Pregnancy History Classification: G5P2-1-1-2
This woman's obstetric history is classified as G5P2-1-1-2 (Gravida 5, Para 2-1-1-2), indicating 5 total pregnancies including the current one, with 2 full-term deliveries, 1 preterm delivery (the stillbirth at 34 weeks), 1 spontaneous abortion, and 2 living children.
Understanding the GTPAL System
The standard obstetric notation uses the GTPAL (or GPAL) system to document pregnancy history 1:
G (Gravidity): Total number of pregnancies, including the current one = 5
- Current pregnancy
- 2 previous full-term deliveries
- 1 stillbirth at 34 weeks
- 1 spontaneous abortion
P (Parity): Broken down into four components:
- T (Term births): Deliveries at ≥37 weeks = 2 1
- P (Preterm births): Deliveries between 20-36 weeks = 1 (the stillbirth at 34 weeks counts as a preterm delivery) 1, 2
- A (Abortions): Pregnancy losses before 20 weeks = 1 (the spontaneous abortion) 1, 2
- L (Living children): Current number of living children = 2
Critical Documentation Details
The stillbirth at 34 weeks is classified as a preterm delivery, not an abortion, because it occurred after 20 weeks gestation 2. The World Health Organization defines stillbirth as fetal death at ≥20 completed weeks of gestation 2. This distinction is clinically important because:
- Stillbirth history increases cardiovascular disease risk by 49% compared to women without this history 3
- Second-trimester losses (like this 34-week stillbirth) should be accurately counted in obstetric scoring as they guide testing for conditions like antiphospholipid syndrome 1
- Women with stillbirth history have approximately 2-fold increased risk of CVD-related mortality 3
Clinical Implications of This History
This woman's obstetric history places her at elevated risk for several complications 4, 5:
- Recurrent adverse outcomes: History of spontaneous abortion and stillbirth identifies increased risk for recurrent pregnancy loss, preterm birth, or stillbirth in subsequent pregnancies 4
- Placental complications: Women with history of first-trimester spontaneous abortion have increased incidence of placenta-mediated pregnancy complications, including late-onset preeclampsia, oligohydramnios, and placenta accreta spectrum 5
- Maternal complications: Increased risk of gestational diabetes, thyroid-related diseases, and cesarean delivery 5, 6
This patient warrants antiphospholipid syndrome testing given her history of both spontaneous abortion and stillbirth, as recommended by the American College of Rheumatology for patients with recurrent pregnancy loss 1.