A 27 years old female 16 week pregnant has 2 year old twins who were born at 36 weeks gestation and a 5 year old who was born at 40 weeks. She had no history of abortion what is her GTPAL score?

1. A

   G=3, T=1, P=0, A=0, L=3

2. B

   G=3, T=1, P=0, A=2, L=3

3. C

   G=3, T=1, P=2, A=0, L=3

4. D

   G=3, T=1, P=0, A=0, L=2

Appeared in: HPSSC Staff Nurse - 2021

Explanation

• The GTPAL score is a standardized format for summarizing a woman's obstetric history.
• G (Gravida) is 3, which includes her current pregnancy, the previous twin pregnancy, and the previous singleton pregnancy.
• T (Term) is 1, for the child born at 40 weeks gestation (a pregnancy is term if it reaches 37 weeks).
• P (Preterm) is 1, for the twin pregnancy delivered at 36 weeks. A delivery between 20 and 36 6/7 weeks is preterm. A multiple birth (twins, triplets, etc.) counts as a single preterm or term event.
• A (Abortion) is 0, as the patient has no history of pregnancy loss before 20 weeks.
• L (Living) is 3, representing her two living twins and her one living singleton child.

Why Other Options Were Wrong

• Option B: This option incorrectly states the patient had 2 abortions (A=2). The clinical history clearly mentions no history of abortion.
• Option C: This option incorrectly counts the preterm births as 2 (P=2). A single pregnancy that results in multiple births (like twins) is counted as only one preterm birth event.
• Option D: This option incorrectly counts the number of living children as 2 (L=2). The patient has 3 living children: the two twins and the 5-year-old.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Calculation of the GTPAL score for obstetric history as background academic context rather than a clinical decision trigger.
• The GTPAL score provides a quick, standardized summary of a patient's obstetric history, which is essential for assessing risks in the current pregnancy.
• A history of preterm birth (P=1 in this case) is one of the strongest predictors of future preterm birth, alerting the healthcare team to monitor the patient more closely for signs of preterm labor.
• Accurate documentation ensures continuity of care and helps all members of the healthcare team understand the patient's background at a glance.

How to Approach the Question

• This is an analytical question requiring the application of a standard medical mnemonic (GTPAL) to a clinical scenario.
• First, clearly define each component of GTPAL: Gravida, Term, Preterm, Abortion, Living.
• Go through the patient's history systematically, assigning a value to each letter one by one.
• For 'G' (Gravida), count every pregnancy, including the current one.
• For 'T' (Term), count pregnancies delivered at or after 37 weeks.
• For 'P' (Preterm), count pregnancies delivered between 20 and 36 6/7 weeks. Remember that a single twin pregnancy counts as ONE birth event.

Concept Tested & Keywords

• Concept Tested: Calculation of the GTPAL score for obstetric history.
• Stem keywords: GTPAL score, pregnant, 16 week, twins, 36 weeks, 40 weeks, no history of abortion
• Lead-in keywords: what is her GTPAL score
• Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

Question ID

QrrFH8VZTAuuOwGQj7KMhH

Copy ID

Reference Book

E6 Obstetrics Williams p. 71-95