# A nurse is reviewing the obstetric history of a 28-year-old woman during her prenatal visit. The patient states: "I had one full-term pregnancy that resulted in a live birth, one miscarriage at 10 weeks, and one stillbirth at 32 weeks. This is my fourth pregnancy." How should the nurse document this patient's gravidity and parity using the GTPAL system? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542819 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is reviewing the obstetric history of a 28-year-old woman during her prenatal visit. The patient states: "I had one full-term pregnancy that resulted in a live birth, one miscarriage at 10 weeks, and one stillbirth at 32 weeks. This is my fourth pregnancy." How should the nurse document this patient's gravidity and parity using the GTPAL system? ## 보기 1. G4 T1 P0 A1 L1 **✔ 정답** 2. G4 T1 P1 A1 L1 3. G3 T1 P0 A2 L1 4. G4 T2 P0 A1 L1 **정답: 1** ## 해설 Gravidity (G) is total pregnancies (4). Term births (T) is 1 (full-term live birth). Preterm births (P) is 0 (stillbirth at 32 weeks is not preterm as it ended in fetal death). Abortions (A) is 1 (miscarriage at 10 weeks). Living children (L) is 1. Option 1 (G4 T1 P0 A1 L1) is correct. Other options have incorrect counts for P or T. ## 심화 해설 Understanding the GTPAL System The GTPAL system is a standardized method for documenting a woman's obstetric history, providing a more detailed picture than the simple gravida/para system. It allows healthcare providers to quickly assess potential risk factors based on past pregnancy outcomes. The components are: - G (Gravidity): The total number of pregnancies, regardless of outcome, including the current one. - T (Term births): The number of pregnancies delivered at 37 weeks of gestation or later. - P (Preterm births): The number of pregnancies delivered between 20 weeks and 36 weeks and 6 days of gestation. - A (Abortions): The number of pregnancies ending before 20 weeks of gestation, whether spontaneous (miscarriage) or elective. - L (Living children): The number of children currently alive. Applying the System to the Patient's History The patient's statement provides all the necessary data points. Let's break down each element to determine the correct GTPAL code. **1. Calculating Gravidity (G)** The patient states, "This is my fourth pregnancy." This is a straightforward count of all pregnancies, including the current one. Therefore, Gravidity is 4. **2. Calculating Term Births (T)** The patient reports "one full-term pregnancy that resulted in a live birth." A full-term delivery is defined as one occurring at 37 weeks or later . This single event meets the criteria. Therefore, T is 1. **3. Calculating Preterm Births (P)** The patient reports "one stillbirth at 32 weeks." A delivery at 32 weeks falls within the preterm window of 20 weeks to 36 weeks and 6 days. A stillbirth is a delivery, and it is categorized by the gestational age at which it occurred. Therefore, this event is counted as a preterm birth. P is 1. It is critical to recognize that a stillbirth is not counted in the "A" category if it occurs after 20 weeks. **4. Calculating Abortions (A)** The patient reports "one miscarriage at 10 weeks." A miscarriage is a spontaneous abortion, and a pregnancy loss at 10 weeks is before the 20-week threshold. Therefore, this event is counted as an abortion. A is 1. **5. Calculating Living Children (L)** The patient has one child from the full-term pregnancy. The miscarriage and the stillbirth did not result in a living child. Therefore, L is 1. Synthesizing the GTPAL Code Combining all the calculated components, the correct documentation is: **G4 T1 P1 A1 L1** This corresponds to option 1 in the answer choices. A history that includes a prior preterm birth and a stillbirth is clinically significant. The presence of a prior preterm delivery is a well-established and powerful predictor of recurrence in subsequent pregnancies . Similarly, a history of stillbirth is a key maternal risk factor that requires heightened surveillance and targeted interventions in the current pregnancy to mitigate the risk of another adverse outcome . The GTPAL system efficiently flags these risks at a glance, allowing the nurse and the healthcare team to initiate appropriate monitoring and preventive care plans. ## 임상 시나리오 Clinical Guide: Documenting Obstetric History with GTPAL The GTPAL system provides a standardized, detailed snapshot of a patient's obstetric history, which is critical for identifying potential risks in the current pregnancy. Accurate documentation relies on strict adherence to gestational age cutoffs. Step-by-Step Calculation - **G (Gravidity):** Count every pregnancy, including the current one, ectopic pregnancies, and molar pregnancies. The outcome or number of fetuses does not matter. - **T (Term):** Count deliveries occurring at **37 weeks and 0 days** or later. This includes both live births and stillbirths at this gestational age. - **P (Preterm):** Count deliveries occurring from **20 weeks and 0 days to 36 weeks and 6 days**. This includes live births and stillbirths. A 32-week stillbirth is documented here. - **A (Abortion):** Count pregnancies ending before **20 weeks and 0 days**. This includes spontaneous miscarriages, elective terminations, and ectopic pregnancies. - **L (Living):** Count the number of children currently alive at the time of data collection. This is not a count of deliveries, as a multiple gestation could result in multiple living children from one birth event. Critical Distinctions & Common Pitfalls - **Stillbirth vs. Abortion:** The key differentiator is the 20-week threshold. A fetal demise at 18 weeks is an abortion (A), while a demise at 32 weeks is a preterm birth (P). - **Multiple Gestations:** A twin pregnancy delivered at 38 weeks counts as G1, T1, P0, A0, L2. The pregnancy event is counted once for G, T, and P, but the living children are counted individually for L. - **Current Pregnancy:** Always include the current pregnancy in the G (gravidity) count, but do not count its outcome in T, P, A, or L until delivery has occurred. Clinical Reasoning for Risk Assessment A GTPAL of G4 T1 P1 A1 L1 indicates a multigravida with a history of both a preterm birth and a spontaneous abortion. This history alerts the nurse and provider to potential recurrence risks, such as preterm labor, cervical insufficiency, or other maternal conditions, prompting closer surveillance during the current pregnancy. ## 핵심 개념 - **Gravidity** — The total number of pregnancies a woman has had, including the current one, regardless of outcome or number of fetuses. - **Parity** — The number of pregnancies that have reached 20 weeks of gestation or beyond, regardless of whether the infant was born alive or stillborn. - **GTPAL** — A detailed obstetric history recording system: Gravidity, Term births (37+ weeks), Preterm births (20-36.6 weeks), Abortions ( - **Term Birth** — A delivery that occurs between 37 weeks and 0 days of gestation and 42 weeks and 0 days of gestation. - **Preterm Birth** — A delivery that occurs after 20 weeks and 0 days of gestation but before 37 weeks and 0 days of gestation. ## 같은 주제 문제 - [A 32-year-old woman presents to the prenatal clinic for her first visit. 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