# A nurse is assessing a pregnant client during her first prenatal visit. The client states, "I have been pregnant 4 times. I had one full-term delivery, one preterm delivery at 34 weeks, one miscarriage at 12 weeks, and I am currently pregnant." How should the nurse document this client's obstetric history using the GTPAL system?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542821  
> language: ko  
> subject: Maternal Newborn Health

## 문제

A nurse is assessing a pregnant client during her first prenatal visit. The client states, "I have been pregnant 4 times. I had one full-term delivery, one preterm delivery at 34 weeks, one miscarriage at 12 weeks, and I am currently pregnant." How should the nurse document this client's obstetric history using the GTPAL system?

## 보기

1. G4 T1 P1 A1 L2 **✔ 정답**
2. G3 T1 P1 A1 L2
3. G4 T2 P0 A1 L2
4. G4 T1 P0 A1 L3

**정답: 1**

## 해설

GTPAL: G=4 (total pregnancies including current), T=1 (term delivery at 39 weeks), P=1 (preterm at 34 weeks), A=1 (miscarriage at 12 weeks), L=2 (living children). This is the correct documentation. Other options miscalculate gravidity, term births, or living children.

## 심화 해설

Clinical Judgment
This question assesses the ability to accurately apply the obstetric history notation system GTPAL. The key is to classify the patient's obstetric history according to the definition of each letter. The patient has been pregnant a total of 4 times, including the current pregnancy, so **G**ravidity is 4. There is 1 full-term delivery at 39 weeks (**T**erm=1), 1 preterm delivery at 34 weeks (**P**reterm=1), and 1 miscarriage at 12 weeks (**A**bortion=1). Currently, there are 2 living children—1 full-term infant and 1 healthy preterm infant—so **L**iving=2. Therefore, the correct answer is G4 T1 P1 A1 L2.

Memory Tip: GTPAL mnemonic - **G**et **T**he **P**atient's **A**ccurate **L**ineage. Or, associate **G**ravidity with the number of **G**estations, **T**erm with **T**imely births, **P**reterm with **P**remature births, **A**bortion with **A**borted pregnancies, and **L**iving with the number of **L**ive children.

KR vs US: While traditional notations like 'para/abortus' are also used in Korea, GTPAL is the standard in the US NGN exam and international clinical practice. It is crucial to clearly understand that A (Abortions) includes all pregnancy terminations before 20 weeks (both spontaneous and therapeutic abortions).

## 임상 시나리오

Clinical Practice Guide
When taking obstetric history, instead of asking, "How many times have you been pregnant, and what were the outcomes?" systematically check each component of GTPAL: total number of pregnancies, number of term deliveries, number of preterm deliveries, number of abortions, and number of living children. When documenting, be sure to follow the numerical order (G, T, P, A, L).
Caution: A common mistake is counting Gravidity excluding the current pregnancy, or including stillbirths in Living. Caution! In GTPAL, 'A' means termination before 20 weeks, 'P' means delivery between 20 and 36+6 weeks, and 'T' means delivery at 37 weeks or later. Twins count as one delivery event (P or T), but the L (living children) number is counted as the actual number of living babies.

## 핵심 개념

- **Gravidity** — Gravidity. This is the total number of pregnancies, including the current one. Multiple gestations are counted as a single pregnancy.
- **Parity** — Obstetric history. In the GTPAL system, it is recorded by breaking it down into T (term births), P (preterm births), and A (abortions).
- **Preterm Birth** — Preterm birth. Delivery occurring between 20 weeks 0 days and 36 weeks 6 days of pregnancy.
- **Abortion** — Miscarriage. This refers to the termination of a pregnancy before 20 weeks of gestation, and in GTPAL, 'A' includes both spontaneous and therapeutic abortions.
- **Term Birth** — Full-term birth. Delivery occurring between 37 weeks 0 days and 42 weeks 6 days of pregnancy.

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