Gravida Parity assignment:
GTPA: stands for: gravida, term, preterm, abortions, living
Gravida: how many pregnancies a woman has had. Term how many pregnancies delivered that have reached or surpassed 37 weeks gestation.
Term: how many pregnancies a woman has had that delivered at 37 weeks or greater.
Preterm: how many pregnancies between 20-36 6/7 weeks gestation.
Abortion: how many pregnancies have been lost at less than 20 weeks. Abortions also may be induced by a physician or spontaneously lost. This also refers to miscarriages.
Living: how many children are living now?
******Multiple births ( twins, triplets and higher order multiples) count as one birth.
!. This is a mom’s 1st pregnancy:
2. This is a mom’s 3rd pregnancy and she had an abortion at 8 weeks for the 1st pregnancy and a miscarriage at 10 weeks, she has no preterm deliveries or living children at present.
3. This is a mom’s 3rd pregnancy the first pregnancy delivered at 38 weeks gestation and the 2nd pregnancy was twins delivered at 37 weeks. 1 of those children died.
4. This is a mom’s 2nd pregnancy. She delivered twins at 37 weeks and both of the babies survived.
5. This is a mom’s 3rd pregnancy. She delivered triplets at 28 weeks and 1 of the babies survived. She had an elective abortion at 6 weeks.
6. This a woman’s 5 pregnancies. She had a birth at 40 weeks, another one at 39 5/7 weeks, she had a third one at 35 6/7 weeks and a 4th one at 36 5/7 weeks. She had one induced abortion at 10 weeks and has currently 4 living children.
7. A pregnant woman who carried one pregnancy to term with a surviving infant; carried one pregnancy to 35 weeks with surviving twins; she carried one pregnancy to 9 weeks as an ectopic ( tubal ) pregnancy; and has 3 living children.
8. A woman who has given birth at term once and has had one miscarriage at 12 weeks would be recorded as?
This assignment is worth 8 points. Use page 259 in your text book. Include 1-3 references.
APA is worth .5
Case 1 is worth .5
Cases 2-8 are worth 1 point each.
Please, in text citation with 1-3 references
Course :Maternal Child Health
TEXTBOOK: Maternal – Child Nursing Care Optimizing Outcomes for Mothers, Children & Families
This is Page 259 from this text book: To use for this assignment
Now Can You—Correctly calculate the EDB?
Calculate the estimated date of birth using Naegele’s rule?
Lynne is a 28-year-old woman who comes to the clinic with a history of amenorrhea and a positive home pregnancy test.
Her last menstrual period began on August 26, 2014. She bled for the usual amount of time and reports that the amount of blood loss was normal. Assuming that Lynne had a 28-day cycle, use Naegele’s rule to calculate her estimated date of birth.
Important to remember: The month of August has 31 days.
- August 26 + 7 days = September 2
- (September) ninth month − 3 = sixth month (June)
- EDD/EDC/EDB = June 2
Correct calculation of the EDB is dependent on a reliable date of the LMP. Hormonal birth control methods such as combined oral contraceptive pills (OCP) and long-lasting progesterone injections can cause continued suppression of ovulation. Therefore, a discrepancy may exist between when the woman thought she ovulated and conceived and when these events actually occurred. Thus, the LMP may not be an accurate tool for estimating the due date.
Occasionally, pregnancy occurs in women who are taking oral contraceptives, usually as the result of a “pill failure” from forgotten pills or because of poor absorption that may result from various causes such as vomiting, diarrhea, or antibiotic use. Thus, contraceptive pill use may have unwittingly been continued during the early weeks of gestation. The nurse can assure the patient that prenatal hormone exposure associated with normal contraceptive use has not been shown to have any detrimental effects on the developing fetus (Nelson & Cwiak, 2011).
The Pregnancy Classification System
Another important task associated with the initial prenatal interview is to determine the patient’s gravidity and parity. Gravid is the state of being pregnant; a gravida is a pregnant woman. Gravidityrelates to the number of times that a woman has been pregnant, irrespective of the outcome. The term nulligravida is used to describe a woman who has never experienced a pregnancy. A primigravida is a woman pregnant for the first time, and a secundigravida is a woman pregnant for a second time. Although officially correct, this term is seldom used and instead the term multigravida is used in its place. A multigravida describes a woman who is pregnant for the third time (or more times). Parity refers to the number of pregnancies carried to a point of viability (generally accepted as 24 weeks of gestation), regardless of the outcome. For example, “para 1” indicates that one pregnancy reached the age of viability. A para 2 means that two pregnancies reached the age of viability. It is important to note that the term parity (or “para”) denotes the number of pregnancies, not the number of fetuses/babies, and does not reflect whether the fetuses/babies were born alive or stillborn. Some facilities use a digital system (i.e., GTPAL) for recording the number of pregnancies and their outcomes.
- G Gravida
- T Number of Term pregnancies
- P Number of Preterm deliveries
Where Research and Practice Meet:
Depo-Provera Use Before PregnancyBone mass can be adversely affected by the use of depot medroxyprogesterone acetate (Depo-Provera). The extent to which bone mass is lowered appears to be linked to the length of use (Bartz & Goldberg, 2011). Calcium has two main physiological functions: promoting skeletal growth and maintaining bone mass. Unfortunately, humans only absorb approximately 10% of the dietary calcium consumed. There are three periods in human life when calcium uptake is increased: during infancy, adolescence (growth spurt), and in the latter half of pregnancy. To counsel prenatal patients appropriately, nurses should understand the benefits associated with meeting the recommended intake of daily calcium and be knowledgeable about factors that increase absorption. Pregnancy is a time when maternal calcium absorption is increased. To take advantage of this physiological alteration, pregnant women should be encouraged to eat a well-balanced diet with adequate amounts of calcium, protein, and vitamin D and routinely participate in weight-bearing exercises (ACOG, 2011e).
- A Number of Abortions, both spontaneous and induced
- L Number of Living children
A detectable level of human chorionic gonadotropin (hCG) must be present in the urine or blood for a pregnancy test to be positive. hCG is produced by the syncytiotrophoblastic cells found in the outer layer of the trophoblast and secreted into the maternal plasma and then excreted in the urine. hCG levels peak between days 60 and 70 of pregnancy and then gradually decrease over approximately the next 40 days to reach a plateau that is maintained throughout the pregnancy. hCG can be detected in maternal blood as early as 1 day after implantation and in urine around day 26. The hCG molecule contains both an alpha subunit and a beta subunit. Because of the large number of commercial pregnancy tests available, women should be advised to use a home pregnancy test that is specific for the beta subunit of hCG because this marker prevents cross reactions with other hormones. The alpha subunit is very similar in molecular structure to luteinizing hormone (LH). Women with high LH levels (e.g., those experiencing perimenopause) who use a pregnancy test designed to detect the complete hCG molecule risk obtaining a false-positive result. If the over-the-counter pregnancy test used relies on urinary hCG, the patient should be advised to follow the manufacturer’s recommendations carefully to avoid an unreliable result. If a home pregnancy test is negative and the signs and symptoms of pregnancy persist, the test should be repeated in a week or the woman should see her health-care provider.
A “chemical pregnancy” is a term used to describe a situation that occurs when a home pregnancy test has confirmed the presence of hCG, but a late and often heavy menstrual period follows. In these instances, conception probably occurred but for some reason the pregnancy was unable to continue and develop into a viable embryo. The frequency of this occurrence is difficult to estimate accurately, but it is thought to affect approximately 30% to 50% of all pregnancies. Before the development of sophisticated methods for detecting an early pregnancy, most of these early and unfruitful fertilizations would have gone undiagnosed.
Optimizing Outcomes—Promoting a healthy beginning for the fetus
The first few weeks of gestation are of paramount importance to the developing fetus. During this time, the fetus is most susceptible to teratogenic substances such as alcohol, drugs, and environmental toxins. If a woman suspects that she may be pregnant despite a negative home pregnancy test, the nurse should advise her to avoid substances that could be potentially harmful to the developing fetus.
The diagnosis of a multiple gestation places the pregnancy into a “high risk” classification. An early diagnosis of a multiple gestation allows for the development of a care plan that includes more frequent visits for maternal–fetal surveillance. As with any pregnancy, early and ongoing prenatal care offers an opportunity for the timely recognition of complications (more often associated with multiple gestations) and the initiation of interventions to maintain the pregnancy as long as possible. The woman expecting a multiple birth also needs additional psychological support, practical advice, and education. She may experience more intense discomforts of pregnancy and need to deal with upsetting and extreme body changes. In addition, she also faces the financial challenges associated with a potentially complicated pregnancy, possible preterm birth, and the economic burden of providing for multiple newborns.
Now Can You—Discuss essential aspects of the current pregnancy?
- 1. Differentiate among the “presumptive,” “probable,” and “positive” signs of pregnancy?
- 2. Explain how to calculate the estimated date of birth using Naegele’s rule?
- 3. Describe the GTPAL pregnancy classification system?
- 4. Explain what women should be taught about home pregnancy testing?
THE MEDICAL HISTORY
To provide the patient with appropriate care to meet medical needs during pregnancy, it is essential that a detailed medical history be obtained. This information gives insights into the patient’s past and present health status and use of preventative services. The nurse should obtain contact information for the primary care provider to facilitate continuity of care. Lack of a family physician may be related to financial difficulties, lack of medical insurance, or cultural/value differences. The nurse can explore these issues through sensitive and respectful questioning, and when appropriate, refer the patient and her family to local agencies that provide services such as the WIC (Women, Infants, and Children) program for nutritional support (Box 9-6).
Some European countries offer “shared” care for low-risk patients to serve as a link between the patient’s primary care provider and her obstetrician. The pregnant woman visits her family physician for the majority of her prenatal care but also sees an obstetrician for two to three visits. If any complications arise, the patient is transferred for the remainder of the pregnancy to the care of the obstetrician. Because any complications that occur during pregnancy are associated with maternal and family stress, referral to a “known” obstetrician hopefully helps to diminish some of the anxiety.
Box 9-6 WIC at a Glance
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