A female comes on first antenatal visit at 10 weeks and states that she already have two earlier pregnancy that was delivered three years ago in that one baby delivered at 36 weeks of gestation and another is delivered at 39 weeks of gestation. What is the GTPAL score?

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

The GTPAL system is a comprehensive way to record a woman's obstetric history.
G stands for Gravida, the total number of pregnancies. In this case, it is 3 (the current pregnancy plus two prior ones).
T stands for Term births (≥37 weeks). The delivery at 39 weeks makes T=1.
P stands for Preterm births (20 to 36+6 weeks). The delivery at 36 weeks makes P=1.
A stands for Abortions (<20 weeks). None were reported, so A=0.
L stands for Living children. The two previous deliveries resulted in two living children, so L=2.

Option B: This option incorrectly states the Gravida (G) as 1. It should be 3, including the current and two previous pregnancies. It also incorrectly lists 0 for Preterm (P) and 1 for Abortion (A).
Option C: This option incorrectly states Gravida (G) as 1, Term (T) as 2, Preterm (P) as 2, and Abortion (A) as 1. All these values contradict the patient's history.
Option D: This option incorrectly states Gravida (G) as 1, Abortion (A) as 1, and Living (L) as 1. The total number of pregnancies is 3, there are no reported abortions, and there are two living children.

Visual 1: Infographic: A step-by-step guide to calculating the GTPAL score from a patient's obstetric history, with clear definitions for each letter and examples.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Obstetrical History using GTPAL Score as background academic context rather than a clinical decision trigger.
Accurate GTPAL scoring is a fundamental skill for nurses in obstetrics. It provides a quick and standardized summary of a patient's pregnancy history, which is essential for risk assessment.
In this specific case, the 'P1' is a critical piece of information. A history of a preterm birth (at 36 weeks) is a significant risk factor for preterm labor in subsequent pregnancies. This alerts the nursing and medical team to monitor the patient more closely for signs of early labor.
What if? If the delivery at 39 weeks had been a set of twins who are both alive, the GTPAL score would be G3T1P1A0L3. The 'L' component counts the number of individual living children, not the number of pregnancies that resulted in live births.

How to Approach the Question

First, identify that the question requires calculating the GTPAL score, a standard format for documenting obstetric history.
Recall the definition for each letter: G (Gravida - total pregnancies), T (Term - births ≥37 weeks), P (Preterm - births 20-36+6 weeks), A (Abortion - losses <20 weeks), L (Living children).
Systematically analyze the patient's history provided in the question for each component.
Calculate G: The woman is currently pregnant (1) + she had two previous pregnancies (2) = 3.
Calculate T: One birth occurred at 39 weeks (term) = 1.
Calculate P: One birth occurred at 36 weeks (preterm) = 1.

Concept Tested & Keywords

Concept Tested: Obstetrical History using GTPAL Score
Stem keywords: antenatal visit, GTPAL score, 36 weeks, 39 weeks, two earlier pregnancy
Lead-in keywords: What is
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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