Early pregnancy loss Quiz: Ace Your Exams

A newly pregnant 26-year-old woman, gravida 1, para 0, at seven weeks of gestation by last menstrual period comes to the emergency department with a six-hour history of vaginal bleeding and worsening menstrual-like cramps. She reports soaking through two menstrual pads an hour for the last four hours, passing several large clots, and is now feeling lightheaded and nauseous. The past medical history is noncontributory, and her only medication is a prenatal vitamin. The family history is significant for two uncomplicated spontaneous early pregnancy losses in her mother. Temperature is 37.1°C (98.8°F), pulse is 112/min, respirations are 22/min, and blood pressure is 88/50 mmHg. On exam, the patient is noted to be pale with delayed capillary refill. Several large clots are removed from the vagina on speculum exam, and the external cervical os is open. Labs are drawn and pending. A bedside pelvic ultrasound shows an intrauterine gestational sac with a yolk sac and an 8 mm fetal pole without fetal cardiac activity. In addition to supportive care, which of the following is the most appropriate next step in management?