**Core Concept**
Abnormal placental perfusion in abruptio placentae (APH) leads to severe hemorrhage and hypovolemic shock. In a 32-week gestation with unstable vitals (BP 80/60), the priority is to stabilize the mother’s hemodynamics and prevent further blood loss.

**Why the Correct Answer is Right**
In severe maternal hypotension due to active hemorrhage from placental abruption, the immediate threat is shock and organ perfusion failure. Blood transfusion is the first-line intervention to restore circulating volume, correct hypovolemia, and maintain vital organ function. While induction of labor or cesarean section may follow, the primary step is volume resuscitation. Transfusion provides immediate correction of anemia and coagulopathy, which are critical in hemorrhagic shock.

**Why Each Wrong Option is Incorrect**
Option A: Careful observation is inappropriate in unstable vitals with active hemorrhage. Delaying intervention increases risk of maternal death.
Option C: Medical induction of labour is not indicated in unstable shock. It may worsen hemorrhage and delay definitive management.
Option D: Immediate cesarean section is a surgical intervention and not the first step in hemorrhagic shock. It requires stable hemodynamics and is typically performed after volume resuscitation.

**Clinical Pearl / High-Yield Fact**
In maternal hemorrhage during pregnancy, **volume resuscitation with blood transfusion** is the cornerstone of management before any definitive obstetric intervention. Do not delay transfusion in unstable patients — it is a life-saving step.

✓ Correct Answer: B. Blood transfusion