Soru

A $29$-year-old primigravid patient at $37$ weeks and $5$ days gestation presents to the obstetric triage unit reporting a sudden gush of clear vaginal fluid occurring $1$ hour ago. Over the past $20$ minutes, she has noticed the fluid becoming increasingly blood-tinged, followed by active, painless vaginal bleeding. She denies abdominal pain or uterine contractions. Her prenatal course was notable for a second-trimester ultrasound showing a velamentous umbilical cord insertion. Temperature is $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), blood pressure is $122/78$ mm Hg, and pulse is $88$/min. The maternal abdomen is soft and non-tender. Speculum examination confirms active bleeding from the external cervical os. Continuous fetal monitoring initially showed a baseline of $145$/min with moderate variability, but now demonstrates a sudden, prolonged deceleration to $70$/min lasting for the past $4$ minutes. Which of the following is the most appropriate next step in management?