A pregnant woman comes to the prenatal clinic for an initial visit. In reviewing her childbearing history, the client indicated that she has delivered premature twins, one full-term baby, and has had no abortions. Which GTPAL should the nurse document in this client's record?

Choice A reason: A miscarriage is defined as a spontaneous abortion of a fetus before the 20th week of gestation. It is a natural pregnancy loss that occurs before labor begins and is usually caused by chromosomal abnormalities, infections, or maternal health problems.

Choice B reason: A miscarriage is not often attributed to careless maternal behavior such as poor nutrition or excessive exercise. These factors may affect the quality of life of the mother and the fetus, but they are not the main causes of miscarriage. Most miscarriages are not preventable and are not the fault of the mother.

Choice C reason: A miscarriage that occurs before the 12th week of pregnancy may manifest only as moderate discomfort and blood loss, but this is not always the case. Some women may experience severe cramping, bleeding, and tissue passing from the vagina. Others may have no symptoms at all and only discover the miscarriage during a routine ultrasound.

Choice D reason: A miscarriage occurs in more than 5% of all clinically recognized pregnancies. The actual rate of miscarriage is estimated to be 10% to 20%, but many women may not realize they are pregnant or may not report the loss to their health care provider.

Choice A reason: Limiting fluid intake throughout the day is not advisable, as it can lead to dehydration and electrolyte imbalance. The pregnant woman should drink at least eight glasses of water per day, preferably between meals.

Choice B reason: Drinking a glass of water with a fat-free carbohydrate before getting out of bed in the morning is a good strategy to prevent nausea and vomiting, as it can stabilize the blood sugar level and prevent an empty stomach. However, it is not the best answer, as it does not address the dietary needs throughout the day.

Choice C reason: Increasing the intake of high-fat foods is not recommended, as it can worsen nausea and vomiting. High-fat foods are harder to digest and can cause gastric irritation and reflux. The pregnant woman should choose low-fat, bland, and easy-to-digest foods.

Choice D reason: Eating small, frequent meals (every 2 to 3 hours) is the best option, as it can prevent nausea and vomiting by avoiding hunger and keeping the stomach moderately full. It can also provide adequate nutrition and calories for the pregnant woman and the fetus.