Mind your Gs and Ps

We talk about patient reproductive histories in short-hand - "She's a G2P1", meaning: she's had two pregnancies (this one counts) and is thus a gravida two, and one delivery; thus a para 1. That's an abbreviation for the longer format, which would be a G2P1001 - again, the G is the pregnancies, and the four digits of the P are various types of pregnancies she's experienced. Many med students use the mnemonic TPAL - the digits stand for, in turn, term pregnancies, premature deliveries, abortions, and live children.

But of course this becomes more complicated. First of all, "abortions" in this and most other medical language refers to any pregnancy loss prior to 20 weeks, regardless of whether is was spontaneous (or what we would call a miscarriage) or a termination. And twins always complicated matters- one pregnancy, two deliveries.

And finally, when you break it down to the short-hand - G2P1 - that one digit after the P refers to the "L" number, the living children this patient has. I was always taught that the "L" digit did not really mean "currently alive" but rather was a reference to children that had survived the neonatal period. That is, it was no longer part of the obstetric history if their 4 year old died in a car accident; that patient, with no living children, would still be a P1. It's tragic, yes, but unlikely to be related to the pregnancy, labor, or delivery we were thinking about now.

I'm seeing my residents, however, use it differently: as a notation for how many live children this patient actually has. The above patient would be presented by them as a P0; she has no children at home.. Arguably, that's a way of melding social history with obstetric history. And arguably, more appropriate.

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None of this terminology ends up being short-hand, in the end, as the terminology has so many possible meanings that an explanation must inevitably accompany it. That is, is the G3P1011 someone who had a term delivery after a six-week miscarriage? This is medically low-risk, and not a red flag for her pregnancy. Or is she someone who had a term delivery, followed by an 17-week intrauterine loss? Or a second trimester termination? Both of those people would have very different concerns and follow-ups, as their bodies would have been subjected to extremely different physiologic and pathologic processes.

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In any case, though, I recently took care of a G9 P0. And you don't need much explanation to know how terrible that is. Nine pregnancies; no living children.

Most of these were in other countries, with minimal medical care so far as I can tell. And yet, it is amazing to me that she has the strength to even try again. This time, things seem to be progressing uneventfully, which is really the best you can hope for in any pregnancy.