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 2025-06-24 |
<PlanDefinition xmlns="http://hl7.org/fhir">
<id value="ANCDT17"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<div>
<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>
Official
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>ANC.DT.17</span>
</p>
</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>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<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>
</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;">2025-06-24 13:58:48-0600</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;"><div><p>If the woman presents with any of the following symptoms and/or test results, conduct counselling and referral as needed</p>
</div></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>
</tr>
<tr>
<td>task</td>
<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>
(((((((((((((((("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" = "++++"))
<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>
((((((("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" = "++++"))
<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>
(((("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"))
<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>
(((("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"))
<i>(Should Conduct hypertension counselling)</i>
<br/>
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</div>
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<extension url="libraryName">
<valueString value="ANCContactDataElements"/>
</extension>
<extension url="name">
<valueString value="Systolic blood pressure"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dataElement: ANC.B8.DE17 Systolic blood pressure
@activity: ANC.B8 Physical exam
@description: Systolic blood pressure (SBP) in mmHg
*/
define "Systolic blood pressure":
WC.Earliest(
[Observation: Cx."Systolic blood pressure"] O
where O.status in { 'final', 'amended', 'corrected' }
and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
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<extension url="name">
<valueString value="Repeat systolic blood pressure"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dataElement: ANC.B8.DE20 Repeat systolic blood pressure
@activity: ANC.B8 Physical exam
@description: Repeat measurement of the woman's systolic blood pressure in mmHg after 10–15 minutes rest
*/
define "Repeat systolic blood pressure":
WC.MostRecent(
[Observation: Cx."Repeat systolic blood pressure"] O
where O.status in { 'final', 'amended', 'corrected' }
and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
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<extension url="libraryName">
<valueString value="ANCContactDataElements"/>
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<extension url="name">
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</extension>
<extension url="statement">
<valueString
value="/*
@dataElement: ANC.B8.DE27 Symptoms of severe pre-eclampsia
@activity: ANC.B8 Physical exam
@description: Check if the woman has any of the following symptoms of severe pre-eclampsia
*/
define "Symptoms of severe pre-eclampsia":
[Observation: Cx."Symptoms of severe pre-eclampsia"] O
where O.status in { 'final', 'amended', 'corrected' }
and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
return O.value as FHIR.CodeableConcept"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="ANCContactDataElements"/>
</extension>
<extension url="name">
<valueString value="Diastolic blood pressure"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dataElement: ANC.B8.DE19 Diastolic blood pressure
@activity: ANC.B8 Physical exam
@description: Diastolic blood pressure (DBP) in mmHg
*/
define "Diastolic blood pressure":
WC.Earliest(
[Observation: Cx."Diastolic blood pressure"] O
where O.status in { 'final', 'amended', 'corrected' }
and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
).value as FHIR.Quantity"/>
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<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
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url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="ANCContactDataElements"/>
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<extension url="name">
<valueString value="Repeat diastolic blood pressure"/>
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<extension url="statement">
<valueString
value="/*
@dataElement: ANC.B8.DE21 Repeat diastolic blood pressure
@activity: ANC.B8 Physical exam
@description: Repeat measurement of the woman's diastolic blood pressure in mmHg after 10–15 minutes rest
*/
define "Repeat diastolic blood pressure":
WC.MostRecent(
[Observation: Cx."Repeat diastolic blood pressure"] O
where O.status in { 'final', 'amended', 'corrected' }
and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
).value as FHIR.Quantity"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="ANCContactDataElements"/>
</extension>
<extension url="name">
<valueString value="Urine dipstick result - protein"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dataElement: ANC.B9.DE144 Urine dipstick result - protein
@activity: ANC.B9 Lab tests & imaging
@description: Enter the result for the dipstick test – protein
*/
define "Urine dipstick result - protein":
WC.Only(
[Observation: Cx."Urine dipstick result - protein"] O
where O.status in { 'final', 'amended', 'corrected' }
and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
).value as FHIR.CodeableConcept"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="ANCDT17"/>
</extension>
<extension url="name">
<valueString value="Should Refer urgently to a hospital"/>
</extension>
<extension url="statement">
<valueString
value="/*
(((((((((((((((("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" = "++++"))
*/
define "Should Refer urgently to a hospital":
(
ContactData."Systolic blood pressure" >= 140 'mm[Hg]'
and ContactData."Repeat systolic blood pressure" >= 140 'mm[Hg]'
and ContactData."Symptoms of severe pre-eclampsia" in Cx."Symptoms of severe pre-eclampsia Choices"
) or
(
ContactData."Diastolic blood pressure" >= 90 'mm[Hg]'
and ContactData."Repeat diastolic blood pressure" >= 90 'mm[Hg]'
and ContactData."Symptoms of severe pre-eclampsia" in Cx."Symptoms of severe pre-eclampsia Choices"
) or
(
ContactData."Systolic blood pressure" >= 140 'mm[Hg]'
and ContactData."Repeat systolic blood pressure" >= 140 'mm[Hg]'
and ContactData."Symptoms of severe pre-eclampsia" in Cx."Symptoms of severe pre-eclampsia - No symptoms Choices"
and (
ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 2 plus Choices"
or ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 3 plus Choices"
or ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 4 plus Choices"
)
) or
(
ContactData."Diastolic blood pressure" >= 90 'mm[Hg]'
and ContactData."Repeat diastolic blood pressure" >= 90 'mm[Hg]'
and ContactData."Symptoms of severe pre-eclampsia" in Cx."Symptoms of severe pre-eclampsia - No symptoms Choices"
and (
ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 2 plus Choices"
or ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 3 plus Choices"
or ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 4 plus Choices"
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="ANCContactDataElements"/>
</extension>
<extension url="name">
<valueString value="Existing chronic health conditions"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dataElement: ANC.B6.DE83 Existing chronic health conditions
@activity: ANC.B6 Profile
@description: Does the woman have any current chronic health conditions or problems?
*/
define "Existing chronic health conditions":
[Observation: Cx."Existing chronic health conditions"] O
where O.status in { 'final', 'amended', 'corrected' }
and Coalesce(WC.ModifierExtension(O, 'who-notDone').value, false) is false
and Last(Split(O.encounter.reference, '/')) = Last(Split(encounter, '/'))
return O.value as FHIR.CodeableConcept"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="ANCDT17"/>
</extension>
<extension url="name">
<valueString value="Should Conduct hypertension counselling"/>
</extension>
<extension url="statement">
<valueString
value="/*
(((("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"))
*/
define "Should Conduct hypertension counselling":
ContactData."Existing chronic health conditions" in Cx."Existing chronic health conditions - Hypertension Choices"
or (
ContactData."Systolic blood pressure" in Interval[140 'mm[Hg]', 160 'mm[Hg]']
and ContactData."Repeat systolic blood pressure" in Interval[140 'mm[Hg]', 160 'mm[Hg]']
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 1 plus Choices"
)
or (
ContactData."Diastolic blood pressure" in Interval[90 'mm[Hg]', 110 'mm[Hg]']
and ContactData."Repeat diastolic blood pressure" in Interval[90 'mm[Hg]', 110 'mm[Hg]']
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 1 plus Choices"
)
or (
ContactData."Systolic blood pressure" in Interval[140 'mm[Hg]', 160 'mm[Hg]']
and ContactData."Repeat systolic blood pressure" in Interval[140 'mm[Hg]', 160 'mm[Hg]']
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - None Choices"
)
or (
ContactData."Diastolic blood pressure" in Interval[90 'mm[Hg]', 110 'mm[Hg]']
and ContactData."Repeat diastolic blood pressure" in Interval[90 'mm[Hg]', 110 'mm[Hg]']
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - None Choices"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="ANCDT17"/>
</extension>
<extension url="name">
<valueString value="Should Refer urgently to a hospital 3"/>
</extension>
<extension url="statement">
<valueString
value="/*
(((("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"))
*/
define "Should Refer urgently to a hospital 3":
(
ContactData."Systolic blood pressure" >= 160 'mm[Hg]'
and ContactData."Repeat systolic blood pressure" >= 160 'mm[Hg]'
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 1 plus Choices"
) or
(
ContactData."Diastolic blood pressure" >= 110 'mm[Hg]'
and ContactData."Repeat diastolic blood pressure" >= 110 'mm[Hg]'
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 1 plus Choices"
) or
(
ContactData."Systolic blood pressure" >= 160 'mm[Hg]'
and ContactData."Repeat systolic blood pressure" value >= 160 'mm[Hg]'
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - None Choices"
) or
(
ContactData."Diastolic blood pressure" >= 110 'mm[Hg]'
and ContactData."Repeat diastolic blood pressure" >= 110 'mm[Hg]'
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - None Choices"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="ANCDT17"/>
</extension>
<extension url="name">
<valueString value="Should Refer urgently to a hospital 2"/>
</extension>
<extension url="statement">
<valueString
value="/*
((((((("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" = "++++"))
*/
define "Should Refer urgently to a hospital 2":
(
ContactData."Systolic blood pressure" <= 140 'mm[Hg]'
and ContactData."Repeat systolic blood pressure" <= 140 'mm[Hg]'
and ContactData."Symptoms of severe pre-eclampsia" in Cx."Symptoms of severe pre-eclampsia - No symptoms Choices"
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 2 plus Choices"
) or
(
ContactData."Systolic blood pressure" > 160 'mm[Hg]'
and ContactData."Repeat systolic blood pressure" > 160 'mm[Hg]'
and ContactData."Symptoms of severe pre-eclampsia" in Cx."Symptoms of severe pre-eclampsia - No symptoms Choices"
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 2 plus Choices"
) or
(
ContactData."Diastolic blood pressure" in Interval[90 'mm[Hg]', 110 'mm[Hg]']
and ContactData."Repeat diastolic blood pressure" in Interval[90 'mm[Hg]', 110 'mm[Hg]']
and ContactData."Symptoms of severe pre-eclampsia" in Cx."Symptoms of severe pre-eclampsia - No symptoms Choices"
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 2 plus Choices"
) or
(
ContactData."Systolic blood pressure" in Interval[140 'mm[Hg]', 160 'mm[Hg]']
and ContactData."Repeat systolic blood pressure" in Interval[140 'mm[Hg]', 160 'mm[Hg]']
and ContactData."Symptoms of severe pre-eclampsia" in Cx."Symptoms of severe pre-eclampsia - No symptoms Choices"
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 3 plus Choices"
) or
(
ContactData."Diastolic blood pressure" in Interval[90 'mm[Hg]', 110 'mm[Hg]']
and ContactData."Repeat diastolic blood pressure" in Interval[90 'mm[Hg]', 110 'mm[Hg]']
and ContactData."Symptoms of severe pre-eclampsia" in Cx."Symptoms of severe pre-eclampsia - No symptoms Choices"
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 3 plus Choices"
) or
(
ContactData."Systolic blood pressure" in Interval[140 'mm[Hg]', 160 'mm[Hg]']
and ContactData."Repeat systolic blood pressure" in Interval[140 'mm[Hg]', 160 'mm[Hg]']
and ContactData."Symptoms of severe pre-eclampsia" in Cx."Symptoms of severe pre-eclampsia - No symptoms Choices"
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 4 plus Choices"
) or
(
ContactData."Diastolic blood pressure" in Interval[90 'mm[Hg]', 110 'mm[Hg]']
and ContactData."Repeat diastolic blood pressure" in Interval[90 'mm[Hg]', 110 'mm[Hg]']
and ContactData."Symptoms of severe pre-eclampsia" in Cx."Symptoms of severe pre-eclampsia - No symptoms Choices"
and ContactData."Urine dipstick result - protein" in Cx."Urine dipstick result - protein - 4 plus Choices"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToQuantity"/>
</extension>
<extension url="statement">
<valueString
value="define function ToQuantity(quantity FHIR.Quantity):
case
when quantity is null then null
when quantity.value is null then null
when quantity.comparator is not null then
Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')
when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'
or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then
System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }
else
Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCalendarUnit"/>
</extension>
<extension url="statement">
<valueString
value="define function ToCalendarUnit(unit System.String):
case unit
when 'ms' then 'millisecond'
when 's' then 'second'
when 'min' then 'minute'
when 'h' then 'hour'
when 'd' then 'day'
when 'wk' then 'week'
when 'mo' then 'month'
when 'a' then 'year'
else unit
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOCommon"/>
</extension>
<extension url="name">
<valueString value="Earliest"/>
</extension>
<extension url="statement">
<valueString
value="define function Earliest(observations List<Observation>):
First(
observations O
sort by issued
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value ObservationStatus): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToBoolean"/>
</extension>
<extension url="statement">
<valueString
value="define function ToBoolean(value boolean): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOCommon"/>
</extension>
<extension url="name">
<valueString value="ModifierExtension"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns the single WHO core modifier extension (if present) on the given resource with the specified id.
@comment: This function uses singleton from to ensure that a run-time exception is thrown if there
is more than one extension on the given resource with the specified url.
*/
define function ModifierExtension(domainResource DomainResource, id String):
singleton from ModifierExtensions(domainResource, id)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOCommon"/>
</extension>
<extension url="name">
<valueString value="ModifierExtensions"/>
</extension>
<extension url="statement">
<valueString
value="/*
@description: Returns any WHO core modifier extensions defined on the given resource with the specified id.
@comment: NOTE: Extensions are not the preferred approach, but are used as a way to access
content that is defined by extensions but not yet surfaced in the
CQL model info.
*/
define function ModifierExtensions(domainResource DomainResource, id String):
domainResource.modifierExtension E
where E.url = ('http://fhir.org/guides/who/core/StructureDefinition/' + id)
return E"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString value="define function ToString(value uri): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value string): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOCommon"/>
</extension>
<extension url="name">
<valueString value="MostRecent"/>
</extension>
<extension url="statement">
<valueString
value="define function MostRecent(observations List<Observation>):
Last(
observations O
sort by issued
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToConcept"/>
</extension>
<extension url="statement">
<valueString
value="define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCode"/>
</extension>
<extension url="statement">
<valueString
value="define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="WHOCommon"/>
</extension>
<extension url="name">
<valueString value="Only"/>
</extension>
<extension url="statement">
<valueString
value="define function Only(observations List<Observation>):
singleton from observations"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements" id="effective-data-requirements">
<valueCanonical value="#effective-data-requirements"/>
</extension>
<extension
url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem">
<valueReference>🔗
<reference value="Device/cqf-tooling"/>
</valueReference>
</extension>
<url value="http://smart.who.int/anc/PlanDefinition/ANCDT17"/>
<identifier>
<use value="official"/>
<value value="ANC.DT.17"/>
</identifier>
<version value="0.3.0"/>
<name value="ANCDT17"/>
<title
value="ANC.DT.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
<code value="eca-rule"/>
</coding>
</type>
<status value="active"/>
<experimental value="false"/>
<date value="2025-06-24T13:58:48-06:00"/>
<publisher value="World Health Organization (WHO)"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.who.int"/>
</telecom>
</contact>
<description
value="If the woman presents with any of the following symptoms and/or test results, conduct counselling and referral as needed"/>
<useContext>
<code>
<system
value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
<code value="task"/>
<display value="Workflow Task"/>
</code>
<valueCodeableConcept>
<coding>
<system value="http://smart.who.int/anc/CodeSystem/activity-codes"/>
<code value="ANC.B10.4."/>
<display value="Diagnosis and treatment"/>
</coding>
</valueCodeableConcept>
</useContext>
<jurisdiction>
<coding>
<system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
<code value="001"/>
</coding>
</jurisdiction>
<library value="http://smart.who.int/anc/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>
<condition>
<kind value="applicability"/>
<expression>
<description
value="(((((((((((((((("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" = "++++"))"/>
<language value="text/cql-identifier"/>
<expression value="Should Refer urgently to a hospital"/>
</expression>
</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="((((((("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" = "++++"))"/>
<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="(((("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"))"/>
<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="(((("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"))"/>
<language value="text/cql-identifier"/>
<expression value="Should Conduct hypertension counselling"/>
</expression>
</condition>
</action>
</action>
</PlanDefinition>