This client presented to Hospital on 10/1/00 after a 3-hour onset of uterine contractions.

Within 75 minutes of admission, the mother had a precipitous delivery while using the toilet. A precipitous delivery is defined as a rapid or sudden labor of less than three hours' duration, beginning from onset of cervical changes to completed birth of neonate. The infant did well initially post-partum with the exception of cold stress, which is normal for a pre-mature infant.

Within 2 hours of life the infant was noted to have hypoglycemia. This is a normal physiologic response within 2-4 hours postnatally as a result of a dip in blood glucose. She was treated appropriately with IV fluids and glucose. This resolved within 24 hours and IVs were discontinued. This infant was at an increased risk for this secondary to prematurity and cold stress. In addition this infant had brief period of grunting reported without respiratory distress.

Expiratory grunting may be common to infants born of a precipitous delivery. Prior to birth the fetal lungs and airways are filled with fluid, which is expelled during a normal vaginal delivery by thoracic compression during transit through the vagina. When the thoracic compression is lacking or inefficient, such as in a precipitous delivery, there is retention and subsequent delay in the resorption of normal fetal lung liquid. This appears to have resolved spontaneously with this infant. There is no indication from these records that this client or her infant received care that failed to meet the standard of care.