Archer - Maternal and Newborn

Risk factors for preeclampsia include all of the following, except: A. Chronic hypotension B. Age C. Race D. Family history of preeclampsia

Choice A is correct. Chronic hypotension is not a risk factor for preeclampsia; therefore, this is the correct answer to the question. Instead, a history of high blood pressure is a risk factor. This hypertension is defined as a blood pressure reading above 140/90 mmHg.

The nurse is counseling a female client interested in starting contraception. The client tells the nurse a preference for contraception that does not involve pills or any invasive device. Based on the client's preferences, the nurse may recommend which contraceptive product to the primary healthcare provider (PHCP)? A. Depot medroxyprogesterone B. Intrauterine device (IUD) C. Hormonal vaginal ring D. Combined estrogen-progestin pill

Choice A is correct. Depot medroxyprogesterone acetate is an injection that provides contraception for 13 weeks. Considering that the client prefers no pills or anything invasive, this would be an appropriate recommendation to the PHCP.

The nurse is caring for a client who has been prescribed depot medroxyprogesterone acetate. Which of the following statements, if made by the client, requires follow-up? A. "I will need another injection in 8 weeks." [34%] B. "I may gain weight while on this medication." [7%] C. "I can expect increased vaginal bleeding." [41%] D. "I should increase by weight-bearing exercises." [17%]

Choice A is correct. Depot medroxyprogesterone acetate is an injection that provides contraception for 13 weeks. The client should return for another injection at 13-week intervals - not 8 weeks. Depot medroxyprogesterone acetate is an effective contraceptive that is given intramuscularly or subcutaneously every 13 weeks. While a client takes depot medroxyprogesterone acetate, calcium and vitamin D supplementation are recommended, coupled with weight-bearing exercises. Women who have a high risk for cardiovascular disease and a stroke should not take depot medroxyprogesterone acetate.

The client admitted to the gynecology ward for premature labor is given terbutaline to arrest labor. The nurse should monitor which parameter when administering this medication? A. Breath sounds B. Urine output C. Pain D. Level of consciousness

Choice A is correct. One of the most common side effects of terbutaline is pulmonary edema. The nurse should monitor the client's breath sounds as well as assess for respiratory crackles and difficulty of breathing to detect if pulmonary edema is present.

A G1P0 client with a blood type A negative is at her 28th-week gestation and was advised a RhoGAM injection today. Which statement by the client indicates the need for further teaching about this therapy? A. "This shot is meant to prevent my baby from developing antibodies against my blood, right?" B. "I understand that if we find out my baby is Rh positive, then I'll need to get another one of these injections." C. "This shot should help to protect me in future pregnancies if this baby comes out Rh positive, like her dad." D. "This shot will prevent me from becoming sensitized to Rh-positive blood."

Choice A is correct. RhoGAM is administered to Rh-negative mothers to prevent them from producing antibodies against their Rh-positive fetus. "This shot is meant to prevent my baby from developing antibodies against my blood, right?" indicates that the client needs further teaching.

Which of the following best describes the reflex of a newborn, which includes: hand opening with abducted and extended extremities following a jarring motion? A. Moro reflex B. Grasp reflex C. Babinski reflex D. Rooting reflex

Choice A is correct. The Moro reflex occurs in response to a slight drop, sudden movement of the crib, or a loud noise, the newborn quickly makes a symmetrical abduction of the extremities and places the index fingers and thumbs into a "C" shape. The newborn's neurological system is immature at birth. The nurse may notice periodic jerking or twitching, which is considered normal. Tremors are not considered a normal finding in a newborn. The newborn's cry can provide information about the neurological status. A high-pitched scream can indicate an increase in intracranial pressure. When assessing the reflexes, the nurse needs to consider the gestational age, not the birth weight. Premature infants will have a reduced response to the reflex evaluation. The nurse should document and report the following warning signs: Tremors A high-pitched cry Abnormal pupil responses Hypertonic or hypotonic positions Absent newborn reflexes

A newly registered nurse is buddying up with a senior nurse in the delivery room. During their shift, the nurse asks the senior nurse regarding the prevention of cold stress immediately after delivery. Which is the most appropriate response by the senior nurse? A. The nurse should dry the neonate and place the baby under a radiant warmer for 2 hours immediately after birth. B. The nurse should give oxygen for the first 30 minutes after birth C. The nurse should decrease integumentary stimulation after birth. D. The nurse needs to make sure that the environmental temperature is maintained at a constant level.

Choice A is correct. To prevent cold stress, the nurse needs to stop heat loss from the newborn. Drying the infant and placing the baby in a radiant warmer ensures that the newborn does not lose any heat through conduction, evaporation, or convection.

The nurse is caring for a post cesarean section client in the maternity ward. The nurse must assess for which finding that indicates a common complication after delivery? A. A distended bladder B. Soaked perineal pads and a soft fundus C. Shivering D. An elevated temperature

Choice B is correct. Bleeding due to uterine atony is likely to occur in a client post cesarean section. Signs that indicate postpartum hemorrhage include frequently soaked dressing and perineal pads, a soft fundus, tachycardia, and low blood pressure.

The client in the delivery room has just delivered her third child. The physician ordered methylergonovine (Methergine) for the client and it was promptly administered. Which manifestation would indicate to the nurse that the medication is having its intended effect? A. The client reports a decrease in pain. B. The nurse palpates a firm uterus on the client. C. The client states that she wants to empty her bladder D. The client's blood pressure increases.

Choice B is correct. Methylergonovine promotes vasoconstriction and uterine contraction. A firm and contracted uterus is a sign that the medication is having its desired effect.

The nurse cares for a client diagnosed with pelvic inflammatory disease (PID). The nurse anticipates the primary healthcare provider (PHCP) to prescribe which medication? A. Voriconazole B. Doxycycline C. Phenazopyridine D. Famciclovir

Choice B is correct. Pelvic inflammatory disease (PID) is most likely caused by sexually transmitted infections or bacterial vaginosis. Doxycycline is an effective antibiotic utilized in PID.

Your pregnant client has been hospitalized with hyperemesis gravidarum. She is given ondansetron to treat this illness. What serious side effects should the hospital nurses be watching for? A. Continued nausea and vomiting B. Prolonged QT interval C. Respiratory distress D. Constipation

Choice B is correct. Prolonged QT intervals have been noted as a severe side effect of ondansetron. This medication is used to treat hyperemesis gravidarum when the patient is losing weight and or unable to cope with pregnancy-related nausea.

Relaxin is a hormone that is released throughout a woman's pregnancy to help prepare her uterine ligaments for the growth of her fetus and uterus. A downside to relaxin is that it may: A. Cause high blood pressure in some women B. Lead to musculoskeletal injury due to loose ligaments C. Make urinating more difficult than normal D. Increase bowel motility

Choice B is correct. Relaxin can lead to clumsiness because of increased flexibility and ligament relaxation. This clumsiness increases the risk of musculoskeletal injury. Relaxin may also cause round ligament pain, indigestion, and an increase in the frequency of urination.

While performing a cardiovascular assessment on an infant at 2 hours of life, you note the following: Normal sinus rhythm HR = 178 Systolic murmur +1 pedal pulses +3 radial pulses 5 second capillary refill No edema What is the priority nursing action after this assessment? A. Continue to monitor B. Notify the health care provider C. Administer PRN acetaminophen D. Re-evaluate the patient in one hour

Choice B is correct. This patient is displaying signs and symptoms of congenital heart disease; specifically coarctation of the aorta. Even if you did not know which congenital heart disease they may have, you would be expected to know that the healthcare provider needs to be notified of these symptoms. Your patient is in normal sinus rhythm and has a normal heart rate for the newborn age group. The systolic murmur, the gradient in peripheral pulses, and 5 second capillary refill are all abnormal. The murmur indicates that there is an opening somewhere in the heart where there should not be. This could be an ASD, VSD, or one of the bypasses in fetal circulation (the ductus arteriosus or foramen ovale) may not have closed on their own. The gradient in pulses indicates that there is more blood flow in the top half of the body than in the lower half - this is what points to coarctation of the aorta. A capillary refill time of 5 seconds is the last abnormal sign for this patient. Capillary refill should be less than 3 seconds in a newborn - delayed capillary refill indicates poor perfusion and must be addressed quickly. It is important to recognize that these are abnormal signs and symptoms and need to be reported to the health care provider for prompt intervention.

A nurse in the nursery is assessing a newborn in the unit. Which finding would necessitate further investigation? A. A soft spot just above the newborn's head B. Greasy, white substances that resemble cheese on the baby's neck, back, and thighs C. A single crease on the palm D. Acrocyanosis

Choice C is correct. A single crease on the palm is also called a Simian crease and would indicate that the child has Down's syndrome. The nurse should further assess this finding to confirm Down's syndrome in the child.

The nurse is caring for a neonate with a decreased cardiac output. If noted in this patient, which of the following is not a sign of decreased cardiac output? A. Oliguria B. Difficulty breastfeeding C. Bradycardia D. Hypotension

Choice C is correct. Bradycardia is not a typical symptom of decreased cardiac output in neonates. Instead, a decreased cardiac output generally results in tachycardia as the heart pumps faster to compensate. Typical signs of decreased cardiac output in an infant include oliguria, difficulty feeding, hypotension, irritability, restlessness, pallor, and decreased distal pulses.

While assessing a newborn infant in the nursery, you observe bounding +3 radial pulses and faint +1 pedal pulses. You also notice that the feet are cold and pale, while the hands are warm and pink. Which cardiac defect do you suspect this infant has? A. Tetralogy of Fallot (TOF) [30%] B. Hypoplastic left heart syndrome [9%] C. Coarctation of the aorta (COA) [47%] D. Transposition of the great arteries [14%]

Choice C is correct. Coarctation of the aorta is a narrowing of the aorta near the ductus arteriosus. Because of this narrowing, there is increased blood flow to the upper extremities and decreased blood flow to the lower extremities. That is what causes the symptoms described in the question: bounding upper pulses, faint lower pulses, and overall better perfusion to the upper extremities.

A nurse is doing an assessment on a client who is 6-hours postpartum after delivering a full-term infant. The client verbalized feeling dizzy and faint. Which is the most appropriate nursing action? A. Place the client in Trendelenburg's position B. Review the pre-delivery hemoglobin and hematocrit C. Instruct the client to get out of bed slowly and ask for help when ambulating D. Inform the nursery nurse to delay rooming-in until the client is stable

Choice C is correct. In the first 8 hours postpartum, orthostatic hypotension is a regular occurrence that may be manifested by feeling faint or dizzy. The nurse should reassure the client that this is normal and focus on the client's safety. The client should always be instructed to get help when getting out of bed and ambulating until the symptoms subside.

The licensed practical nurse (LPN) informs another nurse that the 1-day post-partum client she is taking care of has changed 3 perineal pads in the last 4 hours. What is the initial action of the nurse? A. Document the finding. B. Instruct the LPN to massage the client's uterus. C. Assess the patient immediately. D. Ask the LPN why the nurse was not informed earlier.

Choice C is correct. The initial action of the nurse would be to assess the client first to confirm if she has excessive bleeding.

A couple in a fertility clinic tell the nurse that they are concerned about transmitting a particular disease to their children. The nurse refers them to genetic counseling. All of the following are the purposes of genetic counseling, except: A. Reassure people who are concerned about their children inheriting a particular disorder as well as provide concrete and accurate information. B. Allow people who are affected by inherited disorders to make informed choices about future reproduction. C. Educate the couple on how to prevent their child from acquiring inherited disorders. D. Educate the couple about inherited disorders and the process of inheritance.

Choice C is correct. This is an incorrect statement and therefore the correct answer to the question. Genetic counseling aims to let people understand that they have no control over inherited traits. Marriages and relationships can suffer because of this unless they are given adequate support.

You are caring for a newborn born at term. On your assessment. You note that central cyanosis is present and persistent at five minutes after birth. You attach a pulse oximeter to the newborn. When determining whether or not the infant requires supplemental oxygen, you know that the expected oxygen saturation at 5 minutes after birth is: A. 65-70% B. 70-75% C. 75-80% D. 80-85%

Choice D is correct. At five minutes after birth, the expected SpO2 is in the 80-85% range. Regardless of the cyanosis, if the oxygen saturation is within this range, the infant probably does not need supplemental oxygen at this point. The American Heart Association and American Academy of Pediatrics suggest the following table for Target Pre-ductal Oxygen Saturation levels following birth.

Which assessment question would be most appropriate for a patient who is experiencing dyspareunia? A. "Do you take anti-hypertensive medication?" B. "Do you currently have a new partner?" C. "Have you been diagnosed with a neurological disorder?" D. "Do you use antihistamines?"

Choice D is correct. Factors contributing to dyspareunia include diabetes, hormonal imbalances, vaginal, cervical, or rectal disorders, antihistamine, alcohol, tranquilizer, or illicit drug use, and cosmetic or chemical irritants to the genitals. Dyspareunia is painful sexual intercourse due to medical or psychological causes. The pain can primarily be on the external surface of the genitalia, or more profound in the pelvis upon deep pressure against the cervix. It can affect a small portion of the vulva or vagina or be felt all over the surface.

The nurse is caring for a 48-hour old newborn. Based on the previous shift's report, the newborn has not yet passed stools since it was delivered. The nurse would suspect which condition? A. Celiac disease B. Cystic fibrosis C. Intussusception D. Hirschsprung's disease

Choice D is correct. Most healthy infants will pass meconium (first stool) by 24 hrs, and almost 100% of normal full-term neonates will pass meconium by 48 hours. Failure to pass meconium within the first 48 hours of life may indicate Hirschsprung's disease, a congenital anomaly resulting in mechanical obstruction due to inadequate motility (aganglionosis) in an intestinal segment.

A client is on her first day postpartum and is progressing successfully in breastfeeding her baby. What is the appropriate way for the client to remove the baby from her breast? A. Gently pull the infant away from the breast. B. Withdraw the breast from the infant's mouth even while the infant is latched. C. Pinch the areola until the infant releases the nipple from her mouth. D. Insert a clean finger into the infant's mouth beside the nipple.

Choice D is correct. The insertion of a clean finger into the infant's mouth breaks the suction and the nipple can be removed without trauma.

The nurse is teaching a client scheduled for a vaginal and cervical colposcopy with biopsy. Which of the following information should the nurse include? A. You should not eat or drink eight hours prior to this test. B. You will need to have someone drive you home after this test. C. A metallic taste is common once you get the contrast dye D. Vaginal intercourse may be painful after the procedure.

Choice D is correct. Vaginal intercourse following a vaginal colposcopy with a biopsy is not advised 48-hours after the procedure. Intercourse may be painful and increase post-procedure bleeding.

While working in the neonatal intensive care nursery, you are assigned to take care of a baby who is 31 weeks gestation. Which of the following complications must you know to monitor given the baby's gestational age? Select all that apply. A. Hypoglycemia B. Hypothermia C. Birth injuries D. Fat wasting

Choices A and B are correct. Infants born before 37 weeks gestation have low stores of glucose and therefore hypoglycemia is a common complication of prematurity. Blood glucose should be monitored closely (Choice A). Preterm infants are at risk for poor thermoregulation and hypothermia due to decreased stores of muscle and fat. Their body temperatures should be regulated via incubator, radiant warming, bundling, or other methods of temperature control, as indicated (Choice B).

Which of the following are bypasses in fetal circulation? Select all that apply. A. Ductus arteriosus B. Foramen ovale C. Ductus pulmonic D. Foramen aortic

Choices A and B are correct. The ductus arteriosus is a bypass in fetal circulation. It connects the pulmonary artery to the aorta (Choice A). The foramen ovale is a bypass in fetal circulation. It is an opening between the right and left atriums of the heart (Choice B).

You are working in the newborn nursery taking care of a 2-day old infant with fetal alcohol spectrum disorder and preparing the family for discharge. Which of the following educational points are essential to include? Select all that apply. A. Regular therapy appointments will need to be scheduled. B. An individualized education plan should be formulated with the child's school when he is preparing for kindergarten. C. With proper therapy, the condition will improve. D. A regular infant diet should be followed.

Choices A and B are correct. Therapy will be incredibly important for this infant after discharge. Physical therapy, occupational therapy, and speech therapy should all be incorporated with this infant's care plan. They will keep track of milestones and help aid in the development, motor skills, and cognitive abilities of the infant. Parents should be educated about the importance of these therapies so that they take them seriously and keep up with their appointments (Choice A). This child will require special education when starting school. The parents should be educated about this need so that they are realistic about their culture and prepared for the future needs of the child. Individualized education plans will be accommodated through the school system; the therapists and health care providers of the child can help inform them (Choice B).

Which of the following neurological assessments would be considered abnormal in a newborn? Select all that apply. A. High pitched cry B. Pupils are 2mm, equal, round, and react briskly to light. C. Lethargy D. Sleeping between each feeding

Choices A and C are correct. A high, pitched cry is an irregular finding in a newborn. It can be a sign of withdrawal in neonatal abstinence syndrome, or a sign of increased ICP if there is birth trauma (Choice A). For the level of consciousness, lethargy is not a normal finding. We expect the newborn to be alert. Lethargic, obtunded, stuporous, or comatose are all abnormal findings (Choice C).

Which of the following signs or symptoms would you expect in a postpartum patient experiencing subinvolution? Select all that apply. A. Boggy uterus B. Board-like abdomen C. Decreased fundal height D. Increased bleeding

Choices A and D are correct. A boggy uterus is a sign of subinvolution. Boggy, refers to a womb that is not firm and contracting as it is expected to in the postpartum stage. The uterus should contract to clamp down and prevent bleeding, but in sub-involution, it does not do so (Choice A). Increased bleeding is a sign of subinvolution. When the uterus is not contracting and clamping down on itself, it is not preventing postpartum bleeding. A healthy postpartum uterus would be contracting firmly, but this does not occur with subinvolution, so the mother is at risk for increased bleeding (Choice D).

You are providing education to a mother who gave birth three weeks ago. She has developed mastitis. Which of the following educational points are appropriate? Select all that apply. A. Continue to breastfeed your child normally. B. If unable to breastfeed, express milk every 2 hours. C. Do not take antibiotics. D. Wear a supportive bra without an underwire.

Choices A and D are correct. It is essential to educate mothers with mastitis that they should continue to breastfeed. The infection will not be passed to their child and they do not need to worry about any adverse effects for their infants. By continuing to breastfeed, the clogged milk ducts should become unclogged and mastitis should improve (Choice A). Wearing a supportive bra but one without an underwire is appropriate educational advice for a mother with mastitis. The support will help with the pain and tenderness in the breasts, but an underwire could cause clogged milk ducts, so it should be avoided (Choice D).

The nurse is conducting a health screening at a local health fair. Which of the following should the nurse recognize as a risk factor for developing ovarian cancer? Select all that apply. A. Nulliparity B. Advancing age C. Family history D. Herpes simplex virus (HSV) E. Early menarche

Choices A, B, C, and E are correct. Risk factors for ovarian cancer include nulliparity, advancing age, family history, and early menarche. Additional information: Ovarian cancer is an aggressive gynecological cancer that often only manifests symptoms once cancer has advanced. Risk factors for ovarian cancer include family history with the BRCA1 or BRCA2 genetic mutation. Early menarche, nulliparity, endometriosis, and smoking all are risk factors for this cancer. The early stages of this cancer are often asymptomatic. As ovarian cancer spreads, then the symptoms may become noticeable such as abdominal or pelvic pain.

Which of the following statements is true regarding fetal circulation? Select all that apply. A. There are high pressures in the fetal lungs causing decreased pulmonary circulation. B. Blood shunts from left to right in the fetal circulation. C. The ductus venosus allows freshly oxygenated blood to go to the fetal brain first. D. There are higher pressures in the right atrium in the fetal circulation.

Choices A, C, and D are correct. A is correct. In fetal circulation, the alveoli are filled with fluid. This causes high pressures in the fetal lungs, which shunts blood away from the pulmonary circulation. C is correct. The ductus venosus is a bypass in fetal circulation that shunts blood away from the weak fetal liver and to the brain. This allows the brain to get fresh oxygen first. D is correct. The pressures on the right side of the heart are higher in fetal circulation than on the left side of the heart.

The nurse counsels a client about a newly inserted copper intrauterine device (IUD) for contraception. It would require follow-up if the client states which of the following? Select all that apply. A. "This device may raise my risk for breast cancer." B. "I may continue to have bleeding and cramping." C. "I should perform weight-bearing exercises." D. "I will need my device replaced after 12 years." E. "This device may raise my risk for a stroke."

Choices A, C, and E are correct. The copper intrauterine device is non-hormonal; therefore, it does not raise the risk of breast cancer. Unlike depot medroxyprogesterone, the IUD does not cause bone demineralization. An increase in cardiovascular disease is not associated with the copper IUD as it is non-hormonal.

The nurse is caring for a 1-day old newborn client diagnosed with jaundice. Which of the following statements is true regarding jaundice in newborns? Select all that apply. A. Jaundice within the first 24 hours of life is physiologic. B. Unconjugated bilirubin is excreted in the stool. C. Assessing a newborn for jaundice involves inspection of the skin, sclera, and mucous membranes. D. When treating a jaundiced infant with phototherapy, an important nursing consideration is to ensure their eyes and genitals are covered

Choices C and D are correct. When assessing an infant suspected to have jaundice, the most important thing to do will be to evaluate the skin, sclera, and mucous membranes (Choice C). When bilirubin levels are high, there will be a yellow tinge to these areas due to the high levels of the bilirubin pigment in the blood. Jaundice usually starts in the face and forehead area, so the nurse should begin her assessment looking there. The sclera and mucous membranes are a common location to appreciate the yellow discoloration, especially in a patient with darker skin. When treating a jaundiced infant with phototherapy, important nursing considerations are to ensure their eyes and genitals are covered (Choice D). Phototherapy helps reduce serum bilirubin levels by converting bilirubin into water-soluble isomers that can be eliminated without conjugation in the liver. Phototherapy light can be harmful to the infant's eyes and genitals. Nurses should ensure these areas are covered with an eye mask and a diaper.

The nurse is educating a pregnant client who is admitted with deep vein thrombosis in her left lower extremity. The client is at 24 weeks of gestation. The client is placed on Low Molecular Weight Heparin (LMWH). Which of the following statements by the client indicate that she understands the education regarding LMWH? Select all that apply. A. "My blood thinner will be stopped soon after delivery." B. "Since I am on LMWH, I must have a planned cesarean section." C. "I hate injections. I will likely switch to warfarin after delivery." D. "There is an increased risk of fractures with long term LMWH therapy." E. "If I notice blisters or black-red areas at the injection site, then I will hold LMWH and immediately contact the doctor." F. "If I decide to switch to warfarin after delivery, then I should not breastfeed."

Choices C, D, and E are correct. LMWH is the anticoagulant of choice during pregnancy because it does not cross the placenta, but one may switch to warfarin in the post-partum period. While warfarin is contraindicated during active pregnancy due to its potential to cause congenital fetal disabilities, maternal/fetal bleeding, and miscarriages, it is considered safe in the post-partum period. Warfarin is also safe in lactating/breastfeeding women. The client will need a minimum of 3 to 6 months of anticoagulation and therefore will be requiring anticoagulation for a few weeks even after delivery. Additionally, the risk of recurrent venous thromboses is high up to 6 weeks post-partum. Since the client does not like injections, oral anticoagulation with warfarin is an option for her after delivery (Choice C). Long-term treatment with LMWH may decrease bone mineral density (osteopenia, osteoporosis) and increase the risk of fractures (Choice D). For those with pre-existing osteoporosis and fracture risk, close monitoring is needed when on long-term LMWH therapy. It is common to have some bruising and swelling at the injection site. However, the presence of blisters and necrotic areas (blackish-red central portion) at the injection site may serve as a warning sign of a complication known as heparin-induced-thrombocytopenia (HIT). If the patient or the nurse notes necrotic areas at the injection site, the physician must be notified immediately and LMWH must be discontinued (Choice E). HIT is a rare but dangerous complication with unfractionated and low-molecular-weight heparins. The body forms antibodies to heparin that may cross-react with platelet antigens and cause a drop in the platelets. Despite a decline in the platelet count, HIT is associated with the formation of thromboses (deep vein thrombosis and pulmonary embolism) because HIT antibodies disrupt and activate the clotting system. If HIT is confirmed, heparin should never be re-initiated. Other anticoagulants, such as argotraban or fondaparinaux, are used.

The nurse is assessing a client who is five months pregnant and has a son born at 40 weeks of gestation and a daughter born at 33 weeks of gestation. It would be correct for the nurse to document this client's GTPAL as A. G4-T1-P1-A0-L2 B. G3-T1-P1-A0-L2 C. G3-T1-P1-A0-L3 D. G3-T2-P0-A0-L2

This client is currently pregnant and has had two other pregnancies prior to the current one. This would make her a gravida three (G3). She has delivered one child at 40 weeks of gestation, which is one term birth (T1). She delivered one child at 33 weeks (P1). She has had two live births (L2). A method for calculating gravida and para is to separate pregnancies and their outcome using the acronym GTPAL: G = gravida, T = term, P = preterm, A = abortions, and L = living children. G = pregnancies or gravida, T = term pregnancies delivered, P = preterm pregnancies delivered, A = abortions (spontaneous and induced), and L = living children Term pregnancies are any pregnancy 37 weeks or greater; preterm is any pregnancy 20-36 weeks; abortions are any abortions spontaneous or induced prior to 20 weeks.