When calculating GTPAL, how are twins counted in the preterm and term categories?

• A. Count as 1
• B. Count as 2
• C. Not counted
• D. Count as 0.5

Answer: (A)

In GTPAL, counts are based on pregnancies, not the number of babies born in each pregnancy. A multiple gestation like twins is still one pregnancy, so it contributes a single count to the term or preterm category depending on when delivery occurred. If the twins are delivered at term, that one pregnancy adds to the term count; if delivered preterm, it adds to the preterm count. The number of living babies is tracked separately—so if both twins survive, the living count increases accordingly (for example, two living babies from that pregnancy). Example: one pregnancy with twins born at term who both survive would be G1 T1 P0 A0 L2.