A 26-year-old woman in her sixth month of pregnancy is brought to the emergency department. She had been punched in the abdomen. She is found to have generalized abdominal pain, tenderness, abdominal distention, ileus, and absent fetal heart sounds. The patient's blood pressure is 80/60 mm Hg; despite administration of 3 L of Ringer's lactate, her blood pressure only comes up to 90/60 mm Hg. What is the next step in management?

Exploratory laparotomy with evacuation of the uterus and closure of the uterus disruption is the procedure of choice despite continued hypotension. Blood administration should be instituted but is not as critical as gaining surgical hemostasis. A PASG may have a limited temporizing effect but should not be used as an alternative to exploratory laparotomy. Any patient with abdominal trauma who is hypotensive should not be sent for a CT scan.