A pregnant client comes to the office for her first prenatal examination at 10 weeks. She has been pregnant twice before, the first delivery produced a viable baby girl at 39 weeks 3 years ago; the second pregnancy produced a viable baby boy at 36 weeks 2 years ago. Both children are living and well. Using the GTPAL system to record her obstetrical history, the nurse should record?

1. A

   3-2-0-0-2

2. B

   2-2-0-2-2

3. C

   3-1-1-0-2

4. D

   2-1-1-0-2

Appeared in: NORCET -4 , 2023

Explanation

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• The GTPAL system is a comprehensive method to document a woman's obstetric history.
• G (Gravida) is the total number of pregnancies, including the current one. The client is currently pregnant and had two prior pregnancies, so G=3.
• T (Term) is the number of births at or after 37 weeks. The first delivery was at 39 weeks, so T=1.
• P (Preterm) is the number of births between 20 and 36 6/7 weeks. The second delivery was at 36 weeks, so P=1.
• A (Abortion) is the number of pregnancy losses before 20 weeks. The client has none, so A=0.
• L (Living) is the number of living children. Both children are alive, so L=2. This results in the notation 3-1-1-0-2.

Why Other Options Were Wrong

• Option A: This option incorrectly classifies the preterm delivery (at 36 weeks) as a term delivery, resulting in T=2 and P=0, which is inaccurate.
• Option B: This option incorrectly calculates Gravida as 2, failing to include the current pregnancy. It also misclassifies the preterm birth as term (T=2) and incorrectly states there were 2 abortions (A=2).
• Option D: This option incorrectly calculates Gravida as 2. The term 'Gravida' must always include the current pregnancy.

Related Visual

• Visual 1: Infographic - A chart breaking down the GTPAL mnemonic with clear definitions and examples for each letter (Gravida, Term, Preterm, Abortion, Living). This helps learners memorize the components and their specific timeframes.

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Obstetrical History Documentation using GTPAL System in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Accurate GTPAL documentation is crucial for initial risk assessment. A history of preterm birth (P=1) immediately flags the client for increased surveillance and potential interventions to prevent a recurrence.
• The GTPAL score provides a quick, standardized summary for all healthcare providers involved in the client's care, ensuring continuity and awareness of her obstetric history.
• What if? If the second baby, born at 36 weeks, had not survived, the GTPAL would change to 3-1-1-0-1. The 'L' component is critical for understanding the family's current situation and potential grief.

How to Approach the Question

• First, understand what each letter in the GTPAL mnemonic stands for: G (Gravida), T (Term), P (Preterm), A (Abortion), L (Living).
• Read the clinical scenario carefully, extracting each piece of information related to the client's pregnancies.
• Calculate 'G' by counting all pregnancies: the current one + all previous ones.
• Calculate 'T' by counting deliveries that occurred at or after 37 weeks.
• Calculate 'P' by counting deliveries that occurred between 20 weeks and 36 weeks 6 days.
• Calculate 'A' by counting any pregnancy losses before 20 weeks.

Concept Tested & Keywords

• Concept Tested: Obstetrical History Documentation using GTPAL System
• Stem keywords: pregnant client, prenatal examination, 10 weeks, GTPAL system, obstetrical history
• Lead-in keywords: nurse should record
• Clinical cues: Currently pregnant at 10 weeks
• Clinical cues: Pregnant twice before

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