A 29-year-old woman, gravida 2 para 1, at 10 weeks gestation

A 29-year-old woman, gravida 2 para 1, at 10 weeks gestation comes to the emergency department for vaginal bleeding with passage

of large clots and intense lower abdominal cramping The bleeding began 3 hours ago and she reports worsening dizziness on

standing The patient initiated prenatal care a week ago and an ultrasound at that time revealed a 9-week gestation with a normal

fetal heart rate. Today, temperature is 37 C (98 7 F), blood pressure is 90/65 mm Hg, pulse is 110/min, and respirations are 17/min.

Large clots of blood are evacuated from the vagina during pelvic examination, after which active bleeding from an open cervical os is

noted. Blood type is AB negative. Hemoglobin is 8.0 g/dl. A bedside transvaginal ultrasound reveals a 9-week-size fetus in the

lower uterine segment with no cardiac activity. Intravenous fluids are begun Which of the following is the most appropriate next step

in management of this patient?

  • QA Administer misoprostol
  • 0 B. Administer oxytocin
  • 0 C. Expectant management
  • 0 D. Hysterectomy
  • 0 E. Laparoscopy
  • 0 F Suction curettage

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