Reporting gravida and para on obstetric patients can get confusing for first responders. It’s a skill that many EMS don’t use often because they don’t see pregnant patients everyday. EMTs need to know how to calculate gravida and para for use in the field and for the NREMT exam. Learn all about gravida/para and TPAL here and then check out the gravida and para examples towards the bottom of this page.
Gravida Para Meaning
• Gravida is the number of times the mother has been pregnant. This includes the current pregnancy if your patient is pregnant.
• Para is the number of viable births, greater than 20 weeks gestation. In some regions it may be > 24 weeks. (Expanded definition below.)
Some patients can be reported using the simple G-P-, but others will need the full para expressed using TPAL subcategories, which are discussed below.
Why Do We Record Para Gravida
Initially you might be learning these terms to pass the NREMT exam, but they are useful in real world situations. Here are a few reasons learning and recording your patient’s obstetric history is important.
- What normal labor looks like can depend on the number of previous births (Para).
- Outcomes of previous pregnancies can indicate risk and outcome of the current pregnancy.
- The amount of previous pregnancies and deliveries (gravity and para) can influence risks associated with the current pregnancy.
- Using the medical terms keeps things professional so you don’t say things like “she’s been pregnant three times but only has one kid.” in front of the patient.
Gravida and para are simple to learn but easy to forget if you don’t see any OB patients for a long time.
Para Medical Term
The meaning of gravida is straightforward, but para is a bit more complicated. The number of viable births > 20 weeks has to be broken into subcategories for some patients.
The medical term para is separated into four subcategories that form the mnemonic TPAL.
- T – Number of term pregnancies.
- P – Number of preterm pregnancies.
- A – Number of abortions.
- L – Number of living children
When reporting para TPAL: a term pregnancy is 37 or more weeks and preterm is less than 37 weeks.
The number of abortions refers to ectopic pregnancies, miscarriages, spontaneous abortions, elective abortions, therapeutic abortions etc.
Multiple Pregnancy and Para
When recording gravity and para you are reporting the number of pregnancies and number of births, not the number of children. For this reason, multiple pregnancies such as twins or triplets will count as only one birth in para or TPAL.
Gravida Para Examples
Test out your understanding of gravida and para with these sample questions below. They will start out simple and get harder as you go. Use the limited information in each statement below to determine gravida, para, and TPAL if need.
Simple gravida/para example:
A 24 y/o F is complaining of abdominal pain at 6 out of 10. She is 19 weeks pregnant.
Easy gravida/para example:
You arrive at a 37 y/o woman’s house and find her complaining of lasting nausea, severe vomiting and a headache. She has 2 children who were born at 38 and 39 weeks and is currently in her first trimester of pregnancy.
Your patient is a pregnant 35 year old female with 3 children. They were born at 35 weeks, 38 weeks and 39 weeks.
You get called to a patient during her fourth pregnancy. She has 3 living children, but her first pregnancy resulted in a spontaneous abortion at 7 weeks. She gave birth to twins at 35 weeks from her second pregnancy and to a son at 39 weeks from her third pregnancy.
Currently pregnant, 1 spontaneous abortion, 1 child, 1 with twins = 4 Pregnancies.
- Term- 1 at 39 weeks.
- Preterm- 1 set of twins (multiple pregnancy counts as one birth) at 35 weeks.
- Abortion- 1 spontaneous abortion.
- Living- She has 3 living children.
Your patient is 2 days post laparoscopic surgery for an ectopic pregnancy. She is complaining of abdominal tenderness and increased pain on exertion. Before this surgery she had 2 previous ectopic pregnancies. She already has 3 living children, twins born at 34 weeks and one born at 38 weeks.
1 ectopic 2 days ago, 2 prior ectopics, 1 child, 1 with twins = 5 Pregnancies.
- Term- 1 at 38 weeks.
- Preterm- 1 set of twins (multiple pregnancy counts as one) at 34 weeks.
- Abortion- 3 ectopics count towards abortions.
- Living- She has 3 living children.
What About GPA
For simple obstetric histories it’s common to record gravida and para without using TPAL. Depending on where you are located, GPA may also be used for charting gravida/para/abortion.
- Gravida = Number of times pregnant
- Para = Total live births
- Abortions = Includes ectopic pregnany, miscarriage, etc.
A woman pregnant for the first time is G1 P0 A0.
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Christina Beutler is the creator of EMT Training Base. She is a former EMT and a current Registered Nurse. Christina’s path changed after taking a Basic First Aid class while in Community College, and a career in healthcare opened up. Working as an Emergency Medical Technician led to a passion for nursing and a job working in the Intensive Care Unit and Critical Care Unit right out of Nursing School. To learn more about Christina’s story, head over to the About page.