# Situation: A 26-year-old woman comes to the Rural Health Unit (RHU) for her first prenatal visit on May 6, 2026. Her last menstrual period (LMP) began on January 28, 2026, and her menstrual cycles have always been regular at 28 days. She has no medical conditions and reports no danger signs. Her past pregnancies were: a daughter born at 39 weeks, now 6 years old; twins born at 34 weeks, one of whom died on the second day of life; and a miscarriage at 9 weeks. How should the nurse record her obstetric history using the gravida, term, preterm, abortion, living (GTPAL) system?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629368  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 26-year-old woman comes to the Rural Health Unit (RHU) for her first prenatal visit on May 6, 2026. Her last menstrual period (LMP) began on January 28, 2026, and her menstrual cycles have always been regular at 28 days. She has no medical conditions and reports no danger signs.

Her past pregnancies were: a daughter born at 39 weeks, now 6 years old; twins born at 34 weeks, one of whom died on the second day of life; and a miscarriage at 9 weeks. How should the nurse record her obstetric history using the gravida, term, preterm, abortion, living (GTPAL) system?

## 보기

1. G3 T1 P1 A1 L2
2. G4 T1 P1 A1 L2 **✔ 정답**
3. G4 T1 P2 A1 L2
4. G4 T1 P1 A1 L3

**정답: 2**

## 해설

Gravida counts every pregnancy including the current one: 3 past pregnancies plus this one = G4. The daughter is one term birth (T1); the twin birth at 34 weeks is one preterm birth because a multiple birth counts once (P1); the miscarriage before 20 weeks is A1. Living children count individually: the daughter and the surviving twin = L2.

## 심화 해설

What each GTPAL letter counts
The GTPAL system records obstetric history in five numbers. Gravida (G) is the number of pregnancies, including the current one, regardless of outcome. Term (T) is the number of pregnancies delivered at 37 weeks or more. Preterm (P) is the number delivered from 20 weeks up to before 37 weeks. Abortion (A) is the number of pregnancies ending before 20 weeks, whether spontaneous or induced. Living (L) is the number of children currently alive. Pregnancies and births are counted per pregnancy, while living children are counted individually.

Applying it to her history
She has had three past pregnancies and is pregnant now, so she is G4. Her daughter born at 39 weeks is one term birth: T1. The twins born at 34 weeks came from one pregnancy, so they count as one preterm birth: P1. The miscarriage at 9 weeks is before 20 weeks: A1. Her living children are the 6-year-old daughter and the surviving twin: L2. Her record is therefore G4 T1 P1 A1 L2.

| Letter | Counts | Her history | Value |
| --- | --- | --- | --- |
| G | All pregnancies, including current | 3 past + current | 4 |
| T | Births at 37 weeks or more | Daughter at 39 weeks | 1 |
| P | Births from 20 to before 37 weeks | Twins at 34 weeks (one pregnancy) | 1 |
| A | Pregnancies ending before 20 weeks | Miscarriage at 9 weeks | 1 |
| L | Children now living | Daughter and surviving twin | 2 |

How each wrong record was built
G3 T1 P1 A1 L2 leaves out the current pregnancy, which is always counted in gravida. G4 T1 P2 A1 L2 counts the twins as two preterm births, but a multiple birth counts once in T or P because it is one pregnancy. G4 T1 P1 A1 L3 counts both twins as living, but the twin who died on the second day of life is not a living child. Watch out! Twins affect only the L value as two persons; in G, T, and P they count as one pregnancy.

Why it matters in prenatal care
An accurate GTPAL record helps the nurse identify risk factors in the current pregnancy. Her previous preterm twin birth and neonatal death are important history to note, and the RHU team should review them at this first prenatal visit and watch for signs of preterm labor. With her LMP of January 28, 2026, she is about 14 weeks pregnant at this visit, so the nurse can also plan her schedule of prenatal visits, tetanus-diphtheria immunization, and laboratory tests.

## 임상 시나리오

Recording GTPALCounting twins and the current pregnancy
G counts every pregnancy, including the current one: 3 past + current = G4.

T and P count pregnancies, not babies: the daughter at 39 weeks is T1, and the twins at 34 weeks are P1. The 9-week miscarriage is A1.

L counts living children individually: the daughter and the surviving twin = L2. Record: G4 T1 P1 A1 L2.

CautionA multiple birth counts once in T or P but each living child counts in L.

## 핵심 개념

- **Gravida** — The number of times a woman has been pregnant, including the current pregnancy.
- **GTPAL** — A system recording gravida, term births, preterm births, abortions, and living children.
- **Preterm birth** — A birth from 20 weeks up to before 37 weeks of gestation.
- **Abortion (obstetric)** — A pregnancy that ends before 20 weeks of gestation, spontaneously or induced.

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