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Gravida / Para

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I was recently told that the common EMS definitions of all pregnancies versus live births (Gravidity vs Parity) seen in many textbooks is not consistent with what hospitals and other healthcare providers (like L&D nurses) use. Apparently, hospitals use Parity to mean how many times she has been pregnant over 20 weeks (or similar time period...24 weeks, etc) regardless of stillborns or miscarriages.

I think the common EMS definition I've heard from several places is useful to use, but it's inappropriate to report GP to a receiving nurse/doctor using a different definition (even if they're going to eventually ask patient themselves...in some emergent conditions it might not be possible right away).

Maybe someone who works both in EMS and hospital environment can clear things up for me.... Thanks.

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Posted · Report post

This is a topic that often causes confusion. Gravida simply means the number of times you had a bun or buns in the oven. Twins only count once. Para can be a bit more on the complicated side. Para means that you were able to carry that bun or buns long enough to be considered viable. The exact definition of para varies somewhat from source to source. However, most would agree that para is at least 20 or more weeks.

Take care,

chbare.

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Posted (edited) · Report post

Someone mixed up their definitions. The 20-week thing is the definition of para, not gravida. Gravida applies to any conception. However, they are not considered para until 20 weeks of gestation, regardless of whether born alive or stillborn.

EDIT: chbare beat me to it.

Edited by Dustdevil
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Posted · Report post

I think we're all on the same page as far as which one is Para and which Grava (unless I'm having a semi-dyslexic moment?).

What concerns me is that EMS books (including my Bledsoe's Brady book) are giving an incomplete definition of Para (live births instead of viable pregnancies).

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Posted · Report post

In the field and even in our hospitals para is used for live births. Then abortion is used for any miscarriage (spontaneous abortion ) or intentional abortion. So I get a patient that is G9P6A2, breaks down as, 9 pregnancy's, 6 live births, 2 abortions of some sort, and 1 in the oven.

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Here we break it down as follows:

Live births: only pertinent if still born carried full term or late term abortion (ie post 20 weeks) *note also make sure to include any children deceased in later years in this count !

Para: delivered babies in total

Gravida: how many times pregnant

So say you had a woman with a full term carried still born, 2 viable kids, and 2 abortions

I would count her as 2 Live birth, 3 Para, 5 Gravida

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Posted · Report post

Local protocols and practices are, for me, anyway, ask how many times pregnant, and how many live births. If they don't match, gently (!) ask how many aborts and miscarriages ("Sorry, I have to ask").

If birth is imminent, never mind, do what ya gotta do.

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Posted (edited) · Report post

... The exact definition of para varies somewhat from source to source. However, most would agree that para is at least 20 or more weeks.

Well I came out at 24 ... (maybe it was 26) .... guess that's why I'm working on becoming a paramedic huh? :lol::lol:

Edited by kiwimedic
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For the people who work in hospitals and use Parity to mean pregnancies that made it over a certain number of weeks....is the same definition used in all hospital's you've worked in? Is it in your textbooks? Or could it be a regional thing?

Basically my EMT friend is in nursing school and was surprised to find she was being taught a different definition than what she'd been using when reporting to nurses all her time as an EMT. And the nurses who work at the hospital she's doing clinicals at have no idea EMTs/Paramedics are taught a different definition.

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Directly from my OB/Gyn nursing textbook:

Maternal Newborn Nursing, Third Edition, Olds, London, Ladewig, 1988

Para: Delivery after 20 weeks of gestation (pregnancy) regardless of whether the fetus is born alive or dead.

I don't recall what my paramedic textbook said. I don't recall being surprised by any change in definition in nursing school though. But this is one of those things that is so briefly covered in medic school, and then so rarely used or reviewed, that a lot of medics probably just forget the fine details.

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But this is one of those things that is so briefly covered in medic school, and then so rarely used or reviewed, that a lot of medics probably just forget the fine details.

I know I did. The few times it's been necessary, I give my report using plain language, and ask the nurses at our L+D hospital what they use when I'm writing up my report to save space.

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I know I did. The few times it's been necessary, I give my report using plain language, and ask the nurses at our L+D hospital what they use when I'm writing up my report to save space.

Hmmm, we use it with just about every single pregnant patient...at all provider levels.

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So do I, I just don't see that many pregnant patients with the places I work at. Closest thing I've had to a pregnant patient within the last 12 months was a young woman who'd very recently become un-pregnant. And that was last fall.

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LOL. At my old service we had almost an active labor call every shift. I do not miss doing that.

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LOL. At my old service we had almost an active labor call every shift. I do not miss doing that.

As noted elsewhere, I've been on the ambulances from the fall of 1973. In that time, I have assisted in TWO (Count them! 2) births.

As for Gravida, Momma B (my mom) used to be a "Home Instruction" teacher, which is now under "Special Education". Some of her students over the years, were on her register for the condition of "Gravida".

I never recall ever hearing that term used in EMS.

"Para" is totally new to me in any usage other than Medics, "Para-Troopers", and certain educators, such as Lady J, my girlfriend, who is a teaching "Para-Professional".

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Posted · Report post

I know our local EMT school teaches it.

And it's in both Mosby's and Brady's paramedic texts.

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I know our local EMT school teaches it.

And it's in both Mosby's and Brady's paramedic texts.

Again, I make note that local protocols are local, and might not be the protocol across the town, county, or state boundary line, or international border.

I'm BLS, not ALS, so I couldn't confirm or deny it being covered in the 2 medic books, or other medic books mentioned, and used in training.

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Para is a well known term within the hospital environment in the United States and outside of the country. The term "para" is actually an abbreviation for the term parity. Parity in medicine obviously is a count of how many times a mother has given birth. However, most will agree that gestation beyond 20 weeks meets the requirements for "para."

You may even hear the term nullipara. This refers to a mother who for a variety of reasons has been unable to carry a baby beyond the 20 week mark. To make it more complicated, I still know a few people who break the "para" concept down into what is called the TPAL format. T: Total births, P: number of preterm births, A: Abortions (most will include spontaneous and planned), L: number of living children. For example; a mother has been pregnant two times with one spontaneous abortion and one preterm child that is still living. The TPAL score may look like this: 2-1-1-1. Clearly, this can be quite confusing.

Take care,

chbare.

Edited by chbare
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I prefer TPAL, because it breaks it down. That's what our local perinatal center uses for their forms.

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My first time through EMT-B, we were told that 'gravida' referred to the first pregnancy, and 'paragravida' referred to more than one pregnancy, regardless of the outcome of that pregnancy.

After reading the different 'definitions' that have been offered, I looked it up and this is what I've found:

Gravida/para/abortus (GPA), or sometimes just gravida/para (GP), is a shorthand notation for a woman's obstetric history.

Gravida indicates the total number of times a woman has been pregnant, regardless of whether these pregnancies were carried to term. A current pregnancy, if any, is included in this count. Para indicates the number of viable (>20 wks) births. Pregnancies consisting of multiples, such as twins or triplets, count as ONE birth for the purpose of this notation. Abortus is the number of pregnancies that were lost for any reason, including induced abortions or miscarriages. The abortus term is sometimes dropped when no pregnancies have been lost.

Therefore, the history of a woman who has had two pregnancies (both of which resulted in live births) would be noted as G2P2.

A woman who had 4 pregnancies, one of which was miscarried, is noted as G4P3A1.

Ok, so I haven't said anything that hasn't been said before. What I'm finding shocking is that while we covered childbirth in this EMT-B class (y'all already know I had to retake the course to get my license back after expiration), Emergency Care: 11th Edition makes no reference to either term.

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I learned this lil' trick about 5 years ago, and it has stuck with me since.

We all know that G is for Gravida & P is for Parita.

So.....

G = Gettin' it.

P = Payin' for it.

Now before all of you nay-sayers start in on me......stop. I am fully aware that this would be completely inappropriate to use as professional terminology, and as such....I would not even come close to considering doing so. However, in the back of my mind....when the poop hits the fan, this pops up, and saves me from wracking my brain in order to remember.

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Posted · Report post

I like it! :thumbsup:

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