What is the GTPAL system?
GTPAL is an acronym used to describe a client’s obstetrical history. It represents a client’s total number of pregnancies as well as the outcome of each pregnancy.
When and why is GTPAL used?
This system is used to provide a quick and structured summary of the prior obstetric experiences of a client. It can be a tool to gain a bird’s eye view on a woman’s birth history, helping to spot patterns, inconsistencies, and problems that need to be addressed. It gives information on potential risks that may affect the client now based on previous obstetric events and can help tailor care and monitoring.
For example, a client who has experienced term and preterm births may benefit from interventions to prevent preterm labor. Picking up on a pattern of spontaneous abortions could lead to investigation and treatment of an underlying problem.
GTPAL also provides a way to concisely and clearly document pregnancy outcomes so that future providers can easily and clearly understand the client’s history.
Limitations of GTPAL
The GTPAL system mainly looks at pregnancy outcomes, not necessarily each specific baby. In multiple pregnancies, there may be several different outcomes of the same pregnancy.
This issue is addressed by using GTPAL alongside other markers of potential issues to obtain a complete picture of the client’s history.
One such marker is the measure of “parity,” which calculates the amount of births after viability (post 20 weeks).
Note: Any birth after the threshold of viability is calculated as part of the parity, regardless of the actual outcome. If the birth takes place after 27 weeks, it counts toward the parity, even if the baby does not survive.
GTPAL terminology explained
Gravidity
Gravidity refers to the total numbers of (self-reported) pregnancies a client has had.
| Nulligravida | Client has never been pregnant. |
| Primigravida | Client is pregnant for the first time. |
| Multigravida | Client has had two or more pregnancies. |
Parity
Gravidity includes the total number of pregnancies. Parity, on the other hand, only includes pregnancies if the pregnancy has lasted long enough for the fetus to have a reasonable chance of survival if born prematurely (threshold of viability).
Viability is defined as the ability of the fetus to survive outside the uterus, which typically requires being born after 20 weeks.
| Nullipara | Client has never been pregnant beyond the stage of viability. |
| Primipara | Client has been pregnant once beyond the stage of viability => has delivered a baby with a viable chance of survival. |
| Multipara | Client has been pregnant two or more times beyond the stage of viability. |
What does GTPAL stand for?
The acronym stands for gravidity (or gravida), term, preterm, abortions, and living children (or live births).
When using the GTPAL system, each letter stands for one aspect of the obstetric history. When written in notes, it will look like this: G5 T3 P1 A0 L4.
G: gravidity
Gravidity stands for the total number of pregnancies the client has had. This includes the current pregnancy.
Gravidity is determined by whatever the client tells you. The pregnancies do not have to be confirmed by a provider.
Examples:
A woman who has had 3 miscarriages, one full term pregnancy and one preterm pregnancy will have a gravida of 5. The miscarriages are included in her gravidity because although she did not have a live baby, she was still pregnant.
A woman who has had one triplet pregnancy and one full term singleton pregnancy would have a gravida of 2, even though she has 4 children now. This is because even though her triplet pregnancy resulted in 3 babies, she was only pregnant twice.
A client who has had one miscarriage, one live birth, and is currently pregnant, would be G3, as the current pregnancy is also included.
T: term deliveries
The number of term deliveries is the number of deliveries the client has had after 37 weeks of pregnancy.
Note that this is counting “delivery events,” not babies: whether there was one baby, twins, or even more babies per delivery; each term delivery still only counts as one.
Examples:
If a client had one baby born at 32 weeks’ gestation , “T” would be zero, as she had no babies born at 37 or more weeks.
A client who had one baby at 36 weeks’ gestation and twins at 39 weeks’ gestation would be considered to have a “T” of one. She only carried one of her pregnancies to term.
P: preterm deliveries
The number of preterm deliveries includes the number of deliveries the client has had between 20–37 weeks.
Example:
A client has a pregnancy that was carried to 22 weeks, and a living infant was born. Their baby passed away 3 hours later in the NICU. This pregnancy would still be considered a preterm birth because a living infant was born before 37 weeks’ gestation.
A: abortions
“Abortions” is used as an umbrella term for all losses, whether they are elective or spontaneous. This is important history, as previous terminations may have a risk of affecting future pregnancies.
This number includes all previous abortions, miscarriages, and ectopic pregnancies (less than 20 weeks). Again, this counts events, not babies.
Example:
A client has had one termination of pregnancy, one miscarriage at 11 weeks’ gestation, and one live birth. The “A” would be scored as 2: The client had two pregnancy losses before 20 weeks, one of which was elective.
L: living children
The last number stands for the number of currently living children the client has.
Example:
A client gives birth to quadruplets, and 3 were alive at birth while one was stillborn. The “L” would be scored as 3.
Complete GTPAL examples & practice questions
Example 1: twins and a single sibling, abortion and miscarriage
A client is currently 12 weeks pregnant. She has had one previous delivery of twins at 32 weeks, a miscarriage at 10 weeks, and one elective abortion at 6 weeks. The client also delivered a single baby at 38 weeks. What is her GTPAL?
Answer: G5 T1 P1 A2 L3
- G: 5
- The client has been pregnant 5 times in total.
- Once with the twins, once ending in miscarriage, once ending in elective abortion, and once the singleton delivery; plus the current pregnancy.
- T: 1
- The singleton was born at 38 weeks, which is one term delivery.
- P: 1
- The twins were born at 32 weeks, so this is one preterm delivery.
- The number of babies in this delivery is not relevant.
- A: 2
- One elective abortion
- One miscarriage
- L: 3
- The client has twins and one singleton, so 3 living children overall.
Example 2: twins and a spontaneous abortion
A client is currently pregnant. She has had one previous delivery of twins at 34 weeks and one spontaneous abortion at 8 weeks.
What is her GTPAL?
Answer: G3 T0 P1 A1 L2
- G: 3 (three overall pregnancies: the twins, the abortion, and the current one)
- T: 0
- P: 1 (the twins were born prematurely, counting as one delivery)
- A: 1
- L: 2
Example 3: practice client
A 36 year old client is attending an antenatal check-up for her current pregnancy.
Here is a table of her pregnancy history:
| Birth year | Gestation | Complications | Outcome |
| 2015 | 34 weeks | Preterm rupture of membranes | Alive |
| 2017 | 36 weeks | Twin pregnancy | Alive |
| 2018 | 13 weeks | Unknown | Intrauterine death |
| 2021 | 41 weeks | None | Alive |
What would her GTPAL score be?
Answer: G5 T1 P2 A1 L4
- G: The client has a gravidity of 5 because she has been pregnant 5 times. She had a pregnancy in 2015, 2017, 2018, 2021, and she is currently pregnant. Remember to include a current pregnancy for calculating gravida. It is also important to remember that a twin pregnancy is only counted as one pregnancy.
- T: Only one pregnancy was carried to full term (in 2021, delivered at 41 weeks’ gestation). The current pregnancy can not be counted yet.
- P: The number of preterm births is scored as 2. This includes the birth in 2015 at 34 weeks’ gestation and the birth in 2017 at 36 weeks’ gestation. The miscarriage at 13 weeks is not included, as this baby had already died before birth. The twin pregnancy is, again, only counted once, because although there were two babies, it was only one pregnancy.
- A: Abortions would be calculated as 1. Remember, an abortion is a miscarriage or a termination of pregnancy. The client had a miscarriage in 2018, which is considered an abortion for GTPAL.
- L: In this case, there are 4 living children. One baby born alive in 2015, twins (which each get counted) born alive in 2017, and an alive singleton born in 2021.
