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

PlanDefinition: ANC.DT.25 Anaemia, iron and folic acid supplementation

Official URL: http://fhir.org/guides/who/anc-cds/PlanDefinition/ANCDT25 Version: 0.3.0
Active as of 2021-06-11 Computable Name: ANCDT25
Other Identifiers: ANC.DT.25 (use: official, )

Usage:Workflow Task: Conduct laboratory tests and imaging

Testing for anaemia is recommended for all pregnant women. Regardless of test results, iron and folic acid supplementation is recommended. The amount of iron and folic acid supplementation will vary depending on anaemia diagnosis, population prevalence of anaemia, and whether the woman has side-effects due to iron and folic acid supplementation.

Id: ANCDT25
Url: ANC.DT.25 Anaemia, iron and folic acid supplementation
Version: 0.3.0
Identifier:

value: ANC.DT.25

Name: ANCDT25
Title: ANC.DT.25 Anaemia, iron and folic acid supplementation
Status: active
Experimental: false
Type:

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

code: eca-rule

Date: 2021-06-11 23:38:46-0600
Publisher: World Health Organization (WHO)
Description: Testing for anaemia is recommended for all pregnant women. Regardless of test results, iron and folic acid supplementation is recommended. The amount of iron and folic acid supplementation will vary depending on anaemia diagnosis, population prevalence of anaemia, and whether the woman has side-effects due to iron and folic acid supplementation.
Use Context:
codevaluedisplay
task ANC.B9. Conduct laboratory tests and imaging
Jurisdiction: 001
Libraries:
ANC.DT.25 Anaemia, iron and folic acid supplementation
Actions:
ANC.DT.25 Anaemia, iron and folic acid supplementation:
When: Named Event: ANC.B9. Conduct laboratory tests and imaging
Then:
Anaemia can be diagnosed if Hb level is less than 11 in first or third trimester or Hb level less than 10.5 in second trimester; OR there is no Hb test result recorded, but woman has pallor. If a woman is diagnosed with anaemia during pregnancy, conduct counselling for managing and treating anaemia. Her daily elemental iron should be increased to 120 mg until her haemoglobin (Hb) concentration rises to normal (Hb 110 g/L or higher). Thereafter, she can resume the standard daily antenatal iron dose to prevent recurrence of anaemia. The equivalent of 120 mg of elemental iron equals 600 mg of ferrous sulfate heptahydrate, 360 mg of ferrous fumarate or 1000 mg of ferrous gluconate. Please refer to iron sources listed below for additional guidance that can be provided.
If: Applicability: (((("Blood haemoglobin test result" < 110 g/L) AND ("Gestational age" ≤ 12 weeks)) OR (("Blood haemoglobin test result" < 110 g/L) AND ("Gestational age" ≥ 28 weeks))) OR (("Blood haemoglobin test result" < 105 g/L) AND (13 weeks ≤ "Gestational age" ≤ 27 weeks))) OR (("Blood haemoglobin test conducted" = FALSE) AND ("Pallor present" = TRUE)) (Should Conduct REQUIRED anaemia counselling)
Then:
Conduct REQUIRED anaemia counselling:
"Amount of iron prescribed" = 120 mg:
"Type of iron supplement dosage provided" = "Daily":
"Amount of daily dose of folic acid prescribed" = 0.4 mg:
If a woman is not diagnosed for anaemia, iron and folic acid supplementation is still recommended. Due to the population's high anaemia prevalence, a daily dose of 60 mg of elemental iron is preferred over a lower dose. A daily dose of 400 micrograms (0.4 mg) folic acid is also recommended. The equivalent of 60 mg of elemental iron is 300 mg of ferrous sulfate heptahydrate, 180 mg of ferrous fumarate or 500 mg of ferrous gluconate. Please refer to iron sources listed below for additional guidance that can be provided.
If: Applicability: (((("Blood haemoglobin test result" ≥ 110 g/L) AND ("Gestational age" ≤ 12 weeks) AND ("Population prevalence of anaemia" ≥ 40%)) OR (("Blood haemoglobin test result" ≥ 110 g/L) AND ("Gestational age" ≥ 28 weeks) AND ("Population prevalence of anaemia" ≥ 40%))) OR (("Blood haemoglobin test result" ≥ 105 g/L) AND (13 weeks ≤ "Gestational age" ≤ 27 weeks) AND ("Population prevalence of anaemia" ≥ 40%))) OR (("Blood haemoglobin test conducted" = FALSE) AND ("Pallor present" = FALSE) AND ("Population prevalence of anaemia" ≥ 40%)) (Should \"Anaemia counselling conducted\" IS OPTIONAL)
Then:
"Anaemia counselling conducted" IS OPTIONAL:
"Amount of iron prescribed" = 60 mg:
"Type of iron supplement dosage provided" = "Daily":
"Amount of daily dose of folic acid prescribed" = 0.4 mg:
If a woman is not diagnosed for anaemia, iron and folic acid supplementation is still recommended. Daily oral iron and folic acid supplementation with 30–60 mg of elemental iron and 400 micrograms (0.4 mg) of folic acidc to prevent maternal anaemia, puerperal sepsis, low birth weight and preterm birth. The equivalent of 60 mg of elemental iron is 300 mg of ferrous sulfate hepahydrate, 180 mg of ferrous fumarate or 500 mg of ferrous gluconate. Please refer to iron sources listed below for additional guidance that can be provided.
If: Applicability: (((("Blood haemoglobin test result" ≥ 110 g/L) AND ("Gestational age" ≤ 12 weeks) AND ("Population prevalence of anaemia" ≤ 20%) AND ("Has side-effects from iron and folic acid supplements" = TRUE)) OR (("Blood haemoglobin test result" ≥ 110 g/L) AND ("Gestational age" ≥ 28 weeks) AND ("Population prevalence of anaemia" ≤ 20%) AND ("Has side-effects from iron and folic acid supplements" = TRUE))) OR (("Blood haemoglobin test result" ≥ 105 g/L) AND (13 weeks ≤ "Gestational age" ≤ 27 weeks) AND ("Population prevalence of anaemia" ≤ 20%) AND ("Has side-effects from iron and folic acid supplements" = TRUE))) OR (("Blood haemoglobin test conducted" = FALSE) AND ("Pallor present" = FALSE) AND ("Population prevalence of anaemia" ≤ 20%) AND ("Has side-effects from iron and folic acid supplements" = TRUE)) (Should \"Anaemia counselling conducted\" IS OPTIONAL 2)
Then:
"Anaemia counselling conducted" IS OPTIONAL:
30 mg ≤ "Amount of iron prescribed" ≤ 60 mg:
"Type of iron supplement dosage provided" = "Daily":
"Amount of daily dose of folic acid prescribed" = 0.4 mg:
If a woman is not diagnosed for anaemia, iron and folic acid supplementation is still recommended. If daily iron is not acceptable due to side-effects, provide intermittent iron and folic acid supplementation instead (120 mg of elemental iron and 2.8 mg of folic acid once weekly). The equivalent of 120 mg of elemental iron is 600 mg of ferrous sulfate heptahydrate, 360 mg of ferrous fumarate or 1000 mg of ferrous gluconate. Please refer to iron sources listed below for additional guidance that can be provided.
If: Applicability: (((("Blood haemoglobin test result" ≥ 110 g/L) AND ("Gestational age" ≤ 12 weeks) AND ("Population prevalence of anaemia" ≤ 20%) AND ("Has side-effects from iron and folic acid supplements" = FALSE)) OR (("Blood haemoglobin test result" ≥ 110 g/L) AND ("Gestational age" ≥ 28 weeks) AND ("Population prevalence of anaemia" ≤ 20%) AND ("Has side-effects from iron and folic acid supplements" = FALSE))) OR (("Blood haemoglobin test result" ≥ 105 g/L) AND (13 weeks ≤ "Gestational age" ≤ 27 weeks) AND ("Population prevalence of anaemia" ≤ 20%) AND ("Has side-effects from iron and folic acid supplements" = FALSE))) OR (("Blood haemoglobin test conducted" = FALSE) AND ("Pallor present" = FALSE) AND ("Population prevalence of anaemia" ≤ 20%) AND ("Has side-effects from iron and folic acid supplements" = FALSE)) (Should \"Anaemia counselling conducted\" IS OPTIONAL 3)
Then:
"Anaemia counselling conducted" IS OPTIONAL:
"Amount of iron prescribed" = 120 mg:
"Type of iron supplement dosage provided" = "Weekly":
"Amount of weekly dose of folic acid prescribed" = 2.8 mg: