Soru

A patient, gravida 3, para 2, is brought to the obstetrical triage unit at 37 weeks and 5 days of gestation due to the sudden onset of constant, agonizing lower abdominal pain and vaginal bleeding. Her medical history is significant for poorly controlled chronic hypertension and daily tobacco use. Vital signs show a temperature of 37.1°C (98.8°F), blood pressure of 168/110 mm Hg, and a heart rate of 115/min. On physical examination, the uterine fundus is rigid and exquisitely tender to light palpation; it does not relax between perceived contractions. Dark red blood is noted at the vaginal introitus. A prior third-trimester ultrasound documented an anterior, high-lying placenta. Sterile vaginal examination demonstrates the cervix is 2 cm dilated and 50% effaced, with the fetal vertex at a -2 station. Continuous fetal monitoring displays a baseline heart rate of 165/min, undetectable variability, and repetitive late decelerations following every contraction. The tocodynamometer indicates low-amplitude, high-frequency contractions occurring every 1 to 2 minutes. Which of the following represents the most appropriate next step in the management of this patient?