A woman comes to the hospital his history is 1 abortion two years back, one twins baby and

now she is pregnant. What is the GTPAL Score?

Appeared in: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Explanation

The correct GTPAL score is G3T1P1A1L2.
G (Gravida) is 3, accounting for the current pregnancy, the past twin pregnancy, and the past abortion.
T (Term) is 1, representing the single twin birth event, which is assumed to be at term based on the options.
P (Para/Preterm) is 1, representing the single twin birth event that reached viability (over 20 weeks). It's crucial to note that a multiple birth counts as one event for parity.
A (Abortion) is 1, as stated in the patient's history.
L (Living) is 2, as the twin birth resulted in two living children.

Option A: This option incorrectly calculates Gravida (G) as 2, failing to include the current pregnancy. It also incorrectly calculates Para (P) as 2; a single twin birth is one para event, not two.
Option B: This option incorrectly calculates Gravida (G) as 2. The total number of pregnancies, including the current one, is 3.
Option C: This option incorrectly calculates the Para (P) value as 2. Parity refers to the number of pregnancies carried to a viable age, not the number of fetuses delivered. A twin pregnancy is a single para event.

Clinical Relevance

Nursing practice connection: Use the key finding related to GTPAL Scoring System to guide bedside assessment, documentation, and the next nursing action.
The GTPAL system provides a concise and standardized summary of a patient's obstetric history, which is essential for rapid communication among healthcare providers.
Accurate GTPAL scoring helps in assessing a patient's risk profile. For example, a high parity (grand multipara) can be associated with risks like postpartum hemorrhage.
Misinterpreting the components, especially with multiple gestations, can lead to an inaccurate understanding of a patient's history and potential risks in the current pregnancy.

How to Approach the Question

First, carefully read the patient's history and identify every separate pregnancy event: current pregnancy, past deliveries, and past abortions/miscarriages.
Calculate 'G' (Gravida) by adding up the total number of pregnancies, including the current one.
Analyze each past pregnancy to determine its outcome: Term (T), Preterm (P), or Abortion (A).
Calculate 'L' (Living) by counting the total number of living children from all pregnancies.
Remember the specific rule for multiple gestations like twins: they count as ONE pregnancy event for G, T, and P, but as multiple children for L.
Assemble the final GTPAL score and compare it with the given options. Be aware that 'P' can sometimes be used for Parity (births after 20 weeks) rather than just Preterm, especially if the options don't fit the standard definition.

Concept Tested & Keywords

Concept Tested: GTPAL Scoring System
Stem keywords: GTPAL Score, abortion, twins baby, pregnant
Lead-in keywords: What is
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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E6 Obstetrics Williams p. 71-95

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 35-43

Practise the full Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Attempt every question from this paper in a timed mock, then review the full solution for each one.