A 32-year-old gravida 2, para 1 client at 34 weeks gestation presents to the labor and delivery unit with sudden onset of severe abdominal pain and vaginal bleeding. Vital signs reveal blood pressure 90/60 mmHg, pulse 120 bpm, and respirations 24/min. The fetal heart rate shows late decelerations with decreased variability. What is the nurse's highest priority action?

When a client presents with sudden severe abdominal pain, vaginal bleeding, and signs of maternal shock with non-reassuring fetal status, immediate action is required. The nurse’s highest priority is to activate the emergency response system by notifying the physician or midwife and simultaneously initiating preparations for an emergency delivery. This triggers the multidisciplinary team response essential for definitive management.

While awaiting the provider’s arrival, the nurse must rapidly implement supportive interventions to stabilize the client. These include inserting two large-bore intravenous catheters to begin fluid resuscitation with crystalloids, administering high-flow oxygen via a non-rebreather mask to maximize maternal and fetal oxygenation, and continuously monitoring maternal vital signs and fetal heart rate. Position the client in a left lateral tilt to relieve pressure on the vena cava and improve venous return.

Prepare the operating room for an emergency cesarean delivery, as this is the most common definitive treatment for a significant abruption with a viable fetus in distress. The nurse should also anticipate the need for blood product transfusion, insert an indwelling urinary catheter to monitor output, and ensure neonatal resuscitation equipment and personnel are available. Thorough documentation of the timeline of events, interventions, and fetal heart rate changes is critical for ongoing care and legal purposes.