Approach to first trimester bleeding Quiz: Ace Your Exams

A 27-year-old woman, G2P1, at 9 weeks gestation presents to the emergency department with vaginal bleeding and lower abdominal pain for the past seven hours. The pain is crampy and a 7/10 on a 10-point scale. She initially had light bleeding, which has become heavy with passage of clots for the past two hours. She is unsure if she has passed any tissue. She does not have fever, chills, or shoulder pain. Past medical and surgical histories are unremarkable. Family history is significant for a sister with systemic lupus erythematosus. Temperature is 98.6°F, pulse is 116/min, respirations are 16/min, and blood pressure is 85/55 mmHg. The patient appears pale. Pelvic examination reveals a soft, boggy 10-week size uterus, a dilated cervical os that admits a fingertip, tissue protruding from the canal, and a moderate amount of blood and clots in the posterior vaginal fornix. Which of the following is the most appropriate next step in management?