Gravida/Para GTPAL... HELP!

  1. 0
    I am having so difficulty with my pt's GTPAL. It seems to be different depending on where in her chart I look! It's quite confusing...
    Pt. Hx:
    3 term births
    1 first trimester miscarriage
    1 20wk live birth
    twins delivered at 25wks
    5 living children
    plus current pregnancy- scheduled c/s at 39wks

    The L&D nurse charted her as G7 P4215
    is she counting the 39wk unborn fetus as a term baby? is this common practice?
    I got G7 P3215 for pre-delivery and then G7P4215. Is this right? or do I now count the neonate in the # of living children and get G7P4216?
    Thanks!
    Last edit by mixyRN on Feb 10, '08
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  3. 11 Comments so far...

  4. 0
    No, she's counting the 20 week live birth in the parity, which is how I was taught - the parity counts any live births from 20 weeks and beyond. She's given birth to four live children (before this one, including the live 20 weeker), two preterm infants (the twins), had one miscarriage/abortion, and has five living children - but she's been pregnant seven times, which is where the current pregnancy is counted. (Remember to only count the twins as ONE pregnancy, even though it's two kids. That really confused me once when I had a patient with triplets!)

    So she's definitely G7P4215. The current pregnancy is not counted as a live birth until it's here, then she's G7P5216 (and God bless her for it).

    And I found this thread when I was checking to make sure I remembered my OB correctly:

    http://allnurses.com/forums/f35/ques...es-148325.html
    Last edit by carolinapooh on Feb 10, '08
  5. 0
    Check with your instructor about including the present pregnancy. Some instructors do not want it added until delivery and you might get points taken off because of it (mine are like this).

    OB hx:
    3 term births
    1 first trimester miscarriage 1
    20wk live birth
    twins delivered at 25wks
    5 living children
    plus current pregnancy- scheduled c/s at 39wks

    G-6 T-3 P-2 A-1 L-5 (without this pregnancy)

    She's been pregnant 6 times (not including this one), which resulted in 3 term births, 3 pre term births (20 wks, twins at 25 wks) 1 abortion (miscarriage is a spontaneous abortion), and five living children.

    It looks like the nurse has a P-4 because she added the miscarriage in but in order for it to be a P-4 the miscarriage would have had to result in a viable fetus (live at birth) which wouldn't be the case because the miscarriage was in the 1st trimester (1-12 wks).

    If you're suppose to have current pregnancy it would be (which is the proper way)

    G-7 T-3 P-2 A-1 L-5 (pending outcome of this pregnancy)

    The rest of the reasonings would be the same.
    Last edit by APBT mom on Feb 12, '08
  6. 0
    p.s. >37 wks is considered term.
  7. 0
    ok, so my final question is about the "P" in TPAL. Regarding the twin pregnancy, I understand that it is considered 1 pregnancy so add 1 to the gravida BUT for the P part of TPAL does it count #children delivered (this case would be 2) or just the pregnancy as a whole (which would be one)

    So I am asking which one is correct:
    (pending outcome of this pregnancy)

    G7 T-3 P-3 A-1 L-5 or G7 T-3 P-2 A-1 L-5
  8. 0
    Quote from mixy
    ok, so my final question is about the "P" in TPAL. Regarding the twin pregnancy, I understand that it is considered 1 pregnancy so add 1 to the gravida BUT for the P part of TPAL does it count #children delivered (this case would be 2) or just the pregnancy as a whole (which would be one)

    So I am asking which one is correct:
    (pending outcome of this pregnancy)

    G7 T-3 P-3 A-1 L-5 or G7 T-3 P-2 A-1 L-5
    The correct way to do it would be P-2 because she only had 2 pre term deliveries (one which resulted in twins).

    Some instructors what it as the outcome of that delivery so she had to preterm births that resulted in 3 children P-3 (this is the way my instructor wants it).

    Just ask your instructor which one she prefers.
  9. 0
    Quote from Tampagirl
    Check with your instructor about including the present pregnancy. Some instructors do not want it added until delivery and you might get points taken off because of it (mine are like this).

    OB hx:
    3 term births
    1 first trimester miscarriage 1
    20wk live birth
    twins delivered at 25wks
    5 living children
    plus current pregnancy- scheduled c/s at 39wks

    G-6 T-3 P-2 A-1 L-5 (without this pregnancy)

    She's been pregnant 6 times (not including this one), which resulted in 3 term births, 3 pre term births (20 wks, twins at 25 wks) 1 abortion (miscarriage is a spontaneous abortion), and five living children.

    It looks like the nurse has a P-4 because she added the miscarriage in but in order for it to be a P-4 the miscarriage would have had to result in a viable fetus (live at birth) which wouldn't be the case because the miscarriage was in the 1st trimester (1-12 wks).

    If you're suppose to have current pregnancy it would be (which is the proper way)

    G-7 T-3 P-2 A-1 L-5 (pending outcome of this pregnancy)

    The rest of the reasonings would be the same.
    Just a comment - but that seems bizarre to me, since regardless of whether the kid is born live or stillborn, she's still pregnant, and she's pregnant now. Even my GYN (whom I oddly enough saw today!) has never heard of not counting the current pregnancy, because she IS pregnant. Weird. Not saying your instructor's wrong, but that makes no sense. My textbook - which I just pulled down and dusted - also says the current pregnancy is counted in the gravida G.

    And the miscarriage is in the A's; the 20 weeker (who obviously died) was still a live birth, hence the P.
    Last edit by carolinapooh on Feb 12, '08
  10. 0
    Quote from carolinapooh
    Just a comment - but that seems bizarre to me, since regardless of whether the kid is born live or stillborn, she's still pregnant, and she's pregnant now. Even my GYN (whom I oddly enough saw today!) has never heard of not counting the current pregnancy, because she IS pregnant. Weird. Not saying your instructor's wrong, but that makes no sense. My textbook - which I just pulled down and dusted - also says the current pregnancy is counted in the gravida G.

    And the miscarriage is in the A's; the 20 weeker (who obviously died) was still a live birth, hence the P.

    It irks me too because I worked in OB and we always counted the current pregnancy. My instructor based it on the fact that you don't know what the outcome is going to be so don't include it. Which I understand but it still should be on there.

    The reason it's a para 2 is because she gave birth at 20 wks (1) and twins at 25 wks (1). Even though the second para resulted in two babies it's counted as one because she gave birth once which resulted in two children. You do it the same way you would for the G. (I don't know if the way I explained it makes sense but that's how the OB MD explained it to me).
  11. 0
    Quote from Tampagirl
    It irks me too because I worked in OB and we always counted the current pregnancy. My instructor based it on the fact that you don't know what the outcome is going to be so don't include it. Which I understand but it still should be on there.

    The reason it's a para 2 is because she gave birth at 20 wks (1) and twins at 25 wks (1). Even though the second para resulted in two babies it's counted as one because she gave birth once which resulted in two children. You do it the same way you would for the G. (I don't know if the way I explained it makes sense but that's how the OB MD explained it to me).
    Exactly. (The OP had still seemed confused on the whole para number; you and I agree on the 2.)

    The instructor claims the outcome is unknown? How insane - she's pregnant, right? The outcome goes in the other alphabet soup. :angryfire:icon_roll

    Where do they find these people?
  12. 0
    Quote from carolinapooh
    Exactly. (The OP had still seemed confused on the whole para number; you and I agree on the 2.)

    The instructor claims the outcome is unknown? How insane - she's pregnant, right? The outcome goes in the other alphabet soup. :angryfire:icon_roll

    Where do they find these people?

    It drives me boonkers. I don't want to be one of those students who say we'll I've done this for such and such time so I just nod my head and smile knowing that if I ever work on a L&D floor I'll do it the way it's supposed to be done. But until then they're the ones that are giving me my grades so I have to play the game.


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