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Patient with Small Gestational Age, Meconium Aspiration Syndrome and Respiratory Distress Syndrome.

Case Scenario: Patient with Small Gestational Age, Meconium Aspiration Syndrome and
Respiratory Distress Syndrome.
Course in the Ward: You are taking care of patient Regina, a 35 year old patient gravida 3 with
one live child and one abortion with 30 weeks pregnancy was admitted from outpatient
department of DDH. She was referred because of bronchial asthma and experiencing difficulty of
breathing for 5 days and 2 days fever, she is a COVID-19 Suspect. Due to oversized baby and
previous LSCS (lower (uterine) segment Caesarean section) which was performed three years
back for postdatism and failure of induction, she had delivered 4.1 kg female baby through
caesarean section and her postpartum period was uneventful.

Family Profile
Regina is married to Brian for almost 10 years now. She works at Vista Mall as a sales
representative and she is a college graduate. She is a hardworking mother and her duty is
overnight shift. They live in a single unit house, and the husband’s source of income is in tricycle
driving. Her health history reveals that she has difficulty in giving birth, she weigh 72 kg classified
Obese Class I and her family history reveals that her mother has type 2 diabetes mellitus and
asthma. On her paternal side they have family history of overweight and hypertension.

Pregnancy History
Regina’s past obstetric history includes her first pregnancy with spontaneous abortion at 24 weeks
5 years ago. Her second pregnancy is oversize baby, with low APGAR score delivered via
Caesarean last June 2020, and reported the baby pass meconium (dark green fecal material) in
the amniotic fluid and take forceful gasps that causes meconium-containing amniotic fluid to be
breathed (aspirated) into the lungs, and the third pregnancy found out that the lung development
of the baby is high risk for respiratory distress syndrome.


Past Medical History
● Obesity, excessive weight gain prior to pregnancy
● Type 2 Diabetes Mellitus
● Spontaneous abortion at 24 weeks
● The patient had a history of hospitalization, due to asthma
● Had undergone Caesarean section for 4.2 kg female baby


Family History
● History of Hypertension and Diabetes Mellitus in the family
● History of Asthma


History of Present Illness:
Baby Boy Rojo was delivered via Primary Cesarean Section for Fetal Bradycardia. Upon delivery,
he has no spontaneous movement, no heart rate and chest rise. Thorough drying and stimulation
was done, secretions were suctioned, and bag valve and ventilation was also provided. On the
first minute of life, there’s still no movement and improvement in color, patient’s heart rate is less
than 60 beats per minute with an APGAR Score of 1. Patient was intubated with Endotracheal
Tube size of 3 level 7, Epinephrine 0.5 ml via ET x 1 given and also provided with Chest
Compressions. On the 5th minutes of life, patient was showing progress with heart rate greater
than 100 beats per minute, an APGAR Score of 4. Pinkish central coloration was noticed and with
irregular respiration. APGAR score of 6 on the 10th minutes of life then 7 on its 15th minutes of
life. Continued on Bag Valve Mask until the patient was admitted to NICU for further management

Ballard Score 30 weeks, Small for Gestational Age, neonate affected by Maternal condition (COVID
suspect); Respiratory Distress Syndrome


Physical Examination:
Vital Signs:
● BP: 60-90 mmhg
● Temp: 36.5°C to 37.5°C
● PR: 120 bpm
● RR: on mechanical ventilator
● Weight: 1.2 kg
● Height: 18 inch
● Blood type: AB (+)
● In general patient had no fever, not bradycardic, no bleeding, no active losses with
positive spontaneous activity