Box 241 Shorthand Notation for Birth History

Most centers use some variation of the following shorthand notation to summarize a woman's pregnancies and their outcomes: G3 P2-0-0-2. The ''G'' stands for ''gravida'' and is the number of pregnancies. The ''P'' stands for ''para,'' for the number of birth/pregnancy outcomes; each of the four numbers after the ''P'' stands for a different outcome:

• The first place is the number of full-term births

• The second place is the number of preterm births

• The third place is the number of abortions/miscarriages

• The fourth place is the number of living children

(A mnemonic for remembering this notation is FPAL: FiliPino AirLines.)

In this example, this woman who is described as being G3 P2-0-0-2 is currently pregnant for the third time; she has delivered two full-term infants, she has had no preterm births and no miscarriages, and both her children are living.

By convention, in the case of a newborn, the notation for the mother reflects the notation when she was pregnant but had not yet delivered this child. For instance, in the case of a first-born child, the mother would be described as G1 P0-0-0-0.

Here's a quiz: Suppose a woman is described as G1 P2-0-0-2. How is that possible?*

*Answer: She has been pregnant once with twins, who were delivered at term and both of whom are living.

"When did you start prenatal care?'' If prenatal care was started late, inquire tactfully about why by asking, ''What is the reason you have not seen a doctor earlier?''

''Did you have any illnesses during your pregnancy?'' If yes, ask the mother to describe them, and find out when during the pregnancy they occurred. Be sure to ask about chronic illnesses, such as diabetes, hypertension, asthma, or epilepsy, because these can have an effect on the health of the fetus. Also, inquire about any rashes that developed during pregnancy.

''How much weight did you gain during your pregnancy?''

''During your pregnancy, did you take any drugs, recreational or otherwise? Any herbal products? Drink alcohol? Smoke cigarettes? Have any 'x-rays'? Have any abnormal bleeding?'' In asking these questions, the concern is whether the fetus has been exposed to any agents, known as teratogens, that can cause birth defects. Although concerns about teratogens are real, many women who have taken innocuous medications during pregnancy feel guilt that their ingestion may have somehow harmed their child; in these cases, reassurance that the agent was safe may relieve a great deal of maternal anxiety.

''Were you told during your pregnancy that you had high blood pressure? diabetes? protein in your urine?''

''What were the results of your blood tests? Were you tested for Group B strep or any other infections?'' Standard prenatal care includes testing for maternal blood group, hepatitis B surface antigen, syphilis, chlamydial infection, and, in the last trimester, group B strep-tococcal vaginal colonization. Testing for gestational diabetes is also becoming more prevalent.

Although testing for human immunodeficiency virus (HIV) infection is not automatic, most women also accept it, because therapy with antiretroviral drugs in the last trimester can reduce rates of congenital infection from 25% to less than 2%.

' 'Did you have any special testing during the pregnancy? ultrasound examinations? amniocentesis or chorionic villus sampling (CVS)?'' If yes, ' 'What were the results?'' Amniocentesis should be offered to all pregnant women aged 35 years and older. Inquire about the reasons for any special testing.

''What was your due date? When was the baby actually born?'' Prematurity (birth before 37 weeks' gestation), and postmaturity (birth after 42 weeks' gestation) are associated with increased risk of early mortality and with specific clinical syndromes.

''When did you first feel the baby move? Was the baby active throughout pregnancy?'' If this is not the first pregnancy, ask the mother to compare this fetus's activity with her other pregnancies.

''How long was your labor? Were there any unusual problems with it?''

''What type of delivery did you have, vaginal or cesarean?'' If cesarean, ask for the reason. Was it because of a previous cesarean birth or a problem related to this pregnancy?*

''Did the baby come out head first or feet first?''

''How long were your membranes ruptured before the child was born?'' If the membranes have been ruptured more than 18 hours, the risk of infection ascending from birth canal to the baby increases rapidly.

''What was the child's birth weight?''

''Were you told of any abnormalities at birth?''

''Were you told the Apgar{ scores?'' If the parents don't know, ask, ''Did he cry right away? Or did the doctors need to do something to help him start breathing?''

''Did the child experience any problems in the newborn nursery, such as breathing difficulties? Jaundice? Feeding problems?''

''Did the child receive oxygen in the nursery? antibiotics? phototherapy?'' ''After delivery, how long did the baby remain in the hospital?'' Did the child go home with you?'' If not, ask why not.

''Were you told that any problems were found on the newborn screening tests?''{ If yes, ' 'What were they? Was follow-up testing performed?''

Note the order of these questions: they begin with the prenatal course, then focus on the actual birth, and then turn to the postnatal course. See the sample write-up of a newborn's history at the end of this chapter. The amount of detail needed in the birth history depends on the age of the child and the clinical situation. Most of this information is pertinent for an infant;for a teenager, it is probably enough to know whether the child was born full term and whether there were any problems in the neonatal period.

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