Mrs. Poonam was pregnant for the first time and delivered a live baby at 35 weeks. When the child becomes 3 years old, she was pregnant again but had a miscarriage at 12 weeks. Then a few months later, she became pregnant again and gave birth at 39 weeks. What is the obstetrical score of Mrs. Poonam using the GTPAL system?

1. A

   G3 T1 P1A1L2

2. B

   G2 T1 P1A1L2

3. C

   G3 T2P0A1L2

4. D

   G3 T0P2A1L2

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

• The GTPAL system provides a comprehensive summary of a woman's pregnancy history.
• G (Gravida) is 3 because Mrs. Poonam has been pregnant three times.
• T (Term) is 1 for the single delivery that occurred at 39 weeks (which is at or after 37 weeks).
• P (Preterm) is 1 for the delivery at 35 weeks (which is between 20 and 36 weeks).
• A (Abortion) is 1 for the miscarriage that occurred at 12 weeks (before 20 weeks).
• L (Living) is 2 because she has two living children from the first and third pregnancies.

Why Other Options Were Wrong

• Option B: This option incorrectly states the Gravida (G) as 2. Mrs. Poonam had three separate pregnancies, so her Gravida is 3.
• Option C: This option incorrectly classifies the births. It counts two Term (T) births and zero Preterm (P) births. The 35-week delivery was preterm, not term.
• Option D: This option incorrectly classifies the births. It counts zero Term (T) births and two Preterm (P) births. The 39-week delivery was term, not preterm.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Obstetrical scoring using the GTPAL system as background academic context rather than a clinical decision trigger.
• The GTPAL score provides a quick and standardized summary of a patient's obstetric history, which is crucial for assessing risks in current and future pregnancies.
• A history of preterm birth (P1) or recurrent miscarriages (A1) can indicate a higher risk for similar outcomes in subsequent pregnancies, requiring closer monitoring.
• Nurses use this score during initial assessments to quickly understand a patient's past pregnancy outcomes and plan appropriate care.

How to Approach the Question

• First, understand what each letter in the GTPAL acronym stands for: G=Gravida (total pregnancies), T=Term births (≥37 weeks), P=Preterm births (20-36 weeks), A=Abortions/miscarriages (<20 weeks), L=Living children.
• Read the patient's history carefully and identify each separate pregnancy and its outcome.
• Go through the history chronologically and tally each event under the correct category.
• Pregnancy 1: Delivery at 35 weeks. This is 1 Gravida, 1 Preterm, and 1 Living child.
• Pregnancy 2: Miscarriage at 12 weeks. This is 1 Gravida and 1 Abortion.
• Pregnancy 3: Delivery at 39 weeks. This is 1 Gravida, 1 Term, and 1 Living child.

Concept Tested & Keywords

• Concept Tested: Obstetrical scoring using the GTPAL system
• Stem keywords: GTPAL system, obstetrical score, pregnant, delivered, 35 weeks, miscarriage, 12 weeks, 39 weeks
• Lead-in keywords: What is
• Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

Question ID

QR3cbve8tFk0P1Ih-BolqO

Copy ID

Reference Book

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 27-35