Soru

An obstetric rapid response is called for a patient at $36\text{ weeks}$ of gestation who presents to the triage unit with a $2\text{-day}$ history of worsening jaundice, persistent nausea, and severe lethargy. She has no significant past medical history, and her prenatal course was previously unremarkable. Upon evaluation, she appears visibly confused and is difficult to arouse. Her temperature is $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), blood pressure is $132/84\text{ mm Hg}$, and heart rate is $108/\text{min}$. Physical examination reveals scleral icterus and right upper quadrant abdominal tenderness. The uterus is soft, and pelvic examination shows a closed cervix. A continuous fetal monitor is placed, demonstrating a baseline heart rate of $145/\text{min}$ with moderate variability and spontaneous accelerations; there are no decelerations.

Initial laboratory studies are obtained and reveal the following:

Hemoglobin: $10.8\text{ g/dL}$
Platelet count: $88,000/\text{mm}^3$
Leukocyte count: $16,500/\text{mm}^3$
Glucose: $42\text{ mg/dL}$
Aspartate aminotransferase (AST): $740\text{ U/L}$
Alanine aminotransferase (ALT): $820\text{ U/L}$
Total bilirubin: $5.6\text{ mg/dL}$
Creatinine: $1.8\text{ mg/dL}$
Prothrombin time: $22\text{ seconds}$ (Reference: $11-14\text{ seconds}$)
Activated partial thromboplastin time: $54\text{ seconds}$ (Reference: $25-40\text{ seconds}$)

Intravenous dextrose is immediately administered, and the patient becomes fully oriented. Blood products are typed and crossmatched. Which of the following is the most appropriate next step in the management of this patient?