Clinical Practice Guidelines Example Implementation Guide - Antenatal Care Guidelines, published by HL7 International - Clinical Decision Support WG. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/cpg-example-anc/ and changes regularly. See the Directory of published versions

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Official URL: http://hl7.org/fhir/uv/cpg/antenatalcare/ImplementationGuide/hl7.fhir.uv.cpg.antenatalcare				Version: 1.0.0
Active as of 2024-03-01				Computable Name: CPGExampleAntenatalCareGuidelines

This CPG example defines computable content for two recommendations in the WHO Antenatal Care Guidelines (ANC):

WHO ANC Guideline

Overall, the guideline recommends a contact schedule consisting of 8 contacts at specific points in the pregnancy. This is represented with the ANC Contact Schedule (a pathway) describing the expected schedule:

ANC Contact 1: up to 12 weeks
ANC Contact 2: 20 weeks
ANC Contact 3: 26 weeks
ANC Contact 4: 30 weeks
ANC Contact 5: 34 weeks
ANC Contact 6: 36 weeks
ANC Contact 7: 38 weeks
ANC Contact 8: 40 weeks
ANC Delivery: 41+ weeks

The protocol contains actions for each expected contact with an applicability condition to specify the timing, and pointing to the ANC Contact (a strategy) describing each contact:

Registration: PlanDefinition/cpg-common-registration
Record health history:
  if "Is First Contact"
	  New profile: Questionnaire/anc-first-contact
	Questionnaire/anc-every-contact
Assess danger signs:
  Questionnaire/anc-quick-check
Assess current pregnancy:
Case management or referral:
Schedule followup visit

(Note that the above content is an example and is not necessarily fit for immediate use).

These definitions reference the ANC Common Library to provide the logic for the applicability conditions.

Within the context of this overall schedule, the guideline contains specific recommendations related to various aspects of the health of the mother. One of these is recommendation A2, for Iron and Folic Acid Supplementation, detailed in the following sections as part of this example.

Iron and Folic Acid Supplementation

Recommendation A2.1

Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron2 and 400 μg (0.4 mg) of folic acid3 is recommended for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.

Recommendation A2.2

Intermittent oral iron and folic acid supplementation with 120 mg of elemental iron5 and 2800 μg (2.8 mg) of folic acid once weekly is recommended for pregnant women to improve maternal and neonatal outcomes if daily iron is not acceptable due to side-effects, and in populations with an anaemia prevalence among pregnant women of less than 20%.

Resources

These recommendations use the ANCRecommendationA2 library to define the logic involved, and the ANCRecommendationA2 recommendation definition to establish the event-condition-action rule for when they should be used.