A client arrives to the clinic reporting she has been unable to conceive for the last year.

The obstetrical history includes a live birth at 28 weeks, a live birth at 22 weeks who lived for 2 days, and 3 miscarriages in the first trimester.

Which GTPAL should the nurse document?

Choice A rationale

Each pregnancy is an independent event with its own set of probabilities. The risk of inheriting an autosomal dominant disorder does not decrease or increase with subsequent children. The probability is determined by the parental genotype, and it remains a constant fifty percent chance for each child born to an affected parent.

Choice B rationale

The question explicitly states that the disorder is autosomal dominant, meaning it is not sex-linked. Therefore, the inheritance pattern is not dependent on the sex of the child. It affects both male and female offspring with equal probability, and it is crucial to provide accurate genetic counseling based on the specific inheritance pattern.

Choice C rationale

The inheritance of an autosomal dominant disorder is probabilistic, not deterministic. Each child has a separate and independent 50% chance of inheriting the mutated gene. The outcome for a previous child does not influence the genetic outcome for a future child, as each pregnancy is a separate genetic event.

Choice D rationale

An autosomal dominant disorder means that a single copy of the mutated gene is sufficient to cause the disorder. Since one parent is affected, they have a fifty percent chance of passing on the mutated allele to each of their children. The other parent, who is unaffected, can only pass on the normal allele, resulting in a fifty percent chance for the disorder.

Choice A rationale

Placenta previa is a condition where the placenta partially or completely covers the cervix. The primary symptom is painless vaginal bleeding, not severe abdominal pain with a rigid abdomen. The rigid, board-like abdomen and severe pain are classic signs of a different, more acute obstetric complication.

Choice B rationale

Oligohydramnios refers to a low volume of amniotic fluid. This condition is not typically associated with severe abdominal pain and a rigid abdomen. It is usually diagnosed through ultrasound and is related to fetal renal anomalies or placental insufficiency. It would not cause the physical symptoms described.

Choice C rationale

Abruptio placentae is the premature separation of the placenta from the uterine wall. The classic signs include severe abdominal pain, a rigid board-like abdomen due to concealed hemorrhage, and vaginal bleeding. The separation causes uterine irritability and hemorrhage, leading to the reported findings. This is a medical emergency requiring immediate intervention.

Choice D rationale

Chorioamnionitis is an infection of the chorion, amnion, and amniotic fluid. The key signs are maternal fever, maternal and fetal tachycardia, and uterine tenderness. A rigid abdomen and severe pain are not the primary symptoms. This condition is a result of ascending infection, not placental separation, and presents with a different clinical picture.