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