A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours.A cesarean section is performed for failure to progress.The fetal heart rate before birth is 180 beats/min with limited variability.At birth,the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic.Based on the maternal history,the cause of this newborn's distress is most likely

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The prolonged rupture of membranes and the tachypnea (before and after birth)both suggest sepsis.There is no evidence of phrenic nerve damage or respiratory distress syndrome.Early signs of sepsis may be difficult to distinguish from other problems such as hypoglycemia,but the prolonged rupture of membranes puts this baby at high risk of sepsis.

A Pregnant Woman at 37 Weeks of Gestation Has Had