MSFinals-3336

MSFinals-3336

A 28-year-old woman is admitted to the Acute Gynaecology Ward with per vaginum bleeding. She is 14 weeks pregnant and has had a scan confirming an intrauterine pregnancy. She reports lower abdominal cramping and bleeding for the last two days, which prompted admission to await an ultrasound scan. You are an FY1 doctor and are called to see her as she has increasing pain and is crying in distress. On examination, she is sweaty and uncomfortable. Abdomen is soft in the upper region, but firm and very tender suprapubically. Observations show temperature 38.7 °C, heart rate 130 bpm, blood pressure 95/65, respiratory rate 22 and oxygen saturations 97% on air. Checking her pad shows fresh bleeding and speculum examination is difficult due to pain, but there is a smelly discharge and you think you see tissue sitting in the os. You manage to get IV access and starts fluid resuscitation.
What is the most important next step in management?