A client who is 4 months pregnant is at the prenatal clinic for her initial visit. Her history reveals she has 7-year-old twins who were born at 34 weeks gestation, a 2-year-old son born at 39 weeks gestation, and a spontaneous abortion 1 year ago at 6 weeks gestation. Using the GTPAL method, the nurse would document her obstetric history as:

Choice A Reason: This is incorrect because maternal diabetes is a condition where the mother has high blood sugar levels during pregnancy. It can cause polyhydramnios, or excess amniotic fluid, not oligohydramnios, or low amniotic fluid.

Choice B Reason: This is correct because fetal anencephaly is a congenital defect where the fetus lacks parts of the brain and skull. It can cause oligohydramnios, as the fetus does not produce enough urine to contribute to the amniotic fluid volume.

Choice C Reason: This is incorrect because placental abruption is a complication where the placenta detaches from the uterine wall before delivery. It can cause bleeding, pain, and fetal distress, but not oligohydramnios.

Choice D Reason: This is incorrect because neural tube defects are congenital defects where the spinal cord or brain does not develop properly. They can cause various neurological problems, but not oligohydramnios.

Choice A Reason: This is incorrect because hemoconcentration by hypertension is a condition where the blood volume decreases and the blood pressure increases, leading to a higher hemoglobin level. A normal hemoglobin level for a pregnant woman in her second trimester is 10.5 to 14 g/dL. A hemoglobin level of 11 g/dL is within the normal range, not indicative of hemoconcentration.

Choice B Reason: This is incorrect because a multiple gestation pregnancy is a pregnancy with more than one fetus, such as twins or triplets. A multiple gestation pregnancy can cause a lower hemoglobin level due to increased blood volume and increased demand for iron. A hemoglobin level of 11 g/dL is not suggestive of a multiple gestation pregnancy.

Choice C Reason: This is incorrect because greater-than-expected weight gain is not directly related to the hemoglobin level. Weight gain during pregnancy depends on various factors such as pre-pregnancy weight, nutrition, physical activity, and genetics. A hemoglobin level of 11 g/dL does not reflect the weight status of the pregnant client.

Choice D Reason: This is correct because iron-deficiency anemia is a common type of anemia that occurs when the body does not have enough iron to produce enough red blood cells. Iron-deficiency anemia can cause a low hemoglobin level and affect the oxygen delivery to the tissues and the fetus. A hemoglobin level of 11 g/dL may indicate iron-deficiency anemia, especially if the client has other symptoms such as fatigue, weakness, pale skin, or cravings for non-food items. The nurse should confirm the diagnosis with further tests and recommend iron supplements and dietary changes to treat the condition.