesia such as IV fentanyl or morphine, with routine cardiorespiratory monitoring. Treat maternal pain appropriately.
   • Avoid NSAIDs, especially later gestation, unless a specialist has a specific indication.
3. Hemorrhage / shock
   • Balanced blood-product resuscitation per your major hemorrhage protocol if bleeding/shock.
   • Consider tranexamic acid 1 g IV over 10 minutes when there is, or is strongly suspected to be, significant traumatic hemorrhage and within 3 hours of injury, followed by your institutional trauma protocol. Do not delay definitive hemorrhage control.
   • Give tetanus prophylaxis as indicated for contaminated/open wounds, using standard wound-management guidance.
4. Do not give empiric tocolysis or steroids simply because she was assaulted.
   • Give antenatal corticosteroids only if preterm delivery is likely and after obstetric assessment.
   • Tocolysis is generally avoided until placental abruption and maternal injury have been excluded.

Obstetric assessment

• Check fetal heart activity and placental location by ultrasound, but a normal ultrasound does not rule out abruption.
• For viable gestation, start continuous CTG as soon as maternal stabilization permits. At least 4-6 hours is generally advised; admit/continue around 24 hours if contractions, bleeding, uterine tenderness/irritability, ruptured membranes, nonreassuring CTG, significant abdominal trauma, or serious maternal injury. The EAST trauma guideline recommends a minimum 6 hours of monitoring after trauma at >20 weeks, with longer monitoring for abnormalities.

Must not miss

• Adult >50 kg: 1 g = 100 mL IV over 15 minutes, every 6 hours if needed.
  Maximum 4 g/day (400 mL/day) if no hepatic risk factors.
• If liver disease, chronic alcohol use, malnutrition, dehydration, or other hepatotoxicity risk: maximum 3 g/day (300 mL/day).
• 33-50 kg: 15 mg/kg = 1.5 mL/kg IV over 15 minutes, maximum 75 mL per dose and 3 g/day.
• Keep at least 4 hours between doses. Include all other oral/IV paracetamol products in the daily total.