GTPAL Score Explained By Ritu Ma'am For All Nursing Exams
GTPALS system is a crucial obstetrical tool for summarizing pregnancy history. It includes Gravida (total pregnancies), Term, Preterm, Abortion, Live Children, and Stillbirths. Parity, a distinct concept, counts pregnancies progressing beyond 22 weeks of gestation, regardless of outcome, and notably excludes the current pregnancy.
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GTPALS system is a simple and standard way to record a woman’s full obstetric history. It includes Gravida, Term, Preterm, Abortion, Live children, and Stillbirths, helping healthcare workers quickly understand past pregnancy outcomes.
Parity is different from GTPALS components. It counts only pregnancies that crossed the period of viability (22 weeks), excludes the current pregnancy, and includes stillbirths. Understanding this difference is important for exams and clinical practice.
GTPALS System and Parity: Obstetrical History
GTPALS system provides a standardized method to summarize a woman's complete obstetric history, crucial for medical assessment. This framework helps healthcare professionals understand past pregnancy outcomes. Alongside GTPALS, the concept of Parity is essential, distinctly defining the number of pregnancies carried to a viable gestational age.
GTPALS Acronym: Full Form and Components
GTPALS system is a standardized method for summarizing a woman's obstetric history. The acronym stands for:
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G: Gravida
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T: Term Pregnancy
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P: Preterm Pregnancy
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A: Abortion (also known as Miscarriage)
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L: Live Children (at present)
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S: Stillbirth
Following the explanation of these components, the concept of Parity (or Para) will be discussed.
Detailed Component Definitions: G-T-P-A-L-S
The G-T-P-A-L-S components explain each part of the GTPALS system and help in clearly understanding a woman’s complete obstetric history
G: Gravida
Gravida refers to the total number of pregnancies a woman has had, regardless of the outcome. It is the total number of times she has conceived.
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Key Rule: The Gravida count includes everything: abortions, stillbirths, live births, and the current pregnancy. It is a common mistake to forget this; the present pregnancy must be counted in the Gravida (G) score.
Classification of Gravida:
|
Classification |
Definition |
|---|---|
|
G0 (Nelligravida) |
A woman who has never been pregnant. |
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G1 (Primigravida) |
A woman who is pregnant for the first first time. |
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G2 & G3 (Multigravida) |
A woman who has been pregnant two or three times. |
|
G4 or more (Grand Multigravida) |
A woman who has been pregnant four or more times. |
T & P: Term Pregnancy & P: Preterm Pregnancy
|
Type of Birth |
Definition |
|---|---|
|
T (Term Pregnancy) |
Refers to a previous birth that occurred at 37 completed weeks of gestation or more. |
|
P (Preterm Pregnancy) |
Refers to a previous birth that occurred before 37 completed weeks of gestation. |
A& L: Abortion (Miscarriage) & L: Live Children
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A (Abortion/Miscarriage): This counts the number of pregnancies lost before the period of viability.
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L (Live Children): This represents the number of living children the woman has at the present time.
The definition of abortion can be based on gestational age or fetal weight, which can cause confusion.
Criteria for Abortion:
|
Criterion |
Definition |
|---|---|
|
Gestational Age |
A pregnancy that terminates before 20-22 weeks of gestation. The 22-week cutoff is often used where younger premature infants might be saved. |
|
Fetal Weight (WHO Definition) |
The WHO primarily defines abortion by weight, not weeks. According to the WHO, an abortion is the termination of a pregnancy where the fetal weight is less than 500 grams. |
S: Stillbirth
A stillbirth is a fetal death that occurs after the period of viability.
Criteria for Stillbirth:
|
Criterion |
Definition |
|---|---|
|
Period of Viability |
Fetal death that occurs after the period of viability. |
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- India: Often defined as after 28 weeks of gestation. |
|
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- International/WHO: Between 22 to 24 weeks of gestation. |
|
|
Fetal Weight |
A fetal death where the weight is more than 500 grams. |
|
Clinical Signs |
A baby born showing no evidence of life (e.g., no heart rate, no breathing). |
Parity (Para)
Parity, also called Para, is a distinct concept from the 'P' in GTPALS.
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Definition: Parity is the number of previous pregnancies that have progressed beyond the period of viability, which is globally understood as 22 weeks of gestation.
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The current pregnancy is never counted in Parity.
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Parity is calculated based on pregnancies that cross 22 weeks, regardless of whether the infant was born alive or was a stillbirth.
Important Clarification: Stillbirth and Parity
This is a critical point and a common source of error.
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If a pregnancy ends in a stillbirth (i.e., the fetus dies after 22 weeks of gestation), it is counted in the Parity score.
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In the GTPALS system, this outcome would be recorded under S (Stillbirth) but not under T (Term) or P (Preterm).
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Therefore, a stillbirth is counted in both the 'S' of GTPALS and in the overall 'Parity' score.
Classification of Parity:
|
Classification |
Definition |
|---|---|
|
P0 (Nulliparous / Nullipara) |
A woman who has never carried a pregnancy beyond the period of viability. |
|
P1 (Primiparous / Primipara) |
A woman who has delivered one pregnancy beyond the period of viability. |
|
P2 & P3 (Multiparous / Multipara) |
A woman who has delivered two or three pregnancies beyond the period of viability. |
|
P4 or more (Grand Multipara) |
A woman who has delivered four or more pregnancies beyond the period of viability. |
The GTPALS system clearly records a woman’s pregnancy history, while Parity counts pregnancies beyond viability. Understanding both concepts helps avoid common mistakes and is essential for clinical practice and exam preparation.
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