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

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

Active as of 2021-06-11

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<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="ANCDT17"/>
  <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;">ANCDT17</td>
        </tr>
        
        
        <tr>
            <th scope="row"><b>Url: </b></th>
            <td style="padding-left: 4px;"><a href="PlanDefinition-ANCDT17.html">ANC.DT.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis</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.17</span>
                </p>
                
            </td>
        </tr>
        
        
        <tr>
            <th scope="row"><b>Name: </b></th>
            <td style="padding-left: 4px;">ANCDT17</td>
        </tr>
        
        
        <tr>
            <th scope="row"><b>Title: </b></th>
            <td style="padding-left: 4px;">ANC.DT.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis</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 23:25:04-0600</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 presents with any of the following symptoms and/or test results, conduct counselling and referral as needed</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.B10.4.</td>
                        <td>Diagnosis and treatment</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-ANCDT17.html">ANC.DT.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis</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.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis:</b> <br/>
                    <b>When:</b> <i>Named Event:</i> ANC.B10.4. Diagnosis and treatment<br/>
                    
                    
                      <b>Then:</b>
                      <table class="grid-dict">
                        
                          <tr>
                            <td>
                              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<br/>
                              
                              <b>If:</b> <i>Applicability:</i> ((((((((((((((((&amp;quot;Systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Repeat systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;Severe headache&amp;quot;))
  OR ((&amp;quot;Diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Repeat diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;Severe headache&amp;quot;)))
  OR ((&amp;quot;Systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Repeat systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;Blurred vision&amp;quot;)))
  OR ((&amp;quot;Diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Repeat diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;Blurred vision&amp;quot;)))
  OR ((&amp;quot;Systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Repeat systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;Epigastric pain&amp;quot;)))
  OR ((&amp;quot;Diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Repeat diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;Epigastric pain&amp;quot;)))
  OR ((&amp;quot;Systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Repeat systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;Dizziness&amp;quot;)))
  OR ((&amp;quot;Diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Repeat diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;Dizziness&amp;quot;)))
  OR ((&amp;quot;Systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Repeat systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;Vomiting&amp;quot;)))
  OR ((&amp;quot;Diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Repeat diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;Vomiting&amp;quot;)))
  OR ((&amp;quot;Systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Repeat systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;None&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;++&amp;quot;)))
  OR ((&amp;quot;Diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Repeat diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;None&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;++&amp;quot;)))
  OR ((&amp;quot;Systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Repeat systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;None&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;+++&amp;quot;)))
  OR ((&amp;quot;Diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Repeat diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;None&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;+++&amp;quot;)))
  OR ((&amp;quot;Systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Repeat systolic blood pressure&amp;quot; ≥ 140 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;None&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;++++&amp;quot;)))
  OR ((&amp;quot;Diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Repeat diastolic blood pressure&amp;quot; ≥ 90 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;None&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;++++&amp;quot;)) <i>(Should Refer urgently to a hospital)</i><br/>
                              
                                
                              
                            </td>
                          </tr>
                        
                          <tr>
                            <td>
                              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<br/>
                              
                              <b>If:</b> <i>Applicability:</i> (((((((&amp;quot;Systolic blood pressure&amp;quot; ≤ 140 mmHg)
  AND (&amp;quot;Repeat systolic blood pressure&amp;quot; ≤ 140 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;No symptoms of severe pre-eclampsia&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;++&amp;quot;))
  OR ((&amp;quot;Systolic blood pressure&amp;quot; &amp;gt; 160 mmHg)
  AND (&amp;quot;Repeat systolic blood pressure&amp;quot; &amp;gt; 160 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;No symptoms of severe pre-eclampsia&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;++&amp;quot;)))
  OR ((90 mmHg ≤ &amp;quot;Diastolic blood pressure&amp;quot; &amp;lt; 110 mmHg)
  AND (90 mmHg ≤ &amp;quot;Repeat diastolic blood pressure&amp;quot; &amp;lt; 110 mmHg)
  AND (Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;No symptoms of severe pre-eclampsia&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;++&amp;quot;)))
  OR ((140 mmHg ≤ &amp;quot;Systolic blood pressure&amp;quot; &amp;lt; 160 mmHg)
  AND (140 mmHg ≤ &amp;quot;Repeat systolic blood pressure&amp;quot; &amp;lt; 160 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;No symptoms of severe pre-eclampsia&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;+++&amp;quot;)))
  OR ((90 mmHg ≤ &amp;quot;Diastolic blood pressure&amp;quot; &amp;lt; 110 mmHg)
  AND (90 mmHg – &amp;quot;Repeat diastolic blood pressure&amp;quot; &amp;lt; 110 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;No symptoms of severe pre-eclampsia&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;+++&amp;quot;)))
  OR ((140 mmHg ≤ &amp;quot;Systolic blood pressure&amp;quot; &amp;lt; 160 mmHg)
  AND (140 mmHg ≤ &amp;quot;Repeat systolic blood pressure&amp;quot; &amp;lt; 160 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;No symptoms of severe pre-eclampsia&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;++++&amp;quot;)))
  OR ((90 mmHg ≤ &amp;quot;Diastolic blood pressure&amp;quot; &amp;lt; 110 mmHg)
  AND (90 mmHg ≤ &amp;quot;Repeat diastolic blood pressure&amp;quot; &amp;lt; 110 mmHg)
  AND (&amp;quot;Symptoms of severe pre-eclampsia&amp;quot; = &amp;quot;No symptoms of severe pre-eclampsia&amp;quot;)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;++++&amp;quot;)) <i>(Should Refer urgently to a hospital 2)</i><br/>
                              
                                
                              
                            </td>
                          </tr>
                        
                          <tr>
                            <td>
                              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.<br/>
                              
                              <b>If:</b> <i>Applicability:</i> ((((&amp;quot;Systolic blood pressure&amp;quot; ≥ 160 mmHg)
  AND (&amp;quot;Repeat systolic blood pressure&amp;quot; ≥ 160 mmHg)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;+&amp;quot;))
  OR ((&amp;quot;Diastolic blood pressure&amp;quot; ≥ 110 mmHg)
  AND (&amp;quot;Repeat diastolic blood pressure&amp;quot; ≥ 110 mmHg)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;+&amp;quot;)))
  OR ((&amp;quot;Systolic blood pressure&amp;quot; ≥ 160 mmHg)
  AND (&amp;quot;Repeat systolic blood pressure&amp;quot; ≥ 160 mmHg)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;None&amp;quot;)))
  OR ((&amp;quot;Diastolic blood pressure&amp;quot; ≥ 110 mmHg)
  AND (&amp;quot;Repeat diastolic blood pressure&amp;quot; ≥ 110 mmHg)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;None&amp;quot;)) <i>(Should Refer urgently to a hospital 3)</i><br/>
                              
                                
                              
                            </td>
                          </tr>
                        
                          <tr>
                            <td>
                              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<br/>
                              
                              <b>If:</b> <i>Applicability:</i> ((((&amp;quot;Existing chronic health conditions&amp;quot; = &amp;quot;Hypertension&amp;quot;)
  OR ((140 mmHg ≤ &amp;quot;Systolic blood pressure&amp;quot; &amp;lt; 160 mmHg)
  AND (140 mmHg ≤ &amp;quot;Repeat systolic blood pressure&amp;quot; &amp;lt; 160 mmHg)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;+&amp;quot;)))
  OR ((90 mmHg ≤ &amp;quot;Diastolic blood pressure&amp;quot; &amp;lt; 110 mmHg)
  AND (90 mmHg ≤ &amp;quot;Repeat diastolic blood pressure&amp;quot; &amp;lt; 110 mmHg)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;+&amp;quot;)))
  OR ((140 mmHg ≤ &amp;quot;Systolic blood pressure&amp;quot; &amp;lt; 160 mmHg)
  AND (140 mmHg ≤ &amp;quot;Repeat systolic blood pressure&amp;quot; &amp;lt; 160 mmHg)
  AND (Urine dipstick result – protein&amp;quot; = &amp;quot;None&amp;quot;)))
  OR ((90 mmHg ≤ &amp;quot;Diastolic blood pressure&amp;quot; &amp;lt; 110 mmHg)
  AND (90 mmHg ≤ &amp;quot;Repeat diastolic blood pressure&amp;quot; &amp;lt; 110 mmHg)
  AND (&amp;quot;Urine dipstick result – protein&amp;quot; = &amp;quot;None&amp;quot;)) <i>(Should Conduct hypertension counselling)</i><br/>
                              
                                
                              
                            </td>
                          </tr>
                        
                      </table>
                    
                  </td>
                </tr>
              
            </table>
          </td>
        </tr>
        
    </table>
</div>
  </text>
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  <identifier>
    <use value="official"/>
    <value value="ANC.DT.17"/>
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  <version value="0.3.0"/>
  <name value="ANCDT17"/>
  <title
         value="ANC.DT.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis"/>
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  <date value="2021-06-11T23:25:04-06:00"/>
  <publisher value="World Health Organization (WHO)"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="https://www.who.int"/>
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  <description
               value="If the woman presents with any of the following symptoms and/or test results, conduct counselling and referral as needed"/>
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  <library value="http://fhir.org/guides/who/anc-cds/Library/ANCDT17"/>
  <action>
    <title
           value="ANC.DT.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis"/>
    <trigger>
      <type value="named-event"/>
      <name value="ANC.B10.4. Diagnosis and treatment"/>
    </trigger>
    <action id="1">
      <title value="Refer urgently to a hospital"/>
      <description value="Refer urgently to a hospital"/>
      <textEquivalent
                      value="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"/>
      <documentation>
        <type value="citation"/>
        <label
               value="Pregnancy, childbirth, postpartum and newborn care guide (IMPAC) (2015): recommendation C3 (1)
Managing complications guide (IMPAC) (2017): Section S-53, Table S-12 (5)"/>
      </documentation>
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          <description
                       value="((((((((((((((((&quot;Systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Repeat systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;Severe headache&quot;))
  OR ((&quot;Diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Repeat diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;Severe headache&quot;)))
  OR ((&quot;Systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Repeat systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;Blurred vision&quot;)))
  OR ((&quot;Diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Repeat diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;Blurred vision&quot;)))
  OR ((&quot;Systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Repeat systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;Epigastric pain&quot;)))
  OR ((&quot;Diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Repeat diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;Epigastric pain&quot;)))
  OR ((&quot;Systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Repeat systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;Dizziness&quot;)))
  OR ((&quot;Diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Repeat diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;Dizziness&quot;)))
  OR ((&quot;Systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Repeat systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;Vomiting&quot;)))
  OR ((&quot;Diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Repeat diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;Vomiting&quot;)))
  OR ((&quot;Systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Repeat systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;None&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;++&quot;)))
  OR ((&quot;Diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Repeat diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;None&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;++&quot;)))
  OR ((&quot;Systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Repeat systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;None&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;+++&quot;)))
  OR ((&quot;Diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Repeat diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;None&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;+++&quot;)))
  OR ((&quot;Systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Repeat systolic blood pressure&quot; ≥ 140 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;None&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;++++&quot;)))
  OR ((&quot;Diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Repeat diastolic blood pressure&quot; ≥ 90 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;None&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;++++&quot;))"/>
          <language value="text/cql-identifier"/>
          <expression value="Should Refer urgently to a hospital"/>
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      </condition>
    </action>
    <action id="2">
      <title value="Refer urgently to a hospital"/>
      <description value="Refer urgently to a hospital 2"/>
      <textEquivalent
                      value="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"/>
      <documentation>
        <type value="citation"/>
        <label
               value="Pregnancy, childbirth, postpartum and newborn care guide (IMPAC) (2015): recommendation C3 (1) 
Managing complications guide (IMPAC) (2017): Section S-52, Table S-12 (5)
WHO pre-eclampsia and eclampsia recommendations (2011): 6, 7 (7)"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description
                       value="(((((((&quot;Systolic blood pressure&quot; ≤ 140 mmHg)
  AND (&quot;Repeat systolic blood pressure&quot; ≤ 140 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;No symptoms of severe pre-eclampsia&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;++&quot;))
  OR ((&quot;Systolic blood pressure&quot; &gt; 160 mmHg)
  AND (&quot;Repeat systolic blood pressure&quot; &gt; 160 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;No symptoms of severe pre-eclampsia&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;++&quot;)))
  OR ((90 mmHg ≤ &quot;Diastolic blood pressure&quot; &lt; 110 mmHg)
  AND (90 mmHg ≤ &quot;Repeat diastolic blood pressure&quot; &lt; 110 mmHg)
  AND (Symptoms of severe pre-eclampsia&quot; = &quot;No symptoms of severe pre-eclampsia&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;++&quot;)))
  OR ((140 mmHg ≤ &quot;Systolic blood pressure&quot; &lt; 160 mmHg)
  AND (140 mmHg ≤ &quot;Repeat systolic blood pressure&quot; &lt; 160 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;No symptoms of severe pre-eclampsia&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;+++&quot;)))
  OR ((90 mmHg ≤ &quot;Diastolic blood pressure&quot; &lt; 110 mmHg)
  AND (90 mmHg – &quot;Repeat diastolic blood pressure&quot; &lt; 110 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;No symptoms of severe pre-eclampsia&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;+++&quot;)))
  OR ((140 mmHg ≤ &quot;Systolic blood pressure&quot; &lt; 160 mmHg)
  AND (140 mmHg ≤ &quot;Repeat systolic blood pressure&quot; &lt; 160 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;No symptoms of severe pre-eclampsia&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;++++&quot;)))
  OR ((90 mmHg ≤ &quot;Diastolic blood pressure&quot; &lt; 110 mmHg)
  AND (90 mmHg ≤ &quot;Repeat diastolic blood pressure&quot; &lt; 110 mmHg)
  AND (&quot;Symptoms of severe pre-eclampsia&quot; = &quot;No symptoms of severe pre-eclampsia&quot;)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;++++&quot;))"/>
          <language value="text/cql-identifier"/>
          <expression value="Should Refer urgently to a hospital 2"/>
        </expression>
      </condition>
    </action>
    <action id="3">
      <title value="Refer urgently to a hospital"/>
      <description value="Refer urgently to a hospital 3"/>
      <textEquivalent
                      value="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."/>
      <documentation>
        <type value="citation"/>
        <label
               value="Managing complications guide (IMPAC) (2017): S-61 (5)
WHO pre-eclampsia and eclampsia recommendations (2011): 4 (7)"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description
                       value="((((&quot;Systolic blood pressure&quot; ≥ 160 mmHg)
  AND (&quot;Repeat systolic blood pressure&quot; ≥ 160 mmHg)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;+&quot;))
  OR ((&quot;Diastolic blood pressure&quot; ≥ 110 mmHg)
  AND (&quot;Repeat diastolic blood pressure&quot; ≥ 110 mmHg)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;+&quot;)))
  OR ((&quot;Systolic blood pressure&quot; ≥ 160 mmHg)
  AND (&quot;Repeat systolic blood pressure&quot; ≥ 160 mmHg)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;None&quot;)))
  OR ((&quot;Diastolic blood pressure&quot; ≥ 110 mmHg)
  AND (&quot;Repeat diastolic blood pressure&quot; ≥ 110 mmHg)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;None&quot;))"/>
          <language value="text/cql-identifier"/>
          <expression value="Should Refer urgently to a hospital 3"/>
        </expression>
      </condition>
    </action>
    <action id="4">
      <title value="Conduct hypertension counselling"/>
      <description value="Conduct hypertension counselling"/>
      <textEquivalent
                      value="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"/>
      <documentation>
        <type value="citation"/>
        <label
               value="Pregnancy, childbirth, postpartum and newborn care guide (IMPAC) (2015): C3 (1)"/>
      </documentation>
      <condition>
        <kind value="applicability"/>
        <expression>
          <description
                       value="((((&quot;Existing chronic health conditions&quot; = &quot;Hypertension&quot;)
  OR ((140 mmHg ≤ &quot;Systolic blood pressure&quot; &lt; 160 mmHg)
  AND (140 mmHg ≤ &quot;Repeat systolic blood pressure&quot; &lt; 160 mmHg)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;+&quot;)))
  OR ((90 mmHg ≤ &quot;Diastolic blood pressure&quot; &lt; 110 mmHg)
  AND (90 mmHg ≤ &quot;Repeat diastolic blood pressure&quot; &lt; 110 mmHg)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;+&quot;)))
  OR ((140 mmHg ≤ &quot;Systolic blood pressure&quot; &lt; 160 mmHg)
  AND (140 mmHg ≤ &quot;Repeat systolic blood pressure&quot; &lt; 160 mmHg)
  AND (Urine dipstick result – protein&quot; = &quot;None&quot;)))
  OR ((90 mmHg ≤ &quot;Diastolic blood pressure&quot; &lt; 110 mmHg)
  AND (90 mmHg ≤ &quot;Repeat diastolic blood pressure&quot; &lt; 110 mmHg)
  AND (&quot;Urine dipstick result – protein&quot; = &quot;None&quot;))"/>
          <language value="text/cql-identifier"/>
          <expression value="Should Conduct hypertension counselling"/>
        </expression>
      </condition>
    </action>
  </action>
</PlanDefinition>