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.01 Danger signs - JSON Representation

Active as of 2025-06-24

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{
  "resourceType" : "PlanDefinition",
  "id" : "ANCDT01",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n<div>\n    <table class=\"grid dict\">\n        \n        <tr>\n            <th scope=\"row\"><b>Id: </b></th>\n            <td style=\"padding-left: 4px;\">ANCDT01</td>\n        </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Url: </b></th>\n            <td style=\"padding-left: 4px;\"><a href=\"PlanDefinition-ANCDT01.html\">ANC.DT.01 Danger signs</a></td>\n        </tr>\n        \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        \n        <tr>\n            <th scope=\"row\">\n                <b>\n                    \n                        Official\n                    \n                </b>\n            </th>\n            <td style=\"padding-left: 4px;\">\n                \n                <p style=\"margin-bottom: 5px;\">\n                    <span>ANC.DT.01</span>\n                </p>\n                \n            </td>\n        </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Title: </b></th>\n            <td style=\"padding-left: 4px;\">ANC.DT.01 Danger signs</td>\n        </tr>\n        \n\n        \n\n        \n\n        \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://terminology.hl7.org/6.4.0/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\n        \n        <tr>\n            <th scope=\"row\"><b>Date: </b></th>\n            <td style=\"padding-left: 4px;\">2025-06-24 13:58:48-0600</td>\n        </tr>\n        \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        \n        <tr>\n            <th scope=\"row\"><b>Description: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>Before each contact, during the Quick Check, the health worker should check whether the woman has any of the danger signs listed here – if yes, she should be referred to the hospital urgently; if no, the normal contact should be continued as normal</p>\n</div></td>\n        </tr>\n        \n\n        \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>\n                        <th><b>code</b></th>\n                        <th><b>value</b></th>\n                    </tr>\n                    \n                        <tr>\n                            <td>task</td>\n                            <td/>\n                        </tr>\n                    \n                </table>\n            </td>\n        </tr>\n        \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        \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>\n                        <td><a href=\"Library-ANCDT01.html\">ANC.DT.01 Danger signs</a></td>\n                    </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                            \n                            <b> ANC.DT.01 Danger signs:</b> \n                            \n                            <br/>\n                            \n                            <b>When:</b>\n                            \n                            <i>Named Event:</i> ANC.B5 Quick check\n                            <br/>\n                            \n                            \n                            \n                            \n                            <b>Then:</b>\n                            <table class=\"grid-dict\">\n                                \n                                <tr>\n                                    <td>\n                                        \n                                        If no danger signs are present, the health worker can continue with the normal ANC contact\n                                        \n                                        <br/>\n                                        \n                                        \n                                        <b>If:</b>\n                                        \n                                        <i>Applicability:</i>\n                                        \n                                        &quot;Danger signs&quot; = &quot;No danger signs&quot;\n                                        \n                                        <i>(Should Proceed with ANC contact)</i>\n                                        <br/>\n                                        \n                                        \n                                        \n                                        \n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td>\n                                        \n                                        Bluish discolouration around the mucous membranes in the mouth, lips and tongue.\n                                        \n                                        <br/>\n                                        \n                                        \n                                        <b>If:</b>\n                                        \n                                        <i>Applicability:</i>\n                                        \n                                        &quot;Danger signs&quot; = &quot;Central cyanosis&quot;\n                                        \n                                        <i>(Should Proceed with ANC contact OR Referral for Central cyanosis)</i>\n                                        <br/>\n                                        \n                                        \n                                        \n                                        \n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td>\n                                        \n                                        This is a danger sign that indicates that the woman needs urgent management\n                                        \n                                        <br/>\n                                        \n                                        \n                                        <b>If:</b>\n                                        \n                                        <i>Applicability:</i>\n                                        \n                                        (((((((((((&quot;Danger signs&quot; = &quot;Bleeding vaginally&quot;)\n  OR (&quot;Danger signs&quot; = &quot;Convulsing&quot;))\n  OR (&quot;Danger signs&quot; = &quot;Fever&quot;))\n  OR (&quot;Danger signs&quot; = &quot;Severe headache&quot;))\n  OR (&quot;Danger signs&quot; = &quot;Visual disturbance&quot;))\n  OR (&quot;Danger signs&quot; = &quot;Imminent delivery&quot;))\n  OR (&quot;Danger signs&quot; = &quot;Labour&quot;))\n  OR (&quot;Danger signs&quot; = &quot;Looks very ill&quot;))\n  OR (&quot;Danger signs&quot; = &quot;Severe vomiting&quot;))\n  OR (&quot;Danger signs&quot; = &quot;Severe pain&quot;))\n  OR (&quot;Danger signs&quot; = &quot;Severe abdominal pain&quot;))\n  OR (&quot;Danger signs&quot; = &quot;Unconscious&quot;)\n                                        \n                                        <i>(Should Proceed with ANC contact OR Referral)</i>\n                                        <br/>\n                                        \n                                        \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>\n</div>"
  },
  "contained" : [
    {
      "resourceType" : "Library",
      "id" : "effective-data-requirements",
      "name" : "EffectiveDataRequirements",
      "status" : "active",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/library-type",
            "code" : "module-definition"
          }
        ]
      },
      "relatedArtifact" : [
        {
          "type" : "depends-on",
          "display" : "Library ContactData",
          "resource" : "http://smart.who.int/anc/Library/ANCContactDataElements"
        },
        {
          "type" : "depends-on",
          "display" : "Library Cx",
          "resource" : "http://smart.who.int/anc/Library/ANCConcepts"
        },
        {
          "type" : "depends-on",
          "display" : "Library FHIRHelpers",
          "resource" : "http://smart.who.int/anc/Library/FHIRHelpers|4.0.1"
        },
        {
          "type" : "depends-on",
          "display" : "Library WC",
          "resource" : "http://smart.who.int/anc/Library/WHOCommon"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Danger signs",
          "resource" : "http://smart.who.int/anc/ValueSet/anc-b5-de48"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Danger Signs - No danger signs Choices",
          "resource" : "http://smart.who.int/anc/ValueSet/anc-b5-de49"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Danger signs Choices",
          "resource" : "http://smart.who.int/anc/ValueSet/anc-b5-de50"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Danger Signs - Central cyanosis Choices",
          "resource" : "http://smart.who.int/anc/ValueSet/anc-b5-de51"
        }
      ],
      "parameter" : [
        {
          "name" : "encounter",
          "use" : "in",
          "min" : 0,
          "max" : "1",
          "type" : "string"
        },
        {
          "name" : "Should Proceed with ANC contact",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        },
        {
          "name" : "Should Proceed with ANC contact OR Referral",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        },
        {
          "name" : "Should Proceed with ANC contact OR Referral for Central cyanosis",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        }
      ],
      "dataRequirement" : [
        {
          "type" : "Observation",
          "profile" : [
            🔗 "http://hl7.org/fhir/StructureDefinition/Observation"
          ],
          "mustSupport" : [
            "code",
            "status",
            "encounter",
            "encounter.reference",
            "value"
          ],
          "codeFilter" : [
            {
              "path" : "code",
              "valueSet" : "http://smart.who.int/anc/ValueSet/anc-b5-de48"
            }
          ]
        }
      ]
    }
  ],
  "extension" : [
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "ANCContactDataElements"
        },
        {
          "url" : "name",
          "valueString" : "Danger signs"
        },
        {
          "url" : "statement",
          "valueString" : "/*\n  @dataElement: ANC.B5.DE48 Danger signs\n  @activity: ANC.B5 Quick check\n  @description: Before each contact, the health worker should check whether the woman has any of the danger signs listed here – if yes, she should refer to the hospital urgently; if no, she should continue to the normal contact\n*/\ndefine \"Danger signs\":\n  [Observation: Cx.\"Danger signs\"] O\n    where O.status in { 'final', 'amended', 'corrected' }\n      and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false\n      and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))\n    return O.value as FHIR.CodeableConcept"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 0
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "ANCDT01"
        },
        {
          "url" : "name",
          "valueString" : "Should Proceed with ANC contact"
        },
        {
          "url" : "statement",
          "valueString" : "/*\n\"Danger signs\" = \"No danger signs\"\n*/\ndefine \"Should Proceed with ANC contact\":\n  ContactData.\"Danger signs\" in Cx.\"Danger Signs - No danger signs Choices\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 1
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
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    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "ANCDT01"
        },
        {
          "url" : "name",
          "valueString" : "Should Proceed with ANC contact OR Referral"
        },
        {
          "url" : "statement",
          "valueString" : "/*\n(((((((((((\"Danger signs\" = \"Bleeding vaginally\")\n  OR (\"Danger signs\" = \"Convulsing\"))\n  OR (\"Danger signs\" = \"Fever\"))\n  OR (\"Danger signs\" = \"Severe headache\"))\n  OR (\"Danger signs\" = \"Visual disturbance\"))\n  OR (\"Danger signs\" = \"Imminent delivery\"))\n  OR (\"Danger signs\" = \"Labour\"))\n  OR (\"Danger signs\" = \"Looks very ill\"))\n  OR (\"Danger signs\" = \"Severe vomiting\"))\n  OR (\"Danger signs\" = \"Severe pain\"))\n  OR (\"Danger signs\" = \"Severe abdominal pain\"))\n  OR (\"Danger signs\" = \"Unconscious\")\n*/\ndefine \"Should Proceed with ANC contact OR Referral\":\n  ContactData.\"Danger signs\" in Cx.\"Danger signs Choices\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 2
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "ANCDT01"
        },
        {
          "url" : "name",
          "valueString" : "Should Proceed with ANC contact OR Referral for Central cyanosis"
        },
        {
          "url" : "statement",
          "valueString" : "/*\n\"Danger signs\" = \"Central cyanosis\"\n*/\ndefine \"Should Proceed with ANC contact OR Referral for Central cyanosis\":\n  ContactData.\"Danger signs\" in Cx.\"Danger Signs - Central cyanosis Choices\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 3
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "FHIRHelpers"
        },
        {
          "url" : "name",
          "valueString" : "ToString"
        },
        {
          "url" : "statement",
          "valueString" : "define function ToString(value ObservationStatus): value.value"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 4
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
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    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "FHIRHelpers"
        },
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          "url" : "name",
          "valueString" : "ToBoolean"
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        },
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          "url" : "displaySequence",
          "valueInteger" : 5
        }
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      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
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      "extension" : [
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          "url" : "libraryName",
          "valueString" : "WHOCommon"
        },
        {
          "url" : "name",
          "valueString" : "ModifierExtension"
        },
        {
          "url" : "statement",
          "valueString" : "/*\n@description: Returns the single WHO core modifier extension (if present) on the given resource with the specified id.\n@comment: This function uses singleton from to ensure that a run-time exception is thrown if there\nis more than one extension on the given resource with the specified url.\n*/\ndefine function ModifierExtension(domainResource DomainResource, id String):\n  singleton from ModifierExtensions(domainResource, id)"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 6
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
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          "url" : "libraryName",
          "valueString" : "WHOCommon"
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        },
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          "url" : "statement",
          "valueString" : "/*\n@description: Returns any WHO core modifier extensions defined on the given resource with the specified id.\n@comment: NOTE: Extensions are not the preferred approach, but are used as a way to access\ncontent that is defined by extensions but not yet surfaced in the\nCQL model info.\n*/\ndefine function ModifierExtensions(domainResource DomainResource, id String):\n  domainResource.modifierExtension E\n\t  where E.url = ('http://fhir.org/guides/who/core/StructureDefinition/' + id)\n\t\treturn E"
        },
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          "url" : "displaySequence",
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        }
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      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
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      "extension" : [
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          "url" : "libraryName",
          "valueString" : "FHIRHelpers"
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          "url" : "statement",
          "valueString" : "define function ToString(value uri): value.value"
        },
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          "url" : "displaySequence",
          "valueInteger" : 8
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
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      "extension" : [
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          "url" : "libraryName",
          "valueString" : "FHIRHelpers"
        },
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          "url" : "name",
          "valueString" : "ToString"
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          "url" : "statement",
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        }
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      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
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      "extension" : [
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          "url" : "libraryName",
          "valueString" : "FHIRHelpers"
        },
        {
          "url" : "name",
          "valueString" : "ToConcept"
        },
        {
          "url" : "statement",
          "valueString" : "define function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 10
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
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      "extension" : [
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          "valueString" : "FHIRHelpers"
        },
        {
          "url" : "name",
          "valueString" : "ToCode"
        },
        {
          "url" : "statement",
          "valueString" : "define function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 11
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
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      "id" : "effective-data-requirements",
      "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueCanonical" : "#effective-data-requirements"
    },
    {
      "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem",
      "valueReference" : {
        🔗 "reference" : "Device/cqf-tooling"
      }
    }
  ],
  "url" : "http://smart.who.int/anc/PlanDefinition/ANCDT01",
  "identifier" : [
    {
      "use" : "official",
      "value" : "ANC.DT.01"
    }
  ],
  "version" : "0.3.0",
  "name" : "ANCDT01",
  "title" : "ANC.DT.01 Danger signs",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
        "code" : "eca-rule"
      }
    ]
  },
  "status" : "active",
  "experimental" : false,
  "date" : "2025-06-24T13:58:48-06:00",
  "publisher" : "World Health Organization (WHO)",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://www.who.int"
        }
      ]
    }
  ],
  "description" : "Before each contact, during the Quick Check, the health worker should check whether the woman has any of the danger signs listed here – if yes, she should be referred to the hospital urgently; if no, the normal contact should be continued as normal",
  "useContext" : [
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "task",
        "display" : "Workflow Task"
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://smart.who.int/anc/CodeSystem/activity-codes",
            "code" : "ANC.B5",
            "display" : "Quick check"
          }
        ]
      }
    }
  ],
  "jurisdiction" : [
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          "code" : "001"
        }
      ]
    }
  ],
  "library" : [
    🔗 "http://smart.who.int/anc/Library/ANCDT01"
  ],
  "action" : [
    {
      "title" : "ANC.DT.01 Danger signs",
      "trigger" : [
        {
          "type" : "named-event",
          "name" : "ANC.B5 Quick check"
        }
      ],
      "action" : [
        {
          "id" : "1",
          "title" : "Proceed with ANC contact ",
          "description" : "Proceed with ANC contact ",
          "textEquivalent" : "If no danger signs are present, the health worker can continue with the normal ANC contact",
          "documentation" : [
            {
              "type" : "citation",
              "label" : "Pregnancy, childbirth, postpartum and newborn care guide (IMPAC) (2015) (1)"
            }
          ],
          "condition" : [
            {
              "kind" : "applicability",
              "expression" : {
                "description" : "\"Danger signs\" = \"No danger signs\"",
                "language" : "text/cql-identifier",
                "expression" : "Should Proceed with ANC contact"
              }
            }
          ]
        },
        {
          "id" : "2",
          "title" : "Proceed with ANC contact OR Referral for Central cyanosis",
          "description" : "Proceed with ANC contact OR Referral for Central cyanosis",
          "textEquivalent" : "Bluish discolouration around the mucous membranes in the mouth, lips and tongue.",
          "documentation" : [
            {
              "type" : "citation",
              "label" : "Pregnancy, childbirth, postpartum and newborn care guide (IMPAC) (2015) (1)"
            }
          ],
          "condition" : [
            {
              "kind" : "applicability",
              "expression" : {
                "description" : "\"Danger signs\" = \"Central cyanosis\"",
                "language" : "text/cql-identifier",
                "expression" : "Should Proceed with ANC contact OR Referral for Central cyanosis"
              }
            }
          ]
        },
        {
          "id" : "3",
          "title" : "Proceed with ANC contact OR Referral",
          "description" : "Proceed with ANC contact OR Referral",
          "textEquivalent" : "This is a danger sign that indicates that the woman needs urgent management",
          "documentation" : [
            {
              "type" : "citation",
              "label" : "Pregnancy, childbirth, postpartum and newborn care guide (IMPAC) (2015) (1)"
            }
          ],
          "condition" : [
            {
              "kind" : "applicability",
              "expression" : {
                "description" : "(((((((((((\"Danger signs\" = \"Bleeding vaginally\")\n  OR (\"Danger signs\" = \"Convulsing\"))\n  OR (\"Danger signs\" = \"Fever\"))\n  OR (\"Danger signs\" = \"Severe headache\"))\n  OR (\"Danger signs\" = \"Visual disturbance\"))\n  OR (\"Danger signs\" = \"Imminent delivery\"))\n  OR (\"Danger signs\" = \"Labour\"))\n  OR (\"Danger signs\" = \"Looks very ill\"))\n  OR (\"Danger signs\" = \"Severe vomiting\"))\n  OR (\"Danger signs\" = \"Severe pain\"))\n  OR (\"Danger signs\" = \"Severe abdominal pain\"))\n  OR (\"Danger signs\" = \"Unconscious\")",
                "language" : "text/cql-identifier",
                "expression" : "Should Proceed with ANC contact OR Referral"
              }
            }
          ]
        }
      ]
    }
  ]
}