A nurse is collecting an obstetrical history from a client admitted to the labor and birth… — NCLEX-RN

A nurse is collecting an obstetrical history from a client admitted to the labor and birth unit. The client reports the following history:

- Currently pregnant with twins.
- Delivered a viable male infant at $39$ weeks of gestation, who is now $5$ years old and healthy.
- Delivered viable female twins at $34$ weeks of gestation, both of whom are now $3$ years old and healthy.
- Experienced a spontaneous abortion at $10$ weeks of gestation.
- Delivered a stillborn fetus at $22$ weeks of gestation.

Using the GTPAL system, calculate the number that represents the client's "Preterm" (P) deliveries. Record your answer as a whole number.

Answer: 2

Answer

The client's 'Preterm' (P) score is

2

. This includes the delivery of the twins at

34

weeks (which counts as one delivery event) and the delivery of the stillborn fetus at

22

weeks (which counts as a delivery because it reached

20

weeks of gestation). The current pregnancy is not a delivery, the

39

-week delivery is term (T), and the

10

-week loss is an abortion (A).

Step-by-Step Solution

Define the criteria for a preterm delivery.

A preterm delivery is defined as birth occurring between

20

weeks

0

days and

36

weeks

6

days of gestation.

Establishing the correct gestational age parameters is required before evaluating the client's obstetrical history.

Evaluate the twin delivery at

34

weeks of gestation.

This counts as

1

preterm delivery.

In the GTPAL system, multiple gestations (such as twins or triplets) count as a single pregnancy and a single delivery event.

Evaluate the stillborn delivery at

22

weeks of gestation.

This counts as

1

preterm delivery.

The delivery occurred after

20

weeks of gestation, so it meets the criteria for preterm regardless of the fetal outcome.

Calculate the total preterm (P) count.

The total is

1 + 1 = 2

Summing the identified preterm deliveries yields the final score.

Key Concept

In the GTPAL system, 'Preterm' (P) refers to the number of pregnancies that ended between 20 and 36 weeks 6 days of gestation, with multiple gestations counting as a single delivery and fetal survival not affecting the classification.

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