In August 20, 2008, (10:50 AM) a 28-year-old pregnant woman with a 16-week gestational age fetus was involved in a road car crash resulting in multiple traumas. She had two other children; one (a 7 year-old girl) who was diagnosed with Cerebral Palsy and the other (an 18 month-old boy) who was in good health. Gravid=3, term=2, live=2 (G3T2L2). She was seated in the front seat of a midsize sedan car (Peugeot- Paykan) and her seatbelt was fastened(Figure 1,2). Peugeot- Paykan is a common family car in Iran assembled by the Paykan manufacturing with the same body panels as Paykan, however, manufacturing of Peugeot 504 engines has been suspend since 1991. Her brother was the driver. Nobody else was in the car. The cause of accident was speeding causing lost  of  control  and  subsequently  colliding with front long-vehicle. After the accident, she was transferred to a local Urgent Care Unit and received first aid of the ABCDE care included  : airway, breathing, circulation, disability, and exposure. She was then transferred to a 515-bed General Hospital (Imam Reza Hospital) (arrived at 12.30 AM).  The primary examinations revealed patient was pale, no respiratory distress, Glasgow Coma Scale=15, Blood Pressure=90/50 mmHg, Pulse Rate=100/min, and Respirat-ory Rate=20/min. She had two open IV lines and lower extremities were fixed with removable splints.
Moreover, the inferior of the abdomen and perineum areas were lacerated extensively, including vaginal (labia major and minor were involved, and the clitoris was traumatically removed), rectal areas (external sphincter was torn but the mucosal layer of rectum was intact) (Figure 6). The patient's wounds activated bleeding and four extremities pulse could be palpated. Uterine size was about 18 weeks of pregnancy and a transverse supra pubic scar due to previous cesarean section could be seen. Blood sampling was done, and fluid and blood resuscitation were continued.
Other physical and clinical examinations revealed that the Superior and inferior right ramous of pubis, proximal of right tibia and shaft of left fibula were fractured (Figure 3,4,5).
Furthermore, an abdominal-pelvic ultrasound (portable) didn't reveal any abdominal organ laceration or free fluid in abdomen and pelvic areas. Fetus was alive with normal fetal heart rate and amnionic fluid and placenta was in the posterior wall of the uterus without signs of subchorionic hematoma.
The following procedures were included:
1. Foley catheter was fixed by Urologist (Figure 6). 400 cc clear urine blow out to the urine bag.
2. Induction of anesthesia was started by opioid (fentanyl) and low dose of sodium thiopental. The maintenance of anesthesia was continued by opioid drug.
3. Laparotomy with a midline incision was performed. Abdominal organs exploration were done that revealed an 18 weeks pregnant uterus and no organ damage, but a non-expanding hematoma (sized 10*10 cm) was in the right broad ligament.
4. Diverting Colostomy was done to prevent fecal contamination of the perineum and rectal wound. Secondary infections and necrotizing fasciitis were the main surgical concerns. 
5. Pregnancy was terminated by hysterotomy.
6. Right calcaneal traction and long leg splint were done.
7. The wound of perineum underwent extensive irrigation debridements and it was left open (Figure 4). 
8. After the operation, she was admitted in ICU ward where she started recuperating process.