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="ANCDT22"/>
<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;">ANCDT22</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="PlanDefinition-ANCDT22.html">ANC.DT.22 Asymptomatic bacteriuria (ASB) 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.22</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">ANC.DT.22 Asymptomatic bacteriuria (ASB) 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 tests positive for ASB, provide counselling and treatment 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-ANCDT22.html">ANC.DT.22 Asymptomatic bacteriuria (ASB) 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.22 Asymptomatic bacteriuria (ASB) 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>
A woman is considered to have ASB if she has one of the following test results:
– Positive culture (> 100,000 bacteria/ml)
– Gram-staining positive
– Urine dipstick test positive (nitrites or leukocytes)
Seven-day antibiotic regimen is recommended for all pregnant women with asymptomatic bacteriuria (ASB) to prevent persistent bacteriuria, preterm birth and low birth weight.
"Midstream urine culture is the recommended method for diagnosing asymptomatic bacteriuria (ASB) in pregnancy. In settings where urine culture is not available, on-site midstream urine Gramstaining is recommended over the use of dipstick tests as the method for diagnosing ASB in pregnancy" (2)
<br/>
<b>If:</b>
<i>Applicability:</i>
(((((((((("Midstream urine culture (recommended)" = "Positive – any agent")
OR ("Midstream urine culture (recommended)" = "Positive – Group B Streptococcus (GBS)"))
OR ("Midstream urine Gram-staining" = "Positive"))
OR ("Urine dipstick result – nitrites" = "+"))
OR ("Urine dipstick result – nitrites" = "++"))
OR ("Urine dipstick result – nitrites" = "+++"))
OR ("Urine dipstick result – nitrites" = "++++"))
OR ("Urine dipstick result – leukocytes" = "+"))
OR ("Urine dipstick result – leukocytes" = "++"))
OR ("Urine dipstick result – leukocytes" = "+++"))
OR ("Urine dipstick result – leukocytes" = "++++")
<i>(Should Provide 7-day antibiotic regimen for asymptomatic bacteriuria (ASB))</i>
<br/>
</td>
</tr>
<tr>
<td>
Pregnant women with Group B Streptococcus (GBS) colonization should receive intrapartum antibiotic administration to prevent early neonatal GBS infection.
"Midstream urine culture is the recommended method for diagnosing asymptomatic bacteriuria (ASB) in pregnancy. In settings where urine culture is not available, on-site midstream urine Gramstaining is recommended over the use of dipstick tests as the method for diagnosing ASB in pregnancy" (2)
<br/>
<b>If:</b>
<i>Applicability:</i>
"Midstream urine culture (recommended)" = "Positive – Group B Streptococcus (GBS)"
<i>(Should Provide intrapartum antibiotic to prevent early neonatal Group B Streptococcus (GBS) infection counselling)</i>
<br/>
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource value="http://smart.who.int/anc/Library/FHIRHelpers|4.0.1"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library ContactData"/>
<resource
value="http://smart.who.int/anc/Library/ANCContactDataElements"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library WC"/>
<resource value="http://smart.who.int/anc/Library/WHOCommon"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Cx"/>
<resource value="http://smart.who.int/anc/Library/ANCConcepts"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Midstream urine culture (recommended)"/>
<resource value="http://smart.who.int/anc/ValueSet/anc-b9-de124"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Midstream urine culture (recommended) - Positive - Any agent Choices"/>
<resource value="http://smart.who.int/anc/ValueSet/anc-b9-de126"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Midstream urine culture (recommended) - Positive - Group B Strep (GBS) Choices"/>
<resource value="http://smart.who.int/anc/ValueSet/anc-b9-de127"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Midstream urine Gram-staining"/>
<resource value="http://smart.who.int/anc/ValueSet/anc-b9-de129"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Midstream urine Gram-staining - Positive Choices"/>
<resource value="http://smart.who.int/anc/ValueSet/anc-b9-de130"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Urine dipstick result - nitrites"/>
<resource value="http://smart.who.int/anc/ValueSet/anc-b9-de132"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Urine dipstick result - nitrites Choices"/>
<resource value="http://smart.who.int/anc/ValueSet/anc-b9-de134"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Urine dipstick result - leukocytes"/>
<resource value="http://smart.who.int/anc/ValueSet/anc-b9-de138"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Urine dipstick result - leukocytes Choices"/>
<resource value="http://smart.who.int/anc/ValueSet/anc-b9-de140"/>
</relatedArtifact>
<parameter>
<name value="encounter"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="string"/>
</parameter>
<parameter>
<name
value="Should Provide 7-day antibiotic regimen for asymptomatic bacteriuria (ASB)"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name
value="Should Provide intrapartum antibiotic to prevent early neonatal Group B Streptococcus (GBS) infection counselling"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="encounter"/>
<mustSupport value="encounter.reference"/>
<codeFilter>
<path value="code"/>
<valueSet value="http://smart.who.int/anc/ValueSet/anc-b9-de124"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="encounter"/>
<mustSupport value="encounter.reference"/>
<codeFilter>
<path value="code"/>
<valueSet value="http://smart.who.int/anc/ValueSet/anc-b9-de129"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="encounter"/>
<mustSupport value="encounter.reference"/>
<codeFilter>
<path value="code"/>
<valueSet value="http://smart.who.int/anc/ValueSet/anc-b9-de132"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="encounter"/>
<mustSupport value="encounter.reference"/>
<codeFilter>
<path value="code"/>
<valueSet value="http://smart.who.int/anc/ValueSet/anc-b9-de138"/>
</codeFilter>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="ANCContactDataElements"/>
</extension>
<extension url="name">
<valueString value="Midstream urine culture (recommended)"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dataElement: ANC.B9.DE124 Midstream urine culture (recommended)
@activity: ANC.B9 Lab tests & imaging
@description: Midstream urine culture is the recommended method for diagnosing asymptomatic bacteriuria (ASB) in pregnancy
*/
define "Midstream urine culture (recommended)":
WC.Only(
[Observation: Cx."Midstream urine culture (recommended)"] 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="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="ANCContactDataElements"/>
</extension>
<extension url="name">
<valueString value="Midstream urine Gram-staining"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dataElement: ANC.B9.DE129 Midstream urine Gram-staining
@activity: ANC.B9 Lab tests & imaging
@description: On-site midstream urine Gram-staining is recommended over the use of dipstick tests as the method for diagnosing ASB in pregnancy if midstream culture is not possible
*/
define "Midstream urine Gram-staining":
WC.Only(
[Observation: Cx."Midstream urine Gram-staining"] 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="1"/>
</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 - nitrites"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dataElement: ANC.B9.DE132 Urine dipstick result - nitrites
@activity: ANC.B9 Lab tests & imaging
@description: Dipstick test results – nitrites
*/
define "Urine dipstick result - nitrites":
WC.Only(
[Observation: Cx."Urine dipstick result - nitrites"] 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="2"/>
</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 - leukocytes"/>
</extension>
<extension url="statement">
<valueString
value="/*
@dataElement: ANC.B9.DE138 Urine dipstick result - leukocytes
@activity: ANC.B9 Lab tests & imaging
@description: Dipstick test results – leukocytes
*/
define "Urine dipstick result - leukocytes":
WC.Only(
[Observation: Cx."Urine dipstick result - leukocytes"] 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="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="ANCDT22"/>
</extension>
<extension url="name">
<valueString
value="Should Provide 7-day antibiotic regimen for asymptomatic bacteriuria (ASB)"/>
</extension>
<extension url="statement">
<valueString
value="/*
(((((((((("Midstream urine culture (recommended)" = "Positive – any agent")
OR ("Midstream urine culture (recommended)" = "Positive – Group B Streptococcus (GBS)"))
OR ("Midstream urine Gram-staining" = "Positive"))
OR ("Urine dipstick result – nitrites" = "+"))
OR ("Urine dipstick result – nitrites" = "++"))
OR ("Urine dipstick result – nitrites" = "+++"))
OR ("Urine dipstick result – nitrites" = "++++"))
OR ("Urine dipstick result – leukocytes" = "+"))
OR ("Urine dipstick result – leukocytes" = "++"))
OR ("Urine dipstick result – leukocytes" = "+++"))
OR ("Urine dipstick result – leukocytes" = "++++")
*/
define "Should Provide 7-day antibiotic regimen for asymptomatic bacteriuria (ASB)":
ContactData."Midstream urine culture (recommended)" in Cx."Midstream urine culture (recommended) - Positive - Any agent Choices"
or ContactData."Midstream urine culture (recommended)" in Cx."Midstream urine culture (recommended) - Positive - Group B Strep (GBS) Choices"
or ContactData."Midstream urine Gram-staining" in Cx."Midstream urine Gram-staining - Positive Choices"
or ContactData."Urine dipstick result - nitrites" in Cx."Urine dipstick result - nitrites Choices"
or ContactData."Urine dipstick result - leukocytes" in Cx."Urine dipstick result - leukocytes Choices""/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="ANCDT22"/>
</extension>
<extension url="name">
<valueString
value="Should Provide intrapartum antibiotic to prevent early neonatal Group B Streptococcus (GBS) infection counselling"/>
</extension>
<extension url="statement">
<valueString
value="/*
"Midstream urine culture (recommended)" = "Positive – Group B Streptococcus (GBS)"
*/
define "Should Provide intrapartum antibiotic to prevent early neonatal Group B Streptococcus (GBS) infection counselling":
ContactData."Midstream urine culture (recommended)" in Cx."Midstream urine culture (recommended) - Positive - Group B Strep (GBS) Choices""/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</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="6"/>
</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="7"/>
</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="8"/>
</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="9"/>
</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="10"/>
</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="11"/>
</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="12"/>
</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="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 string): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</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/ANCDT22"/>
<identifier>
<use value="official"/>
<value value="ANC.DT.22"/>
</identifier>
<version value="0.3.0"/>
<name value="ANCDT22"/>
<title value="ANC.DT.22 Asymptomatic bacteriuria (ASB) 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 tests positive for ASB, provide counselling and treatment 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/ANCDT22"/>
<action>
<title value="ANC.DT.22 Asymptomatic bacteriuria (ASB) diagnosis"/>
<trigger>
<type value="named-event"/>
<name value="ANC.B10.4 Diagnosis and treatment"/>
</trigger>
<action id="1">
<title
value="Provide 7-day antibiotic regimen for asymptomatic bacteriuria (ASB)"/>
<description
value="Provide 7-day antibiotic regimen for asymptomatic bacteriuria (ASB)"/>
<textEquivalent
value="A woman is considered to have ASB if she has one of the following test results:
– Positive culture (> 100,000 bacteria/ml)
– Gram-staining positive
– Urine dipstick test positive (nitrites or leukocytes)
Seven-day antibiotic regimen is recommended for all pregnant women with asymptomatic bacteriuria (ASB) to prevent persistent bacteriuria, preterm birth and low birth weight.
"Midstream urine culture is the recommended method for diagnosing asymptomatic bacteriuria (ASB) in pregnancy. In settings where urine culture is not available, on-site midstream urine Gramstaining is recommended over the use of dipstick tests as the method for diagnosing ASB in pregnancy" (2)"/>
<documentation>
<type value="citation"/>
<label
value="WHO ANC recommendations (2016): B.1.2. Asymptomatic bacteriuria (ASB) (3)"/>
</documentation>
<condition>
<kind value="applicability"/>
<expression>
<description
value="(((((((((("Midstream urine culture (recommended)" = "Positive – any agent")
OR ("Midstream urine culture (recommended)" = "Positive – Group B Streptococcus (GBS)"))
OR ("Midstream urine Gram-staining" = "Positive"))
OR ("Urine dipstick result – nitrites" = "+"))
OR ("Urine dipstick result – nitrites" = "++"))
OR ("Urine dipstick result – nitrites" = "+++"))
OR ("Urine dipstick result – nitrites" = "++++"))
OR ("Urine dipstick result – leukocytes" = "+"))
OR ("Urine dipstick result – leukocytes" = "++"))
OR ("Urine dipstick result – leukocytes" = "+++"))
OR ("Urine dipstick result – leukocytes" = "++++")"/>
<language value="text/cql-identifier"/>
<expression
value="Should Provide 7-day antibiotic regimen for asymptomatic bacteriuria (ASB)"/>
</expression>
</condition>
</action>
<action id="2">
<title
value="Provide intrapartum antibiotic to prevent early neonatal Group B Streptococcus (GBS) infection counselling"/>
<description
value="Provide intrapartum antibiotic to prevent early neonatal Group B Streptococcus (GBS) infection counselling"/>
<textEquivalent
value="Pregnant women with Group B Streptococcus (GBS) colonization should receive intrapartum antibiotic administration to prevent early neonatal GBS infection.
"Midstream urine culture is the recommended method for diagnosing asymptomatic bacteriuria (ASB) in pregnancy. In settings where urine culture is not available, on-site midstream urine Gramstaining is recommended over the use of dipstick tests as the method for diagnosing ASB in pregnancy" (2)"/>
<documentation>
<type value="citation"/>
<label
value="WHO ANC recommendations (2016): B.1.2. Asymptomatic bacteriuria (ASB) (3)"/>
</documentation>
<condition>
<kind value="applicability"/>
<expression>
<description
value=""Midstream urine culture (recommended)" = "Positive – Group B Streptococcus (GBS)""/>
<language value="text/cql-identifier"/>
<expression
value="Should Provide intrapartum antibiotic to prevent early neonatal Group B Streptococcus (GBS) infection counselling"/>
</expression>
</condition>
</action>
</action>
</PlanDefinition>