GTPAL and Gravida Para need explanation?

[studentnurse0221]

Scenario: Sandra delivered a baby boy at 38 weeks gestation, twin girls at 36 weeks, and had a miscarriage at 11 weeks. Which of the following should the nurse document: document Gravia and Para as well.

a. G3 T2 P1 A1 L3

b. G4 T2 P2 A1 L3

c. G3 T1 P2 A1 L3

d. G4 T1 P1 A1 L3

My answer is A. But I'm not sure with that, really confuse. HELP! THANKS!

[demylenated, BSN, RN]

iteachob said:

By the way, my username....iteachob.......means I teach OB.

LOL HAHA

Just don't know why, but the fact that this was (or, had to be) pointed out caught my funny bone...

And, yup - I am back in school (ugh) and all 3 of my maternal child books (last three versions, current newest version) and 2 saunders NCLEX study books have your info as correct ? Quick web search confirms it. Multiples do not equal a higher G, T, or P number it is just PER delivery.

So, I trust your info

[fromtheseaRN, BSN, RN]

i was taught the same as iteachob says. those are the number of pregnancies, not fetuses. i'm currently in my preceptorship in L&D, and we use the same way there.

[foreverLaur]

We were taught that Para is broken down into "term, preterm, abortion, living" in order to show the number of fetuses since para does not do that. My textbook explains it the same way - gravida, para, and abortion are number of pregnancies and term, preterm, and living are number of fetuses.

Like I said above, my textbook, my school, and all area hospitals use this method.

I also checked "Maternal-Newborn Nursing Reviews and Rationales" by Prentice Hall which is a NCLEX review book and it defines them as

Gravida - the # of times a woman has been pregnant

Para - the number of births after 20 weeks gestation, born dead or alive (multiple births count as one delivery regardless of the number of infants delivered)

Term - number of term infants born after 37 weeks

Preterm - number of premature infants born between 20 and 37 weeks

Abortion - number of pregnancies that end in spontaneous of therapeutic abortion prior to 20 weeks

Living - number of children currently alive

So how is one supposed to know which is correct? The above definitions I just stated are in TWO independent nursing textbooks and several people on this forum have same different nursing textbooks define it differently.

Do we just go by "hospital policy" for how to use these? Now I am worried about the NCLEX examination since we were taught the whole purpose of using GTPAL instead of GP is to break it down so you can tell about multiple births (twins) and now I am learning that I was taught incorrectly and my textbook is incorrect.

[demylenated, BSN, RN]

foreverLaur said:

Now I am worried about the NCLEX examination since we were taught the whole purpose of using GTPAL instead of GP is to break it down so you can tell about multiple births (twins) and now I am learning that I was taught incorrectly and my textbook is incorrect.

Good question... go on a hope and a prayer that we don't get that question on the NCLEX.

[klone, MSN, RN]

foreverLaur said:

I was not including para in my answer. I was including gravida, term, preterm, abortion, and living. You are correct that para is number of births and does not take into account the number of children. That's why para is broken down into term, preterm, abortion, and living.

But it's still "pregnancy episodes" rather than number of babies in the T and P. That's why the L is there too.

[foreverLaur]

klone said:

But it's still "pregnancy episodes" rather than number of babies in the T and P. That's why the L is there too.

I get that, but that's not how my school teaches it, that's not how my textbook teaches it, and that's not how our area hospitals do it. We do number of babies, not pregnancies for T (term) and P (preterm)

[klone, MSN, RN]

foreverLaur said:

I get that, but that's not how my school teaches it, that's not how my textbook teaches it, and that's not how our area hospitals do it. We do number of babies, not pregnancies for T (term) and P (preterm)

How many area hospitals have you worked in OB as a nursing student? Just wondering how many hospitals y ou've seen this at. As you can see, this is a commonly misunderstood point, and many OB nurses don't even follow it correctly.

Out of curiosity, what textbook do you use, and could you quote here the specific info it gives regarding calculating GPTAL?

[iteachob, MSN, RN]

I've looked at 7 different OB nursing texts that are sitting here in my office. Here's what I have found. Olds, London and Ladewig (a text I have never used) does indeed say # of infants. However, (1) Pillitteri; (2) Lowdermilk & Perry (I have used this text) ; (3) Sherwin, Scoloveno & Weingarten; (4) Murray & McKinney (I currently use this text); (5) The Lippincott Manual of Nursing Practice; and (6) Ward & Hisley all refer to them as # of pregnancies delivered.

So, it seems that there is some debate on this subject. The evidence appears to be weighted heavily in the # of delivered pregnancies vs. # of infants, though.

Silvestri...Saunder's Comprehensive Review for NCLEX-RN also refers to # of deliveries.

[klone, MSN, RN]

And the aforementioned Williams Obstetrics.

[RNLaborNurse4U]

I had this very same debate with my antepartum instructor for my MSN program (nurse-midwifery). What we do at work (teaching hospital) is different than what is taught in my midwifery program.

At work: TPAL is number of pregnancies for the T-P-A sections. So, at work, this would be a G3 P1113.

At school: T-P is number of fetuses. Oh, plus we add a fifth number to the TPAL to indicate the number of multiple gestation pregnancies! For school, this would be a G3 P12131 (the last one indicating one multiple gestation pregnancy).

Talk about confusing.

[foreverLaur]

klone said:

How many area hospitals have you worked in OB as a nursing student? Just wondering how many hospitals y ou've seen this at. As you can see, this is a commonly misunderstood point, and many OB nurses don't even follow it correctly.

Out of curiosity, what textbook do you use, and could you quote here the specific info it gives regarding calculating GPTAL?

I posted it previously (the information) and it is from Old's Maternal-Newborn Nursing & Women's Health Across the Lifespan 8th edition by Davidson, London, Ladewig.

I did clinical in one hospital system, but my we use all area hospitals so I spoke to my classmates who were at the other hospital systems and they said the same thing - it was done the way we were taught in school and in our textbook (which is evidently incorrect).

[sameasalways, ASN, RN]

I am totally not an ob/gyn nurse as evidenced by my post to this board, but it was my understanding that GTPAL and the use of GP are considered different...as in, the doctor would frequently refer to his patients as G2P1 , G3P1 ect..and this stood for :Gravida 2 Para 1, whereas, the acronym GTPAL was different and not as frequently used in routine conversation but was more detailed and stood for something different..the P standing for "preterm" in the GTPAL acronym. This is how I had always determined whether or not the P was Para: number of fetuses delivered after viability (20 weeks) or Preterm: number of preterm deliveries (how many preterm deliveries the mother had, not how may preterm babies the mother had).