A client presents for a prenatal visit at 12 weeks gestation. Her obstetrical history includes delivering triplets at 35 weeks (all surviving), a miscarriage at 9 weeks, and delivering a daughter at 38 weeks. How should the nurse document her GTPAL history?

GTPAL stands for Gravida (total number of pregnancies), Term (deliveries at 37 weeks or beyond), Preterm (deliveries between 20 and 36 weeks 6 days), Abortus (pregnancy losses before 20 weeks, including miscarriages and therapeutic abortions), and Living children. This client's current pregnancy makes her G4. Her obstetrical history includes the triplet delivery at 35 weeks — this counts as one preterm birth (P1) because GTPAL counts the number of deliveries, not the number of neonates, and the triplets were delivered at 35 weeks, which is preterm. Her miscarriage at 9 weeks counts as one abortus (A1). Her daughter delivered at 38 weeks counts as one term delivery (T1). The number of living children is 4 — three triplets plus the daughter (L4). Therefore the correct GTPAL is G4, T1, P1, A1, L4, which corresponds to the option reading G4T1P1A1L4. The option G4T1P2A1L3 is wrong because it incorrectly counts two preterm deliveries and only three living children. G4T1P1A2L3 incorrectly records two abortions and three living children. G4T2P1A1L4 incorrectly classifies the triplet birth at 35 weeks as a term delivery. The key distinction is that all three triplets survived (L4) and the single triplet delivery event was preterm (P1).