A pregnant woman presented in ANC clinic with twins. After history reveals that woman had delivered a child before 2 years at 36 gestation and also tells there is no any history of abortion and medication induced fetal demise. What is the GTPAL score?

1. A

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

2. B

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

3. C

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

4. D

   G=2, T=0, P=2, A-0, L=2

Appeared in: NORCET-7 Mains-2024

Explanation

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• The GTPAL system is a standardized way to summarize a woman's obstetric history.
• G (Gravida) is 2, representing one past pregnancy and the current one (twins count as one pregnancy).
• T (Term) is 0, as the previous birth was at 36 weeks, which is preterm (not at or after 37 weeks).
• P (Preterm) is 1, for the single previous delivery at 36 weeks gestation.
• A (Abortion) is 0, as the history explicitly states no abortions.
• L (Living) is 1, for the one child born from the previous pregnancy. The current fetuses are not counted until after birth.

Why Other Options Were Wrong

• Option A: This option incorrectly states P=2. The 'P' (Preterm) only counts delivered pregnancies. The current pregnancy, although it may result in a preterm birth, has not yet been delivered and is not counted in the P score.
• Option C: This option incorrectly states G=3. Gravida (G) counts the number of pregnancies, not the number of fetuses. A twin pregnancy is a single gravid event.
• Option D: This option incorrectly states P=2 and L=2. The 'P' (Preterm) is 1 for the single past delivery. The 'L' (Living) is 1 because the current twins are not yet born and cannot be counted as living children.

Related Visual

• Visual 1: Infographic - A chart clearly defining each component of the GTPAL mnemonic (Gravida, Term, Preterm, Abortion, Living) with simple icons and examples, highlighting that a twin pregnancy is G1 but can be L2 after birth.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Obstetric History Assessment using GTPAL System as background academic context rather than a clinical decision trigger.
• Accurate GTPAL scoring is crucial for initial patient assessment. It provides a quick, standardized summary of a woman's obstetric history, helping healthcare providers identify potential risks in the current pregnancy.
• A history of preterm birth (P=1) is a significant risk factor for preterm birth in subsequent pregnancies. This woman's history immediately alerts the nurse and provider to monitor for signs of preterm labor.
• What if? If the woman's previous delivery had been at 38 weeks, the GTPAL would change to G=2, T=1, P=0, A=0, L=1, as the delivery would now be classified as term.

How to Approach the Question

• First, understand what each letter in the GTPAL acronym stands for: Gravida, Term, Preterm, Abortion, Living.
• Break down the patient's history into distinct pregnancy events. In this case, there is one past pregnancy and one current pregnancy.
• Calculate 'G' (Gravida) by counting the total number of times the woman has been pregnant, including the current one. Remember, multiples (twins, triplets) count as one pregnancy.
• Calculate 'T' (Term) by counting past deliveries that occurred at 37 weeks or later.
• Calculate 'P' (Preterm) by counting past deliveries that occurred between 20 and 36 6/7 weeks.
• Calculate 'A' (Abortion) by counting pregnancy losses before 20 weeks.

Concept Tested & Keywords

• Concept Tested: Obstetric History Assessment using GTPAL System
• Stem keywords: GTPAL score, pregnant woman, twins, 36 gestation, delivered a child
• Lead-in keywords: What is
• Clinical cues: Current pregnancy with twins: This counts as one pregnancy (Gravida), but if delivered, would count as two living children (Living).
• Clinical cues: Previous delivery at 36 weeks: This is classified as a preterm birth.

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