A 27-year-old G2P1 woman at 34 weeks’ gestation presents to the emergency depament following a motor vehicle collision. In the trauma bay her hea rate is 130/min and blood pressure is 150/90 mm Hg. She is ale and oriented to person, place, and time. She complains of severe abdominal pain that began immediately after the collision. Physical examination reveals bruising over her abdomen, along with a hypeonic uterus and dark vaginal bleeding. A sonogram reveals a placental abruption, and the fetal hea tracing reveals some decelerations. Emergency laboratory tests reveal an International Normalized Ratio of 2.5, with elevated fibrin degradation products. Which of the following is the most appropriate first step in’management?

**Core Concept**
The patient is presenting with symptoms and signs of placental abruption, a condition characterized by premature separation of the placenta from the uterus, leading to maternal and fetal distress. The clinical presentation includes abdominal pain, uterine tenderness, and vaginal bleeding, which can compromise both maternal and fetal well-being.

**Why the Correct Answer is Right**
The patient's laboratory results indicate coagulopathy, as evidenced by an elevated International Normalized Ratio (INR) and fibrin degradation products. This suggests disseminated intravascular coagulation (DIC), a complication of placental abruption that further increases the risk of maternal and fetal morbidity and mortality. The first step in management should focus on stabilizing the patient and addressing the coagulopathy.

**Why Each Wrong Option is Incorrect**
**Option A:** Administering corticosteroids would be appropriate if the patient were at risk of preterm delivery, but this is not the most immediate concern in this scenario.
**Option B:** Performing a cesarean section would be contraindicated in this situation due to the patient's unstable condition and the risk of worsening coagulopathy.
**Option C:** Administering oxytocin would be contraindicated due to the risk of further increasing uterine tone and potentially worsening the placental abruption.

**Clinical Pearl / High-Yield Fact**
In cases of suspected placental abruption, it is essential to assess the patient's coagulation status promptly and consider early consultation with a maternal-fetal medicine specialist to optimize management.

**Correct Answer:** C. Administering fresh frozen plasma (FFP) and/or other coagulation factor concentrates to correct the coagulopathy and stabilize the patient is the most appropriate first step in management.

✓ Correct Answer: C. Administer fresh frozen plasma.