WHO Antenatal Care Guideline Implementation Guide
0.3.0 - CI Build International flag

WHO Antenatal Care Guideline Implementation Guide, published by World Health Organization (WHO). This guide is not an authorized publication; it is the continuous build for version 0.3.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/WorldHealthOrganization/smart-anc/ and changes regularly. See the Directory of published versions

PlanDefinition: ANC.DT.06 Physical symptoms and exam results requiring referral

Official URL: http://fhir.org/guides/who/anc-cds/PlanDefinition/ANCDT06 Version: 0.3.0
Active as of 2021-06-11 Computable Name: ANCDT06
Other Identifiers: ANC.DT.06 (use: official, )

Usage:Workflow Task: Conduct physical exam

If the woman has any of the following physical exam results, refer to the hospital

Id: ANCDT06
Url: ANC.DT.06 Physical symptoms and exam results requiring referral
Version: 0.3.0
Identifier:

value: ANC.DT.06

Name: ANCDT06
Title: ANC.DT.06 Physical symptoms and exam results requiring referral
Status: active
Experimental: false
Type:

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

code: eca-rule

Date: 2021-06-11 22:32:40-0600
Publisher: World Health Organization (WHO)
Description: If the woman has any of the following physical exam results, refer to the hospital
Use Context:
codevaluedisplay
task ANC.B8. Conduct physical exam
Jurisdiction: 001
Libraries:
ANC.DT.06 Physical symptoms and exam results requiring referral
Actions:
ANC.DT.06 Physical symptoms and exam results requiring referral:
When: Named Event: ANC.B8. Conduct physical exam
Then:
Woman has a fever – provide treatment and refer urgently to hospital! Procedure: – Insert an IV line – Give fluids slowly
If: Applicability: ("Body temperature" ≥ 38°C) AND ("Second body temperature" ≥ 38°C) (Should Conduct further investigation and, if necessary, refer urgently if treatment not available at your facility )
Abnormal pulse rate – refer for further investigation Procedure: – Check for fever, infection, respiratory distress, arrhythmia – Refer for further investigation
If: Applicability: 60 bpm > "Second pulse rate" > 100 bpm (Should Refer to a hospital)
Woman has respiratory distress – refer urgently to the hospital!
If: Applicability: (((((("Respiratory exam result" = "Dyspnoea") OR ("Respiratory exam result" = "Cough")) OR ("Respiratory exam result" = "Rapid breathing")) OR ("Respiratory exam result" = "Slow breathing")) OR ("Respiratory exam result" = "Wheezing")) OR ("Respiratory exam result" = "Rales")) OR ("Respiratory exam result" = "Other abnormal respiratory exam result (specify)") (Should Refer urgently to a hospital)
Woman has low oximetry (<92%) – she should be referred urgently to the hospital
If: Applicability: "Oximetry" < 92% (Should Refer urgently to a hospital 2)
Woman's cardiac condition is abnormal and she should be referred urgently to the hospital
If: Applicability: ((((((("Cardiac exam result" = "Heart murmur") OR ("Cardiac exam result" = "Weak pulse")) OR ("Cardiac exam result" = "Tachycardia")) OR ("Cardiac exam result" = "Bradycardia")) OR ("Cardiac exam result" = "Arrhythmia")) OR ("Cardiac exam result" = "Cyanosis")) OR ("Cardiac exam result" = "Cold sweats")) OR ("Cardiac exam result" = "Other abnormal cardiac exam result (specify)") (Should Refer urgently to a hospital 3)
Woman's breast exam was abnormal and she should be referred to hospital for further investigation
If: Applicability: (((((("Breast exam result" = "Nodule") OR ("Breast exam result" = "Discharge")) OR ("Breast exam result" = "Flushing")) OR ("Breast exam result" = "Local pain")) OR ("Breast exam result" = "Bleeding")) OR ("Breast exam result" = "Increased temperature")) OR ("Breast exam result" = "Other breast exam result (specify)") (Should Conduct further investigation and, if necessary, refer urgently to a hospital)
Woman's abdominal exam was abnormal and she should be referred or further evaluated
If: Applicability: ((((((((((((((((("Abdominal exam result" = "Mass/tumour") OR ("Abdominal exam result" = "Pain on superficial palpation")) OR ("Abdominal exam result" = "Pain on deep palpation")) OR ("Abdominal exam result" = "Painful decompression")) OR ("Abdominal exam result" = "Other abnormal abdominal exam result (specify)")) OR ("Pelvic exam result (visual)" = "Abnormal vaginal discharge")) OR ("Pelvic exam result (visual)" = "Evidence of amniotic fluid")) OR ("Pelvic exam result (visual)" = "Foul-smelling vaginal discharge")) OR ("Pelvic exam result (visual)" = "Clusters of erythematous papules")) OR ("Pelvic exam result (visual)" = "Vesicles")) OR ("Pelvic exam result (visual)" = "Genital ulcer")) OR ("Pelvic exam result (visual)" = "Genital pain")) OR ("Pelvic exam result (visual)" = "Tender bilateral inguinal and femoral lymphadenopathy")) OR ("Pelvic exam result (visual)" = "Cervical friability")) OR ("Pelvic exam result (visual)" = "Mucopurulent cervicitis")) OR ("Pelvic exam result (visual)" = "Tender unilateral lymphadenopathy")) OR ("Pelvic exam result (visual)" = "Curd-like vaginal discharge")) OR ("Pelvic exam result (visual)" = "Other abnormal pelvic exam (visual) result (specify)") (Should Refer to a hospital 2)
Woman should be referred urgently if there is evidence of amniotic fluid, which could indicate the start of labour
If: Applicability: ("Pelvic exam result (visual)" = "Evidence of amniotic fluid") AND ("Gestational age" < 37 weeks) (Should Refer urgently to a hospital 4)
If no fetal heartbeat is observed, inform the woman that there might be a problem and that she needs to be referred to the hospital for further examination and next steps. Procedure: – Inform the woman that you cannot find the heartbeat and need to refer her to check if there's a problem – Refer to hospital
If: Applicability: ("Fetal heartbeat present" = FALSE) AND ("Gestational age" ≥ 20 weeks) (Should Refer to a hospital 3)
Fetal heart rate is abnormal after two readings: the woman should be referred to hospital
If: Applicability: (100 bpm > "Second fetal heart rate" > 180 bpm) AND ("Gestational age" ≥ 20 weeks) (Should Refer to a hospital 4)