Maternity Chapter 12
The nurse educates the vegetarian client about which nutritional need during pregnancy? taking a B12 supplement limiting the intake of fiber supplementing the diet with vitamins A and C avoiding high intake of dark green vegetables.
A B12 is found almost exclusively in animal proteins and therefore is absent in the vegetarian diet. Fiber and dark green vegetables are needed. Vitamins A and C are not protein based and are found in a vegetarian diet.
The nurse is reinforcing health care provider education on the technique for an amniocentesis. Which piece of equipment will the nurse have ready? ultrasound equipment Foley catheter sterile urine cup sterile field with scalpel
A First, the health care provider identifies a pocket of amniotic fluid using an ultrasound machine. A scalpel is not used in the procedure. A urine culture is not obtained prior to the procedure nor is a Foley catheter inserted.
A pregnant client at full-term gestation calls the nurse to report contractions every 6 to 7 minutes that are getting stronger. The membranes are intact. The client lives 45 minutes away from the hospital and had a 4-hour labor with the previous birth. What will the nurse advise? Come to the hospital now for assessment. Come to the hospital once your membranes rupture. Come to the hospital once the contractions are 5 minutes apart. Come to the hospital if you are experiencing bloody show.
A Generally, clients are advised to come to the hospital once contractions are 5 minutes apart, but because this client has a history of fast (4 hour) labor and lives 45 minutes away from the hospital, the client should be advised to come to the hospital now. Membranes may rupture at any point in labor and should not dictate the timing of hospital admission. Bloody show is a normal finding in labor, but it does not determine the stage of labor or when the client should come to the hospital.
A woman who is 4 months pregnant notices frequent heart palpitations and leg cramps. She is anxious to learn how to alleviate these. Which nursing diagnosis would best apply to her? Health-seeking behaviors related to ways to relieve discomforts of pregnancy Impaired urinary elimination related to inability to excrete creatine from her muscles Pain related to severe complications of pregnancy Risk for ineffective breathing pattern related to pressure of the growing uterus
A Health-seeking behaviors is a diagnosis used to describe clients who are actively interested in learning ways to improve their health.
A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider? vaginal bleeding painful urination severe, persistent vomiting lower abdominal and shoulder pain
A In a client's second trimester of pregnancy, the nurse should educate the client to look for vaginal bleeding as a danger sign of pregnancy needing immediate attention from the primary care provider. Generally, painful urination, severe/persistent vomiting, and lower abdominal and shoulder pain are the danger signs that the client has to monitor for during the first trimester of pregnancy.
A client at 28 weeks' gestation is asking for a laxative for constipation. What action would the nurse recommend? Eat fiber-rich foods. Take a fiber-based laxative. Use a water-based enema. Insert a glycerin suppository.
A Increasing dietary fiber is the best way to address constipation. Laxatives, suppositories, and enemas only provide temporary relief and may stimulate labor.
A pregnant client wishes to know if sexual intercourse would be safe during her pregnancy. Which should the nurse confirm before educating the client regarding sexual behavior during pregnancy? Client does not have cervical insufficiency. Client does not have anxieties and worries. Client does not have anemia. Client does not experience facial and hand edema.
A The nurse should inform the client that sexual activity is permissible during pregnancy unless there is a history of cervical insufficiency, vaginal bleeding, placenta previa, risk of preterm labor, multiple gestation, premature rupture of membranes, or presence of any infection. Anemia and facial and hand edema would be contraindications to exercising but not intercourse. Freedom from anxieties and worries contributes to adequate sleep promotion.
At the first prenatal visit, the client reports her last menstrual period (LMP) was November 16. The nurse determines the estimated due date to be: August 23 August 13 August 3 September 1
A There are several methods to determine the estimated date of birth. Naegele rule can be used, which involves subtracting 3 months and then adding 7 days to the first day of the LMP. Then correct the year by adding 1 where necessary. Another method is to add 7 days and then add 9 months and add 1 to the year where needed. Thus the client reports her LMP was November 16 subtract 3 months (August), add 7 days (23), and adjust the year by adding 1 year. This client's estimated date of birth is August 23, in the following year.
A client who is uncertain when her LMP occurred is given an EDD of April 23 after the first ultrasound. Based on this information, the nurse determines the client's LMP was probably which day? July 13 July 16 July 19 July 21
B According to Naegele rule, the last menstrual period was July 16th. Take the LMP and add 7 days and subtract 3 months; if finding the LMP from the EDD, subtract 7 days and add 3 months.
While assessing a client's breast during the third trimester, which finding would the nurse expect? pain in the nipple area colostrum from the nipples breasts becoming soft pink-colored nipples
B During the third trimester, the nipples express colostrum. Areolae and nipples appear enlarged with darker pigmentation during the third trimester. The nurse assesses for the softness of the breast, color, and pain in the nipple area in nursing mothers.
A pregnant client arrives for her first prenatal appointment. She reports her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks' gestation. How will the nurse document this in her records? G2 T2 P1 A0 L2 G3 T0 P1 A1 L2 G3 T2 P2 A0 L1 G2 T1 P1 A1 L1
B G indicates the total number of pregnancies (2 prior, now pregnant = 3); T indicates term deliveries at or beyond 38 weeks' gestation (none = 0); P is for preterm deliveries (at 20 to 37 weeks = 1; multiple fetus delivery are scored as 1); A is for abortions or pregnancies ending before 20 weeks' gestation (1); and L refers to living children which is 2. Thus, G3 T0 P1 A1 L2 is what the nurse should note in the client's record.
A pregnant client presents for her first prenatal visit. She informs the nurse that she had an ectopic pregnancy 3 years ago. She ask the nurse if this would happen this time. Which response by the nurse would be best? "Be calm. Why worry about things that likely won't happen?" "Your statistical risk of another tubal pregnancy is increased." "You should not worry about this right now—stress can harm the fetus." "Just because you had one ectopic pregnancy does not mean you will have another."
B If a woman has had tubal/ectopic pregnancy, her statistical risk of another tubal pregnancy is increased. The other comments are not therapeutic and do not supply accurate information or address the client's legitimate concerns.
A client at 32 weeks' gestation tells the nurse that she has been experiencing shortness of breath when walking up the steps at home. She is concerned that something is wrong. What is the nurse's best response? "You only have a few more weeks until the birth and then you will breathe fine again." "The enlarging uterus pushes against your diaphragm and this makes breathing shallow." "Oxygen requirements are increasing in your body because the fetus is growing." "Don't worry about this because it is a normal change that occurs with pregnancy."
B Increasing levels of progesterone cause relaxation of ligaments and joints. This allows the rib cage to flare to accommodate the enlarging uterus. As the uterus enlarges, it pushes up against the diaphragm. This changes respirations from abdominal to costal, and the woman feels short of breath. The nurse should never demean a client's symptoms. Oxygen requirements do increase during pregnancy, but this not the reason for the woman's shortness of breath.
Which information is most important in order to decrease the risk of complications if the client decides to work until her due date? Eat light meals Frequent rest periods Adequate sleep Flat shoes
B It is common to have a client work until she goes into labor as long as she has had a low-risk pregnancy. Frequent rest periods are stressed, if possible, as the client progresses throughout the work day. The other options are good suggestions for any client at the end of pregnancy.
The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question? penicillin rubella acetaminophen folic acid
B Most vaccines are contraindicated during pregnancy and are considered teratogenic, such as rubella. Penicillin and acetaminophen may be taken under provider supervision. Folic acid supplementation should be encouraged.
Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting? drinking liquids with meals limiting intake of heavy, greasy foods increasing fluid intake limiting carbohydrate intake
B Nausea and vomiting can be lessened by limiting intake of fatty and greasy foods and eating small frequent meals every 2 to 3 hours. Other interventions include eating carbohydrate foods such as dry crackers, Melba toast, dry cereal, or hard candy before getting out of bed in the morning. Avoid drinking liquids with meals; avoid coffee, tea, and spicy foods; and eliminate individual food intolerances. Drinking liquids, increasing fluid intake, and limiting carbohydrate intake does not lessen nausea and vomiting.
Which client immunization titer is most important to assess and document in the prenatal record of the pregnant woman? polio rubella rotavirus diphtheria
B Rubella (German measles) is an infection caused by the rubella virus. The virus causes a rash and mild symptoms in children but can be teratogenic to a fetus. A rubella titer determines if the mother is immune to the virus. If the mother is not immune, she will receive a rubella immunization immediately after delivery. Diphtheria and polio are infant vaccines but not as teratogenic to the fetus. Rotavirus is a gastrointestinal virus typically mild in adults.
The nurse is assessing a client at her first prenatal visit and notes the fundal height is palpable at the level of the umbilicus. The nurse predicts the client is at which gestational age? 18 weeks 20 weeks 24 weeks 22 weeks
B Some clients will not seek early prenatal care, especially if it is not their first pregnancy. The uterus expands to reach the height of the umbilicus by week 20. Before week 20 it is too low to be palpated, and after week 20 it may be beyond the umbilicus.
A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of spontaneous abortion (miscarriage) within the first trimester. The nurse is correct to document the history as: G = 4, T = 2, P = 0, A = 0, L = 1 G = 3, T = 1, P = 0, A = 1, L = 1 G = 1, T = 1, P = 1, A = 0, L = 1 G = 2, T = 0, P = 0, A = 0, L = 1
B The GTPAL stands for Gravida -- number of pregnancies, which is 3 (current, 4-year-old, and miscarriage); Term -- only one pregnancy thus far carried to term; Preterm deliveries -- 0; Abortions (either elective or miscarriage) -- 1; Living children -- 1. Do not be distracted by the twins. That is still one pregnancy.
The nurse is teaching about an iron supplement that the client is going to take every day. The nurse teaches the client to take the iron supplement with which type of fluid? hot tea citrus juice low-fat milk ice water
B The citric acid in juice enhances absorption of iron in the GI tract. Ice water and tea do not enhance iron absorption, and milk can inhibit iron absorption.
The nurse is assessing a primipara's fundal height at 36 weeks' gestation and notes the fundus is now located at the xiphoid process of the sternum. The client asks if this is normal. Which response to the client would be best? "By this time, the fundus should drop down lower because the baby is moving towards the pelvic inlet." "At 36 weeks' gestation, the fundus is in the normal expected location." "Just get prepared, the fundus might actually get a little higher until a few days before you go into labor." "To be honest, the fundus should be lower since you have gained minimal weight."
B The fundus grows to reach the umbilicus at 20 to 22 weeks and the xiphoid process of the sternum at 36 weeks. Therefore, this fundus is in the normal, expected location. After 36 weeks' gestation, lightening occurs and the fundus will drop ~4 cm below the xiphoid process. Once the fundus reaches the xiphoid process, it cannot go higher without severely compromising maternal respiratory efforts.
A client in her second trimester of pregnancy visits a health care facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which precaution should the nurse instruct the pregnant client to take when practicing aerobic exercises? Reduce the amount of exercise. Maintain tolerable intensity of exercise. Wear support hose when exercising. Begin a new exercise regimen.
B Women accustomed to exercise before pregnancy are instructed to maintain a tolerable intensity of exercise. They are instructed not to begin a new exercise regimen. A nurse does not tell the client to wear a support hose when exercising or to reduce the amount of exercises.
The nurse is measuring the fundal height of a woman who is at 28 weeks' gestation. Which measurement would the nurse expect? 12 cm 18 cm 28 cm 32 cm
C Fundal height should be approximately equal to the number of weeks' gestation. In this case, it would be 28 cm.
A woman in her second trimester of pregnancy is beginning to experience more headaches. In addition to suggesting holding an ice pack to the forehead, the health care provider recommends which medication to provide some relief from the pain? aspirin products ibuprofen acetaminophen naproxen
C Resting with an ice pack on the forehead and taking a usual adult dose of acetaminophen usually furnishes adequate relief. Compounds with ibuprofen (class C drugs) are not usually recommended because they cause premature closure of the ductus arteriosus in the fetus. Additionally, they have been found to contribute to fetal renal damage, low amniotic fluid, and fetal intracranial hemorrhage. Aspirin and naproxen are also not recommended to take during pregnancy.
A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. What does the nurse anticipate in this woman's pregnancy? cesarean birth increased risk of miscarriage potential for greater than usual back pain increased risk of fetal trauma
C Surgical correction of scoliosis (lateral curvature of the spine) involves implanting stainless-steel rods on both sides of the vertebrae to strengthen and straighten the spine. Such rod implantations do not interfere with pregnancy; a woman may notice more than usual back pain, however, from increased tension on back muscles. If a woman's pelvis is distorted due to scoliosis, a cesarean birth may be scheduled to ensure a safe birth, but this is not required in this scenario. Vaginal birth, if permitted, requires the same management as for any woman. With the improved management of scoliosis, the high maternal and perinatal risks associated with the disorder reported in earlier literature no longer exist.
The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which schedule is recommended for prenatal care? once every 3 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth once every 4 weeks for the first 36 weeks, then weekly until the birth once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth once every 4 weeks for the first 28 weeks, then every 3 weeks until 36 weeks, and then every 2 weeks until the birth
C The best health for mother and baby results when the mother has her first visit before the end of the first trimester (before the end of week 13) and then has regular visits until after she has delivered the baby. The usual timing for visits is about once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.
A nurse is teaching a client who is 30 weeks' pregnant about ways to deal with pyrosis (heartburn). The nurse determines a need for additional teaching based on which client statement? "I need to cut out caffeine." "I should chew my food slowly." "I should lie down for 1/2 hour after eating." "I need to raise the head of my bed about 15 to 30 degrees."
C The client should remain sitting for 1 to 3 hours after eating and avoid lying down within 3 hours of eating. Cutting out caffeine, chewing food slowly, and raising the head of the bed are helpful in reducing pyrosis (heartburn) of pregnancy.
Why is the first prenatal visit usually the longest prenatal visit? Extensive client teaching is done. A pelvic exam with Papanicolaou test is performed. Baseline data is collected. Laboratory tests are performed.
C The first prenatal visit is usually the longest because the baseline data to which all subsequent assessments are compared are obtained at this visit.
A pregnant client is planning a vacation to a different state and questions the nurse concerning precautions. Which suggestion should the nurse prioritize for this client who will be traveling by automobile? Travel no more than 120 miles daily. Sit in the back seat with feet elevated. Stop and walk every 2 hours. Limit trips away from home, greater than 200 miles.
C Walking increases venous return and reduces the possibility of thrombophlebitis, a risk for pregnant women who sit for extended periods of time. Limiting mileage, sitting in the back with the feet elevated, and limiting trips may help, but they are not enough to prevent phlebitis.
The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy? swelling of extremities dyspnea lower abdominal pressure excessive vomiting
D Excessive vomiting is a warning sign in the first trimester. Dyspnea, lower abdominal pressures, and swelling of face or extremities may occur late in pregnancy.
At 32 weeks' gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurse's recommendation for weight gain for the remainder of this pregnancy? Increase weight gain to 1.5 lb (0.68 kg) per week during this pregnancy. Limit weight gain to less than 5 lb (2 kg) for the remainder of this pregnancy. Watch the diet so no additional weight is gained during this pregnancy. Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy.
D Expected weight gain is 1.5 lb (0.68 kg) per month in the first trimester and 1 lb (.45 kg) per week for the second and third trimester. This client needs to continue to gain 1 lb (.45 kg) per week. Restricting weight gain near the end of pregnancy can negatively impact fetal growth.
The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage? All activities that the client does in a prepregnant state Relaxing activities such as hot baths and jacuzzis High-impact movements enabling less time in the activity Stretching and breathing exercises such as yoga
D It is important to exercise during pregnancy. One excellent type of exercise includes yoga, which reduces stress and increases relaxation. Yoga also gently stretches muscles and can increase muscle tone. Contact and high-impact sports are not appropriate for the pregnant mother. Hot areas such as a jacuzzi, hot tub, and sauna are also inappropriate.
An adolescent at 8 weeks' gestation is at her first prenatal visit. During the health history interview, the nurse asks the client, "Are you afraid of anyone?" What is the nurse assessing with this question? mood mental status social history intimate partner violence
D Pregnant women, especially adolescents, are at increased risk for intimate partner violence. The nurse needs to ask enough questions to be certain that the woman is not experiencing physical, sexual, or emotional intimate partnership violence.
The parents of a neonate born at 32 weeks' gestation ask about the purpose of the surfactant being given to the baby. What is the best response by the nurse? Promotes clearing mucus from the respiratory tract Helps maintain a rhythmic breathing pattern Assists with ciliary body maturation in the upper airways Helps the lungs remain expanded after the initiation of breathing
D Surfactant keeps the alveolar surfaces from sticking together, allowing the lungs to expand and making it easier for the neonate to breathe. Surfactant does not remove mucus or mature the upper airway. It does not effect the breathing pattern, just the effort needed to expand the alveoli.
A client in her second trimester of pregnancy has developed varicose veins and experiences leg cramps. Which suggestion would be most appropriate? Perform aerobic exercises. Increase intake of folic acid. Increase intake of calcium. Elevate legs while sitting.
D The nurse should encourage the client to elevate her legs while sitting; this will prevent pooling and engorgement of veins in the lower extremities. Aerobic exercises do not help in preventing varicose veins. Folic acid intake is recommended in the first trimester to prevent congenital abnormalities. Increasing the intake of calcium helps in strengthening bones.
During the examination of a pregnant client, the nurse observes pale mucous membranes and cracks at the corners of the mouth. The nurse recognizes that these findings suggest what type of deficiency? vitamin A vitamin C iron calcium
A These signs are consistent with a vitamin A deficiency. A vitamin C deficiency manifests as easy bruising and swollen/bleeding gums. An iron deficiency presents as fatigue and low energy, and a calcium deficiency would impact the calcification of fetal bones.
A client in her third month of pregnancy arrives at the health care facility for a regular follow-up visit. The client reports discomfort due to increased urinary frequency. Which instruction should the nurse offer the client to reduce the client's discomfort? Avoid consumption of caffeinated drinks. Drink fluids with meals rather than between meals. Avoid an empty stomach at all times. Munch on dry crackers and toast in the early morning.
A To reduce the client's urinary frequency, the nurse should instruct the client to avoid consuming caffeinated drinks, since caffeine stimulates voiding patterns. The nurse instructs the client to drink fluids between meals rather than with meals if the client complains of nausea and vomiting. The nurse instructs the client to avoid an empty stomach at all times, to prevent fatigue. The nurse also instructs the client to munch on dry crackers or toast early in the morning before arising if the client experiences nausea and vomiting; this would not help the client experiencing urinary frequency.
The nurse advises a pregnant client to keep a small high-carbohydrate, low-fat snack at the bedside. The nurse should point out this will assist with which condition? nausea and vomiting faintness slowed GI transit time heartburn
A Women will commonly experience nausea and vomiting upon awakening first thing in the morning. Clients who experience this should be encouraged to have small snacks at their bedside for eating prior to moving from the bed. Heartburn is a result of pressure and hormone action. Faintness is due to pressure on the vena cava, not blood sugar. GI transit time is not affected.
What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances? Eat a well-balanced diet. Avoid medications. Avoid intake of coffee. Maintain personal hygiene.
B The nurse should instruct a client who is pregnant or one who wants to conceive to avoid medications and thus avoid exposure to any kind of teratogenic substance. Eating a well-balanced diet and maintaining personal hygiene, though important during pregnancy, will not prevent a client's exposure to teratogenic substances. Coffee is not a teratogenic substance, so the client need not avoid coffee. However, coffee is not recommended during pregnancy because it may increase the risk of spontaneous abortion (miscarriage).
What is the most effective way for a nurse to assess a woman's usual food intake during her pregnancy? Assess a list she makes describing a good diet. Assess her skin for hydration and color. Ask her to describe her total intake for a week. Ask her to describe her intake for the last 24 hours.
D A 24-hour food intake history is the best method to assess food intake in all individuals.
Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation. 3, 2, 1, 2, 1 4, 2, 2, 1, 1 3, 2, 1, 1, 1 4, 1, 1, 1, 1
D The GTPAL system is used to classifying pregnancy status. G = gravida, T= term, P = preterm, A = number of abortions, L= number of living children.
A pregnant woman has been diagnosed with pica since she eats lead paint chips for their sweetness. The nurse educating this woman should strongly encourage her to abandon this practice because it may have which consequence to the fetus? neurological challenges cataracts fetal growth restriction spontaneous abortion
A Lead ingestion during pregnancy may lead to a newborn who is both cognitively and neurologically challenged. Formaldehyde exposure can lead to spontaneous abortions (miscarriages). Breathing air filled with pollutants (such as carbon monoxide) has been shown to lead to fetal growth restriction. The rubella virus' teratogenic effects on a fetus can be devastating, such as hearing impairment, cognitive and motor challenges, cataracts, and cardiac defects.
The nurse is assisting a primigravida on calculating the due date of her baby using Naegele rule. The most important information provided by the mother is: the first day of the last menstrual period. the ovulation date between her periods. the date that intercourse occurred. the last day of her menstrual period.
A Naegele rule is calculated using the first day of the last menstrual period. From there, 7 days are added and then 3 months are subtracted. The ovulation date, intercourse date, or last day of the menstrual period are not needed.
A nurse is educating a primigravida client about the expected changes during pregnancy. Which measure will provide anticipatory guidance about pregnancy? Avoid wearing high heels, especially during late pregnancy. Eat sweets at bedtime to avoid waking up feeling hungry. Sit in a hot tub for 5 minutes to help ease back pain and leg cramps. Avoid consuming too much fiber in the diet.
A The nurse should ask the client to avoid wearing high heels, especially during late pregnancy because the ligaments relax and the pregnant woman's center of gravity changes; thus, she may lose her balance. The client should avoid a hot tub, sauna, whirlpool, or tanning beds during pregnancy as it can adversely affect the fetus resulting in tachycardia. It can also raise the mother's internal temperature. There is also the possible exposure to bacteria which could result in an infection. The nurse should ask the pregnant woman to consume plenty of fiber and water to prevent constipation and hemorrhoids. If she wakes up feeling very hungry, it could help to eat starchy food, such as a baked potato, just before bedtime. If she eats sweets, she will probably have a rapid rise in blood sugar, followed by a sharp drop. Either of these changes can cause uncomfortable symptoms.
The nurse is assessing a client at her first prenatal visit and reports her LMP started December 1. Which date will the nurse predict for the EDD? October 7 September 8 July 7 August 8
B According to Naegele rule, the estimated date of birth is September 8. Add 7 days and subtract 3 months to the LMP to determine the estimated date of birth.
A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history? G3, T1, P0, A2, L1 G3, T0, P1, A1, L1 G2, T1, P2, A1, L2 G2, T0, P1, A1, L1
B The woman's obstetric history would be documented as G3, T0, P1, A1, L1. G (gravida) = 3 (past and current pregnancy), T (term pregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeks viability to include miscarriage) = 1, and L (number of living children) = 1.
