WHO Antenatal Care Guideline Implementation Guide
0.3.0 - CI Build
WHO Antenatal Care Guideline Implementation Guide, published by World Health Organization (WHO). This guide is not an authorized publication; it is the continuous build for version 0.3.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/WorldHealthOrganization/smart-anc/ and changes regularly. See the Directory of published versions
Active as of 2021-06-11 |
{
"resourceType" : "PlanDefinition",
"id" : "ANCDT06",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <table class=\"grid dict\">\n \n <tr>\n <th scope=\"row\"><b>Id: </b></th>\n <td style=\"padding-left: 4px;\">ANCDT06</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Url: </b></th>\n <td style=\"padding-left: 4px;\"><a href=\"PlanDefinition-ANCDT06.html\">ANC.DT.06 Physical symptoms and exam results requiring referral</a></td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Version: </b></th>\n <td style=\"padding-left: 4px;\">0.3.0</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Identifier: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <b>value: </b> <span>ANC.DT.06</span>\n </p>\n \n </td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Name: </b></th>\n <td style=\"padding-left: 4px;\">ANCDT06</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Title: </b></th>\n <td style=\"padding-left: 4px;\">ANC.DT.06 Physical symptoms and exam results requiring referral</td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Status: </b></th>\n <td style=\"padding-left: 4px;\">active</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Experimental: </b></th>\n <td style=\"padding-left: 4px;\">false</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p style=\"margin-bottom: 5px;\">\n <b>system: </b> <span><a href=\"http://hl7.org/fhir/R4/codesystem-plan-definition-type.html\">http://terminology.hl7.org/CodeSystem/plan-definition-type</a></span>\n </p>\n \n \n <p style=\"margin-bottom: 5px;\">\n <b>code: </b> <span>eca-rule</span>\n </p>\n \n \n \n \n \n </td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Date: </b></th>\n <td style=\"padding-left: 4px;\">2021-06-11 22:32:40-0600</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Publisher: </b></th>\n <td style=\"padding-left: 4px;\">World Health Organization (WHO)</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Description: </b></th>\n <td style=\"padding-left: 4px;\">If the woman has any of the following physical exam results, refer to the hospital</td>\n </tr>\n \n \n \n \n <tr>\n <th scope=\"row\"><b>Use Context: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr><th><b>code</b></th><th><b>value</b></th><th><b>display</b></th></tr>\n \n <tr>\n <td>task</td>\n <td>ANC.B8.</td>\n <td>Conduct physical exam</td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Jurisdiction: </b></th>\n <td style=\"padding-left: 4px;\">001</td>\n </tr>\n \n \n \n \n \n \n \n \n\n \n <tr>\n <th scope=\"row\"><b>Libraries: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr><td><a href=\"Library-ANCDT06.html\">ANC.DT.06 Physical symptoms and exam results requiring referral</a></td></tr>\n \n </table>\n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Actions: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr>\n <td>\n <b> ANC.DT.06 Physical symptoms and exam results requiring referral:</b> <br/>\n <b>When:</b> <i>Named Event:</i> ANC.B8. Conduct physical exam<br/>\n \n \n <b>Then:</b>\n <table class=\"grid-dict\">\n \n <tr>\n <td>\n Woman has a fever – provide treatment and refer urgently to hospital!\nProcedure:\n– Insert an IV line\n– Give fluids slowly<br/>\n \n <b>If:</b> <i>Applicability:</i> (&quot;Body temperature&quot; ≥ 38°C)\n AND (&quot;Second body temperature&quot; ≥ 38°C) <i>(Should Conduct further investigation and, if necessary, refer urgently if treatment not available at your facility )</i><br/>\n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n Abnormal pulse rate – refer for further investigation\nProcedure:\n– Check for fever, infection, respiratory distress, arrhythmia\n– Refer for further investigation<br/>\n \n <b>If:</b> <i>Applicability:</i> 60 bpm &gt; &quot;Second pulse rate&quot; &gt; 100 bpm <i>(Should Refer to a hospital)</i><br/>\n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n Woman has respiratory distress – refer urgently to the hospital!<br/>\n \n <b>If:</b> <i>Applicability:</i> ((((((&quot;Respiratory exam result&quot; = &quot;Dyspnoea&quot;)\n OR (&quot;Respiratory exam result&quot; = &quot;Cough&quot;))\n OR (&quot;Respiratory exam result&quot; = &quot;Rapid breathing&quot;))\n OR (&quot;Respiratory exam result&quot; = &quot;Slow breathing&quot;))\n OR (&quot;Respiratory exam result&quot; = &quot;Wheezing&quot;))\n OR (&quot;Respiratory exam result&quot; = &quot;Rales&quot;))\n OR (&quot;Respiratory exam result&quot; = &quot;Other abnormal respiratory exam result (specify)&quot;) <i>(Should Refer urgently to a hospital)</i><br/>\n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n Woman has low oximetry (&lt;92%) – she should be referred urgently to the hospital<br/>\n \n <b>If:</b> <i>Applicability:</i> &quot;Oximetry&quot; &lt; 92% <i>(Should Refer urgently to a hospital 2)</i><br/>\n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n Woman's cardiac condition is abnormal and she should be referred urgently to the hospital<br/>\n \n <b>If:</b> <i>Applicability:</i> (((((((&quot;Cardiac exam result&quot; = &quot;Heart murmur&quot;)\n OR (&quot;Cardiac exam result&quot; = &quot;Weak pulse&quot;))\n OR (&quot;Cardiac exam result&quot; = &quot;Tachycardia&quot;))\n OR (&quot;Cardiac exam result&quot; = &quot;Bradycardia&quot;))\n OR (&quot;Cardiac exam result&quot; = &quot;Arrhythmia&quot;))\n OR (&quot;Cardiac exam result&quot; = &quot;Cyanosis&quot;))\n OR (&quot;Cardiac exam result&quot; = &quot;Cold sweats&quot;))\n OR (&quot;Cardiac exam result&quot; = &quot;Other abnormal cardiac exam result (specify)&quot;) <i>(Should Refer urgently to a hospital 3)</i><br/>\n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n Woman's breast exam was abnormal and she should be referred to hospital for further investigation<br/>\n \n <b>If:</b> <i>Applicability:</i> ((((((&quot;Breast exam result&quot; = &quot;Nodule&quot;)\n OR (&quot;Breast exam result&quot; = &quot;Discharge&quot;))\n OR (&quot;Breast exam result&quot; = &quot;Flushing&quot;))\n OR (&quot;Breast exam result&quot; = &quot;Local pain&quot;))\n OR (&quot;Breast exam result&quot; = &quot;Bleeding&quot;))\n OR (&quot;Breast exam result&quot; = &quot;Increased temperature&quot;))\n OR (&quot;Breast exam result&quot; = &quot;Other breast exam result (specify)&quot;) <i>(Should Conduct further investigation and, if necessary, refer urgently to a hospital)</i><br/>\n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n Woman's abdominal exam was abnormal and she should be referred or further evaluated<br/>\n \n <b>If:</b> <i>Applicability:</i> (((((((((((((((((&quot;Abdominal exam result&quot; = &quot;Mass/tumour&quot;)\n OR (&quot;Abdominal exam result&quot; = &quot;Pain on superficial palpation&quot;))\n OR (&quot;Abdominal exam result&quot; = &quot;Pain on deep palpation&quot;))\n OR (&quot;Abdominal exam result&quot; = &quot;Painful decompression&quot;))\n OR (&quot;Abdominal exam result&quot; = &quot;Other abnormal abdominal exam result (specify)&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Abnormal vaginal discharge&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Evidence of amniotic fluid&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Foul-smelling vaginal discharge&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Clusters of erythematous papules&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Vesicles&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Genital ulcer&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Genital pain&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Tender bilateral inguinal and femoral lymphadenopathy&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Cervical friability&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Mucopurulent cervicitis&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Tender unilateral lymphadenopathy&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Curd-like vaginal discharge&quot;))\n OR (&quot;Pelvic exam result (visual)&quot; = &quot;Other abnormal pelvic exam (visual) result (specify)&quot;) <i>(Should Refer to a hospital 2)</i><br/>\n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n Woman should be referred urgently if there is evidence of amniotic fluid, which could indicate the start of labour<br/>\n \n <b>If:</b> <i>Applicability:</i> (&quot;Pelvic exam result (visual)&quot; = &quot;Evidence of amniotic fluid&quot;)\n AND (&quot;Gestational age&quot; &lt; 37 weeks) <i>(Should Refer urgently to a hospital 4)</i><br/>\n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n If no fetal heartbeat is observed, inform the woman that there might be a problem and that she needs to be referred to the hospital for further examination and next steps.\n\nProcedure:\n– Inform the woman that you cannot find the heartbeat and need to refer her to check if there's a problem\n– Refer to hospital<br/>\n \n <b>If:</b> <i>Applicability:</i> (&quot;Fetal heartbeat present&quot; = FALSE)\n AND (&quot;Gestational age&quot; ≥ 20 weeks) <i>(Should Refer to a hospital 3)</i><br/>\n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n Fetal heart rate is abnormal after two readings: the woman should be referred to hospital<br/>\n \n <b>If:</b> <i>Applicability:</i> (100 bpm &gt; &quot;Second fetal heart rate&quot; &gt; 180 bpm)\n AND (&quot;Gestational age&quot; ≥ 20 weeks) <i>(Should Refer to a hospital 4)</i><br/>\n \n \n \n </td>\n </tr>\n \n </table>\n \n </td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n </table>\n</div>"
},
"url" : "http://fhir.org/guides/who/anc-cds/PlanDefinition/ANCDT06",
"identifier" : [
{
"use" : "official",
"value" : "ANC.DT.06"
}
],
"version" : "0.3.0",
"name" : "ANCDT06",
"title" : "ANC.DT.06 Physical symptoms and exam results requiring referral",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
"code" : "eca-rule"
}
]
},
"status" : "active",
"experimental" : false,
"date" : "2021-06-11T22:32:40-06:00",
"publisher" : "World Health Organization (WHO)",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "https://www.who.int"
}
]
}
],
"description" : "If the woman has any of the following physical exam results, refer to the hospital",
"useContext" : [
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "task",
"display" : "Workflow Task"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://fhir.org/guides/who/anc-cds/CodeSystem/activity-codes",
"code" : "ANC.B8.",
"display" : "Conduct physical exam"
}
]
}
}
],
"jurisdiction" : [
{
"coding" : [
{
"system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code" : "001"
}
]
}
],
"library" : [
🔗 "http://fhir.org/guides/who/anc-cds/Library/ANCDT06"
],
"action" : [
{
"title" : "ANC.DT.06 Physical symptoms and exam results requiring referral",
"trigger" : [
{
"type" : "named-event",
"name" : "ANC.B8. Conduct physical exam"
}
],
"action" : [
{
"id" : "1",
"title" : "Conduct further investigation and, if necessary, refer urgently if treatment not available at your facility ",
"description" : "Conduct further investigation and, if necessary, refer urgently if treatment not available at your facility ",
"textEquivalent" : "Woman has a fever – provide treatment and refer urgently to hospital!\nProcedure:\n– Insert an IV line\n– Give fluids slowly",
"documentation" : [
{
"type" : "citation",
"label" : "Managing complications guide (IMPAC) (2017): Section S-113 (5)"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "(\"Body temperature\" ≥ 38°C)\n AND (\"Second body temperature\" ≥ 38°C)",
"language" : "text/cql-identifier",
"expression" : "Should Conduct further investigation and, if necessary, refer urgently if treatment not available at your facility "
}
}
]
},
{
"id" : "2",
"title" : "Refer to a hospital",
"description" : "Refer to a hospital",
"textEquivalent" : "Abnormal pulse rate – refer for further investigation\nProcedure:\n– Check for fever, infection, respiratory distress, arrhythmia\n– Refer for further investigation",
"documentation" : [
{
"type" : "citation",
"label" : "Managing complications guide (IMPAC) (2017): Section S-1 (5)"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "60 bpm > \"Second pulse rate\" > 100 bpm",
"language" : "text/cql-identifier",
"expression" : "Should Refer to a hospital"
}
}
]
},
{
"id" : "3",
"title" : "Refer urgently to a hospital",
"description" : "Refer urgently to a hospital",
"textEquivalent" : "Woman has respiratory distress – refer urgently to the hospital!",
"documentation" : [
{
"type" : "citation",
"label" : "Managing complications in pregnancy and childbirth guide (IMPAC) (2017): Section S-149 (5)"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "((((((\"Respiratory exam result\" = \"Dyspnoea\")\n OR (\"Respiratory exam result\" = \"Cough\"))\n OR (\"Respiratory exam result\" = \"Rapid breathing\"))\n OR (\"Respiratory exam result\" = \"Slow breathing\"))\n OR (\"Respiratory exam result\" = \"Wheezing\"))\n OR (\"Respiratory exam result\" = \"Rales\"))\n OR (\"Respiratory exam result\" = \"Other abnormal respiratory exam result (specify)\")",
"language" : "text/cql-identifier",
"expression" : "Should Refer urgently to a hospital"
}
}
]
},
{
"id" : "4",
"title" : "Refer urgently to a hospital",
"description" : "Refer urgently to a hospital 2",
"textEquivalent" : "Woman has low oximetry (<92%) – she should be referred urgently to the hospital",
"documentation" : [
{
"type" : "citation",
"label" : "Managing complications in pregnancy and childbirth guide (IMPAC) (2017): Section S-58 (5)"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "\"Oximetry\" < 92%",
"language" : "text/cql-identifier",
"expression" : "Should Refer urgently to a hospital 2"
}
}
]
},
{
"id" : "5",
"title" : "Refer urgently to a hospital",
"description" : "Refer urgently to a hospital 3",
"textEquivalent" : "Woman's cardiac condition is abnormal and she should be referred urgently to the hospital",
"documentation" : [
{
"type" : "citation",
"label" : "Managing complications in pregnancy and childbirth guide (IMPAC) (2017): Section S-150 (5)"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "(((((((\"Cardiac exam result\" = \"Heart murmur\")\n OR (\"Cardiac exam result\" = \"Weak pulse\"))\n OR (\"Cardiac exam result\" = \"Tachycardia\"))\n OR (\"Cardiac exam result\" = \"Bradycardia\"))\n OR (\"Cardiac exam result\" = \"Arrhythmia\"))\n OR (\"Cardiac exam result\" = \"Cyanosis\"))\n OR (\"Cardiac exam result\" = \"Cold sweats\"))\n OR (\"Cardiac exam result\" = \"Other abnormal cardiac exam result (specify)\")",
"language" : "text/cql-identifier",
"expression" : "Should Refer urgently to a hospital 3"
}
}
]
},
{
"id" : "6",
"title" : "Conduct further investigation and, if necessary, refer urgently to a hospital",
"description" : "Conduct further investigation and, if necessary, refer urgently to a hospital",
"textEquivalent" : "Woman's breast exam was abnormal and she should be referred to hospital for further investigation",
"documentation" : [
{
"type" : "citation"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "((((((\"Breast exam result\" = \"Nodule\")\n OR (\"Breast exam result\" = \"Discharge\"))\n OR (\"Breast exam result\" = \"Flushing\"))\n OR (\"Breast exam result\" = \"Local pain\"))\n OR (\"Breast exam result\" = \"Bleeding\"))\n OR (\"Breast exam result\" = \"Increased temperature\"))\n OR (\"Breast exam result\" = \"Other breast exam result (specify)\")",
"language" : "text/cql-identifier",
"expression" : "Should Conduct further investigation and, if necessary, refer urgently to a hospital"
}
}
]
},
{
"id" : "7",
"title" : "Refer to a hospital",
"description" : "Refer to a hospital 2",
"textEquivalent" : "Woman's abdominal exam was abnormal and she should be referred or further evaluated",
"documentation" : [
{
"type" : "citation",
"label" : "WHO ANC recommendations (2016): B2.2 (2)\nManaging complications in pregnancy and childbirth guide (IMPAC) (2017): Section S-139 (5)"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "(((((((((((((((((\"Abdominal exam result\" = \"Mass/tumour\")\n OR (\"Abdominal exam result\" = \"Pain on superficial palpation\"))\n OR (\"Abdominal exam result\" = \"Pain on deep palpation\"))\n OR (\"Abdominal exam result\" = \"Painful decompression\"))\n OR (\"Abdominal exam result\" = \"Other abnormal abdominal exam result (specify)\"))\n OR (\"Pelvic exam result (visual)\" = \"Abnormal vaginal discharge\"))\n OR (\"Pelvic exam result (visual)\" = \"Evidence of amniotic fluid\"))\n OR (\"Pelvic exam result (visual)\" = \"Foul-smelling vaginal discharge\"))\n OR (\"Pelvic exam result (visual)\" = \"Clusters of erythematous papules\"))\n OR (\"Pelvic exam result (visual)\" = \"Vesicles\"))\n OR (\"Pelvic exam result (visual)\" = \"Genital ulcer\"))\n OR (\"Pelvic exam result (visual)\" = \"Genital pain\"))\n OR (\"Pelvic exam result (visual)\" = \"Tender bilateral inguinal and femoral lymphadenopathy\"))\n OR (\"Pelvic exam result (visual)\" = \"Cervical friability\"))\n OR (\"Pelvic exam result (visual)\" = \"Mucopurulent cervicitis\"))\n OR (\"Pelvic exam result (visual)\" = \"Tender unilateral lymphadenopathy\"))\n OR (\"Pelvic exam result (visual)\" = \"Curd-like vaginal discharge\"))\n OR (\"Pelvic exam result (visual)\" = \"Other abnormal pelvic exam (visual) result (specify)\")",
"language" : "text/cql-identifier",
"expression" : "Should Refer to a hospital 2"
}
}
]
},
{
"id" : "8",
"title" : "Refer urgently to a hospital",
"description" : "Refer urgently to a hospital 4",
"textEquivalent" : "Woman should be referred urgently if there is evidence of amniotic fluid, which could indicate the start of labour",
"documentation" : [
{
"type" : "citation",
"label" : "Managing complications in pregnancy and childbirth guide (IMPAC) (2017): Sections S-51, C-91 (5)"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "(\"Pelvic exam result (visual)\" = \"Evidence of amniotic fluid\")\n AND (\"Gestational age\" < 37 weeks)",
"language" : "text/cql-identifier",
"expression" : "Should Refer urgently to a hospital 4"
}
}
]
},
{
"id" : "9",
"title" : "Refer to a hospital",
"description" : "Refer to a hospital 3",
"textEquivalent" : "If no fetal heartbeat is observed, inform the woman that there might be a problem and that she needs to be referred to the hospital for further examination and next steps.\n\nProcedure:\n– Inform the woman that you cannot find the heartbeat and need to refer her to check if there's a problem\n– Refer to hospital",
"documentation" : [
{
"type" : "citation",
"label" : "Pregnancy, childbirth, postpartum and newborn care guide (IMPAC) (2015): C7 (1)"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "(\"Fetal heartbeat present\" = FALSE)\n AND (\"Gestational age\" ≥ 20 weeks)",
"language" : "text/cql-identifier",
"expression" : "Should Refer to a hospital 3"
}
}
]
},
{
"id" : "10",
"title" : "Refer to a hospital",
"description" : "Refer to a hospital 4",
"textEquivalent" : "Fetal heart rate is abnormal after two readings: the woman should be referred to hospital",
"documentation" : [
{
"type" : "citation",
"label" : "Pregnancy, childbirth, postpartum and newborn care guide (IMPAC) (2015): C7 (1)"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "(100 bpm > \"Second fetal heart rate\" > 180 bpm)\n AND (\"Gestational age\" ≥ 20 weeks)",
"language" : "text/cql-identifier",
"expression" : "Should Refer to a hospital 4"
}
}
]
}
]
}
]
}