WHO Antenatal Care Guideline Implementation Guide
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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

PlanDefinition: ANC.DT.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis

Official URL: http://fhir.org/guides/who/anc-cds/PlanDefinition/ANCDT17 Version: 0.3.0
Active as of 2021-06-11 Computable Name: ANCDT17
Other Identifiers: ANC.DT.17 (use: official, )

Usage:Workflow Task: Diagnosis and treatment

If the woman presents with any of the following symptoms and/or test results, conduct counselling and referral as needed

Id: ANCDT17
Url: ANC.DT.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis
Version: 0.3.0
Identifier:

value: ANC.DT.17

Name: ANCDT17
Title: ANC.DT.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis
Status: active
Experimental: false
Type:

system: http://terminology.hl7.org/CodeSystem/plan-definition-type

code: eca-rule

Date: 2021-06-11 23:25:04-0600
Publisher: World Health Organization (WHO)
Description: If the woman presents with any of the following symptoms and/or test results, conduct counselling and referral as needed
Use Context:
codevaluedisplay
task ANC.B10.4. Diagnosis and treatment
Jurisdiction: 001
Libraries:
ANC.DT.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis
Actions:
ANC.DT.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis:
When: Named Event: ANC.B10.4. Diagnosis and treatment
Then:
Symptom(s) of severe pre-eclampsia! Refer urgently to hospital! Woman has hypertension. If she is experiencing a symptom of severe pre-eclampsia, then refer urgently to the hospital for further investigation and management. Procedure – Give magnesium sulphate – Give appropriate anti-hypertensives – Revise the birth plan – Refer urgently to hospital
If: Applicability: (((((((((((((((("Systolic blood pressure" ≥ 140 mmHg) AND ("Repeat systolic blood pressure" ≥ 140 mmHg) AND ("Symptoms of severe pre-eclampsia" = "Severe headache")) OR (("Diastolic blood pressure" ≥ 90 mmHg) AND ("Repeat diastolic blood pressure" ≥ 90 mmHg) AND ("Symptoms of severe pre-eclampsia" = "Severe headache"))) OR (("Systolic blood pressure" ≥ 140 mmHg) AND ("Repeat systolic blood pressure" ≥ 140 mmHg) AND ("Symptoms of severe pre-eclampsia" = "Blurred vision"))) OR (("Diastolic blood pressure" ≥ 90 mmHg) AND ("Repeat diastolic blood pressure" ≥ 90 mmHg) AND ("Symptoms of severe pre-eclampsia" = "Blurred vision"))) OR (("Systolic blood pressure" ≥ 140 mmHg) AND ("Repeat systolic blood pressure" ≥ 140 mmHg) AND ("Symptoms of severe pre-eclampsia" = "Epigastric pain"))) OR (("Diastolic blood pressure" ≥ 90 mmHg) AND ("Repeat diastolic blood pressure" ≥ 90 mmHg) AND ("Symptoms of severe pre-eclampsia" = "Epigastric pain"))) OR (("Systolic blood pressure" ≥ 140 mmHg) AND ("Repeat systolic blood pressure" ≥ 140 mmHg) AND ("Symptoms of severe pre-eclampsia" = "Dizziness"))) OR (("Diastolic blood pressure" ≥ 90 mmHg) AND ("Repeat diastolic blood pressure" ≥ 90 mmHg) AND ("Symptoms of severe pre-eclampsia" = "Dizziness"))) OR (("Systolic blood pressure" ≥ 140 mmHg) AND ("Repeat systolic blood pressure" ≥ 140 mmHg) AND ("Symptoms of severe pre-eclampsia" = "Vomiting"))) OR (("Diastolic blood pressure" ≥ 90 mmHg) AND ("Repeat diastolic blood pressure" ≥ 90 mmHg) AND ("Symptoms of severe pre-eclampsia" = "Vomiting"))) OR (("Systolic blood pressure" ≥ 140 mmHg) AND ("Repeat systolic blood pressure" ≥ 140 mmHg) AND ("Symptoms of severe pre-eclampsia" = "None") AND ("Urine dipstick result – protein" = "++"))) OR (("Diastolic blood pressure" ≥ 90 mmHg) AND ("Repeat diastolic blood pressure" ≥ 90 mmHg) AND ("Symptoms of severe pre-eclampsia" = "None") AND ("Urine dipstick result – protein" = "++"))) OR (("Systolic blood pressure" ≥ 140 mmHg) AND ("Repeat systolic blood pressure" ≥ 140 mmHg) AND ("Symptoms of severe pre-eclampsia" = "None") AND ("Urine dipstick result – protein" = "+++"))) OR (("Diastolic blood pressure" ≥ 90 mmHg) AND ("Repeat diastolic blood pressure" ≥ 90 mmHg) AND ("Symptoms of severe pre-eclampsia" = "None") AND ("Urine dipstick result – protein" = "+++"))) OR (("Systolic blood pressure" ≥ 140 mmHg) AND ("Repeat systolic blood pressure" ≥ 140 mmHg) AND ("Symptoms of severe pre-eclampsia" = "None") AND ("Urine dipstick result – protein" = "++++"))) OR (("Diastolic blood pressure" ≥ 90 mmHg) AND ("Repeat diastolic blood pressure" ≥ 90 mmHg) AND ("Symptoms of severe pre-eclampsia" = "None") AND ("Urine dipstick result – protein" = "++++")) (Should Refer urgently to a hospital)
Pre-eclampsia diagnosis! Refer to hospital and revise birth plan. Woman has pre-eclampsia – SBP of 140 mmHg or above and/or DBP of 90 mmHg or above and proteinuria 2+ and no symptom of severe pre-eclampsia. Procedure: – Refer to hospital – Revise the birth plan
If: Applicability: ((((((("Systolic blood pressure" ≤ 140 mmHg) AND ("Repeat systolic blood pressure" ≤ 140 mmHg) AND ("Symptoms of severe pre-eclampsia" = "No symptoms of severe pre-eclampsia") AND ("Urine dipstick result – protein" = "++")) OR (("Systolic blood pressure" > 160 mmHg) AND ("Repeat systolic blood pressure" > 160 mmHg) AND ("Symptoms of severe pre-eclampsia" = "No symptoms of severe pre-eclampsia") AND ("Urine dipstick result – protein" = "++"))) OR ((90 mmHg ≤ "Diastolic blood pressure" < 110 mmHg) AND (90 mmHg ≤ "Repeat diastolic blood pressure" < 110 mmHg) AND (Symptoms of severe pre-eclampsia" = "No symptoms of severe pre-eclampsia") AND ("Urine dipstick result – protein" = "++"))) OR ((140 mmHg ≤ "Systolic blood pressure" < 160 mmHg) AND (140 mmHg ≤ "Repeat systolic blood pressure" < 160 mmHg) AND ("Symptoms of severe pre-eclampsia" = "No symptoms of severe pre-eclampsia") AND ("Urine dipstick result – protein" = "+++"))) OR ((90 mmHg ≤ "Diastolic blood pressure" < 110 mmHg) AND (90 mmHg – "Repeat diastolic blood pressure" < 110 mmHg) AND ("Symptoms of severe pre-eclampsia" = "No symptoms of severe pre-eclampsia") AND ("Urine dipstick result – protein" = "+++"))) OR ((140 mmHg ≤ "Systolic blood pressure" < 160 mmHg) AND (140 mmHg ≤ "Repeat systolic blood pressure" < 160 mmHg) AND ("Symptoms of severe pre-eclampsia" = "No symptoms of severe pre-eclampsia") AND ("Urine dipstick result – protein" = "++++"))) OR ((90 mmHg ≤ "Diastolic blood pressure" < 110 mmHg) AND (90 mmHg ≤ "Repeat diastolic blood pressure" < 110 mmHg) AND ("Symptoms of severe pre-eclampsia" = "No symptoms of severe pre-eclampsia") AND ("Urine dipstick result – protein" = "++++")) (Should Refer urgently to a hospital 2)
Woman has severe hypertension. If SBP is 160 mmHg or higher and/or DBP is 110 mmHg or higher, then refer urgently to the hospital for further investigation and management.
If: Applicability: (((("Systolic blood pressure" ≥ 160 mmHg) AND ("Repeat systolic blood pressure" ≥ 160 mmHg) AND ("Urine dipstick result – protein" = "+")) OR (("Diastolic blood pressure" ≥ 110 mmHg) AND ("Repeat diastolic blood pressure" ≥ 110 mmHg) AND ("Urine dipstick result – protein" = "+"))) OR (("Systolic blood pressure" ≥ 160 mmHg) AND ("Repeat systolic blood pressure" ≥ 160 mmHg) AND ("Urine dipstick result – protein" = "None"))) OR (("Diastolic blood pressure" ≥ 110 mmHg) AND ("Repeat diastolic blood pressure" ≥ 110 mmHg) AND ("Urine dipstick result – protein" = "None")) (Should Refer urgently to a hospital 3)
Woman has hypertension – SBP of 140 mmHg or higher and/or DBP of 90 mmHg or higher and no proteinuria. Counselling: – Advice to reduce workload and to rest – Advise on danger signs – Reassess at the next contact or in 1 week if 8 months pregnant – If hypertension persists after 1 week or at next contact, refer to hospital or discuss case with the doctor, if available
If: Applicability: (((("Existing chronic health conditions" = "Hypertension") OR ((140 mmHg ≤ "Systolic blood pressure" < 160 mmHg) AND (140 mmHg ≤ "Repeat systolic blood pressure" < 160 mmHg) AND ("Urine dipstick result – protein" = "+"))) OR ((90 mmHg ≤ "Diastolic blood pressure" < 110 mmHg) AND (90 mmHg ≤ "Repeat diastolic blood pressure" < 110 mmHg) AND ("Urine dipstick result – protein" = "+"))) OR ((140 mmHg ≤ "Systolic blood pressure" < 160 mmHg) AND (140 mmHg ≤ "Repeat systolic blood pressure" < 160 mmHg) AND (Urine dipstick result – protein" = "None"))) OR ((90 mmHg ≤ "Diastolic blood pressure" < 110 mmHg) AND (90 mmHg ≤ "Repeat diastolic blood pressure" < 110 mmHg) AND ("Urine dipstick result – protein" = "None")) (Should Conduct hypertension counselling)