What is the first step to take when managing a patient with bleeding in late pregnancy?

In managing a patient with bleeding in late pregnancy, the first priority is to assess vital signs and circulatory stability. This step is essential for determining the severity of the bleeding and the patient's overall hemodynamic status. Vital signs such as heart rate, blood pressure, and respiratory rate provide critical information about the patient's condition and whether they are experiencing significant blood loss that could lead to shock.

Initiating this assessment enables healthcare providers to identify whether immediate interventions are necessary to stabilize the patient. For instance, a rapid heart rate and low blood pressure may indicate hypovolemia, suggesting that urgent resuscitation measures may need to be implemented. Understanding the patient's stability guides the subsequent management plan, including whether they may need fluids, blood products, or other interventions.

Other options, while relevant in the broader context of care, do not take precedence as an initial step. For example, performing a digital vaginal exam may not be appropriate until the patient's stability is confirmed, due to the potential risks of worsening bleeding or causing infection. Starting oxygen therapy can be important later on, especially if there's evidence of hypoxia or respiratory distress, but it does not address initial vital sign assessment. Requesting a blood transfusion is often necessary in cases of significant bleeding, but it