How should the nurse correctly document the pregnancy history of a client who has had a previous miscarriage, a singleton birth, and twins?

To accurately document pregnancy history using the GTPAL system, it's essential to understand the definitions of gravida and para. Gravida refers to the total number of pregnancies a woman has had regardless of the outcome, while para indicates the number of pregnancies that have resulted in viable offspring, typically categorized into term, preterm, and/or stillbirths.

In this case, the client’s history includes a previous miscarriage (which does not count as a viable pregnancy), one singleton birth, and one set of twins. The client has therefore been pregnant four times in total, counting the miscarriage, singleton birth, and twin pregnancy. This leads to a gravida of 4.

For the para count, we consider only those pregnancies that have resulted in viable offspring. The one singleton birth and the twins (counting as one multiple birth) contribute to a total of 2 viable births. Thus, the para remains 2.

The correct documentation of this client’s pregnancy history is therefore Gravida 4, Para 2. This reflects the precise history and helps in managing the client's care by conveying critical reproductive information.