A nurse is caring for a client at 41 weeks gestation who is undergoing induction of labor with oxytocin. The client suddenly reports severe abdominal pain and states 'something tore inside me.' The fetal heart rate drops from 140 bpm to 80 bpm, and the client becomes hypotensive with a thready pulse. What is the nurse's immediate priority action?

The classic clinical triad includes acute onset of severe, tearing abdominal pain, sudden fetal bradycardia, and maternal signs of shock (hypotension, thready pulse). This is an obstetric emergency requiring a coordinated, rapid response.

1. Activate the emergency response system and notify the obstetrician, anesthesiologist, and surgical team immediately. The goal is to achieve a decision-to-delivery interval of less than 30 minutes.
2. Prepare for immediate cesarean delivery. This is the only definitive intervention. While preparing, simultaneously initiate resuscitative measures.
3. Stop all uterotonic agents (e.g., oxytocin) to reduce uterine activity and potential further damage.
4. Initiate maternal resuscitation: Administer high-flow oxygen via a non-rebreather mask, insert two large-bore IV catheters, and begin rapid fluid resuscitation with crystalloids or blood products as ordered.
5. Position the client in a left lateral tilt to improve venous return and placental perfusion, if it does not delay transport to the operating room.

• Do not delay surgical preparation for diagnostic tests. The diagnosis is primarily clinical.
• Assign a team member to provide clear, calm communication to the client and family about the need for emergency surgery.
• Anticipate the need for massive transfusion protocol activation and prepare for potential neonatal resuscitation.
• Document the time of symptom onset, interventions, and team notifications precisely.