python3 -c " import pdfplumber, re pdf_path = '/home/daytona/workspace/attachments/0a2b6576-fd22-4b6e-93c2-747d78b4da06/dokumen.pub_dc-duttas-textbook-of-obstetrics-including-perinatology-and-contraception-9th-reprint-edition-9786222687-9789786222684-9352702425-1 2.pdf' with pdfplumber.open(pdf_path) as pdf: print(f'Total pages: {len(pdf.pages)}') # Search for PPH-related pages pph_pages = [] for i, page in enumerate(pdf.pages): text = page.extract_text() or '' if 'postpartum haemorrhage' in text.lower() or 'postpartum hemorrhage' in text.lower() or 'PPH' in text: pph_pages.append(i+1) print('PPH pages found:', pph_pages[:30]) "

python3 -c " import pdfplumber pdf_path = '/home/daytona/workspace/attachments/0a2b6576-fd22-4b6e-93c2-747d78b4da06/dokomen.pub_dc-duttas-textbook-of-obstetrics-including-perinatology-and-contraception-9th-reprint-edition-9786222687-9789786222684-9352702425-1 2.pdf' pdf_path = '/home/daytona/workspace/attachments/0a2b6576-fd22-4b6e-93c2-747d78b4da06/dokumen.pub_dc-duttas-textbook-of-obstetrics-including-perinatology-and-contraception-9th-reprint-edition-9786222687-9789786222684-9352702425-1 2.pdf' with pdfplumber.open(pdf_path) as pdf: for i in [4, 7, 13, 21, 27]: page = pdf.pages[i-1] text = page.extract_text() or '' print(f'=== PAGE {i} ===') print(text[:3000]) print() " 2>&1 | head -300

python3 -c " import pdfplumber pdf_path = '/home/daytona/workspace/attachments/0a2b6576-fd22-4b6e-93c2-747d78b4da06/dokumen.pub_dc-duttas-textbook-of-obstetrics-including-perinatology-and-contraception-9th-reprint-edition-9786222687-9789786222684-9352702425-1 2.pdf' with pdfplumber.open(pdf_path) as pdf: print(f'Total pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages): text = page.extract_text() or '' # print first 200 chars of each page to see what chapters are here first_line = text.split('\n')[0] if text else '[empty]' print(f'Page {i+1}: {first_line[:120]}') " 2>&1

mkdir -p /home/daytona/workspace/pph-notes && cat > /home/daytona/workspace/pph-notes/generate_notes.py << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm from reportlab.lib import colors from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, PageBreak, ListFlowable, ListItem, KeepTogether) from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY from reportlab.platypus import CondPageBreak # ── Color Palette ──────────────────────────────────────────────────────────── NAVY = colors.HexColor("#1a2e4a") TEAL = colors.HexColor("#0d7a8a") CORAL = colors.HexColor("#c0392b") GOLD = colors.HexColor("#f39c12") LGRAY = colors.HexColor("#f5f7fa") MGRAY = colors.HexColor("#dce3ec") WHITE = colors.white DKTEXT = colors.HexColor("#2c3e50") MUTED = colors.HexColor("#5d6d7e") # ── Document Setup ──────────────────────────────────────────────────────────── OUTPUT = "/home/daytona/workspace/pph-notes/PPH_Notes_DC_Dutta.pdf" doc = SimpleDocTemplate(OUTPUT, pagesize=A4, leftMargin=1.8*cm, rightMargin=1.8*cm, topMargin=2*cm, bottomMargin=2*cm) # ── Styles ──────────────────────────────────────────────────────────────────── styles = getSampleStyleSheet() def S(name, **kw): return ParagraphStyle(name, **kw) TITLE_S = S("Title", fontSize=22, textColor=WHITE, fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=4, leading=28) SUB_S = S("Subtitle", fontSize=11, textColor=colors.HexColor("#cce8ee"), alignment=TA_CENTER, fontName="Helvetica", spaceAfter=2) H1_S = S("H1", fontSize=13, textColor=WHITE, fontName="Helvetica-Bold", alignment=TA_LEFT, leftIndent=0, spaceAfter=2, spaceBefore=4, leading=17) H2_S = S("H2", fontSize=10.5, textColor=TEAL, fontName="Helvetica-Bold", spaceAfter=2, spaceBefore=6, leading=14) H3_S = S("H3", fontSize=9.5, textColor=CORAL, fontName="Helvetica-Bold", spaceAfter=1, spaceBefore=4, leading=13) BODY_S = S("Body", fontSize=9, textColor=DKTEXT, fontName="Helvetica", spaceAfter=2, leading=13, alignment=TA_JUSTIFY) BULLET_S= S("Bullet", fontSize=9, textColor=DKTEXT, fontName="Helvetica", leftIndent=12, spaceAfter=1, leading=13, bulletIndent=4) NOTE_S = S("Note", fontSize=8.5, textColor=MUTED, fontName="Helvetica-Oblique", spaceAfter=3, leading=12) WARN_S = S("Warn", fontSize=9, textColor=CORAL, fontName="Helvetica-Bold", spaceAfter=2, leading=13) KEY_S = S("Key", fontSize=9, textColor=NAVY, fontName="Helvetica-Bold", spaceAfter=1, leading=13) # ── Helpers ─────────────────────────────────────────────────────────────────── def h1_block(text): """Full-width navy header bar.""" tbl = Table([[Paragraph(text, H1_S)]], colWidths=[17*cm]) tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), NAVY), ("ROUNDEDCORNERS", [4]), ("TOPPADDING", (0,0), (-1,-1), 6), ("BOTTOMPADDING", (0,0), (-1,-1), 6), ("LEFTPADDING", (0,0), (-1,-1), 10), ])) return tbl def h2_block(text): tbl = Table([[Paragraph(text, H2_S)]], colWidths=[17*cm]) tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), LGRAY), ("LINEBELOW", (0,0), (-1,-1), 1.5, TEAL), ("TOPPADDING", (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 3), ("LEFTPADDING", (0,0), (-1,-1), 8), ])) return tbl def bullet(text, bold_prefix=""): if bold_prefix: txt = f"<b>{bold_prefix}</b> {text}" else: txt = text return Paragraph(f"• &nbsp;{txt}", BULLET_S) def info_box(title, items, bg=LGRAY, accent=TEAL): """Coloured info / summary box.""" body = [] for it in items: body.append(Paragraph(f"<b>•</b> {it}", BULLET_S)) inner = Table([[Paragraph(title, KEY_S)]] + [[b] for b in body], colWidths=[16.4*cm]) inner.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), bg), ("LINERIGHT", (0,0), (0,-1), 3, accent), ("LINEBEFORE", (0,0), (0,-1), 3, accent), ("TOPPADDING", (0,0), (-1,-1), 3), ("BOTTOMPADDING", (0,0), (-1,-1), 2), ("LEFTPADDING", (0,0), (-1,-1), 8), ])) return inner def warn_box(text): tbl = Table([[Paragraph(f"⚠ {text}", WARN_S)]], colWidths=[17*cm]) tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), colors.HexColor("#fff3f2")), ("LINEBEFORE", (0,0), (0,-1), 3, CORAL), ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5), ("LEFTPADDING", (0,0), (-1,-1), 8), ])) return tbl def drug_table(headers, rows): data = [headers] + rows col_w = [17*cm / len(headers)] * len(headers) tbl = Table(data, colWidths=col_w) style = [ ("BACKGROUND", (0,0), (-1,0), NAVY), ("TEXTCOLOR", (0,0), (-1,0), WHITE), ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"), ("FONTSIZE", (0,0), (-1,-1), 8.5), ("FONTNAME", (0,1), (-1,-1), "Helvetica"), ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, LGRAY]), ("GRID", (0,0), (-1,-1), 0.4, MGRAY), ("TOPPADDING", (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4), ("LEFTPADDING", (0,0), (-1,-1), 6), ("ALIGN", (0,0), (-1,-1), "LEFT"), ("VALIGN", (0,0), (-1,-1), "TOP"), ] tbl.setStyle(TableStyle(style)) return tbl def sp(n=4): return Spacer(1, n) # ── Cover ───────────────────────────────────────────────────────────────────── def make_cover(): cover_data = [[ Paragraph("POSTPARTUM HAEMORRHAGE", TITLE_S), Paragraph("Crisp Concise Notes", SUB_S), Paragraph("DC Dutta's Textbook of Obstetrics | 9th Edition", NOTE_S), ]] cover = Table(cover_data, colWidths=[17*cm]) cover.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), NAVY), ("ROUNDEDCORNERS", [6]), ("TOPPADDING", (0,0), (-1,-1), 24), ("BOTTOMPADDING", (0,0), (-1,-1), 24), ("LEFTPADDING", (0,0), (-1,-1), 16), ("ALIGN", (0,0), (-1,-1), "CENTER"), ])) return cover # ── Content ─────────────────────────────────────────────────────────────────── story = [] # COVER story.append(make_cover()) story.append(sp(14)) # ── SECTION 1: DEFINITION ───────────────────────────────────────────────────── story.append(h1_block("1. DEFINITION")) story.append(sp()) story.append(h2_block("Primary PPH (Early)")) story.append(bullet("Blood loss <b>≥500 mL</b> after vaginal delivery, or <b>≥1000 mL</b> after caesarean delivery")) story.append(bullet("Occurs within <b>24 hours</b> of delivery")) story.append(bullet("Any bleeding causing haemodynamic instability (or likely to cause it if untreated) also qualifies")) story.append(sp()) story.append(h2_block("Secondary PPH (Late)")) story.append(bullet("Abnormal bleeding between <b>24 hours and 12 weeks</b> postpartum")) story.append(bullet("Usually linked to retained placental fragments or infection")) story.append(sp(8)) # ── SECTION 2: INCIDENCE ───────────────────────────────────────────────────── story.append(h1_block("2. INCIDENCE & SIGNIFICANCE")) story.append(sp()) story.append(Paragraph( "PPH is the <b>leading cause of maternal mortality worldwide</b>, accounting for ~25% of maternal deaths. " "It complicates approximately <b>5–8%</b> of all deliveries. Even in developed countries, a normal uncomplicated " "vaginal delivery may result in 500 mL blood loss without compromise — making clinical signs paramount.", BODY_S)) story.append(sp(8)) # ── SECTION 3: AETIOLOGY ───────────────────────────────────────────────────── story.append(h1_block("3. AETIOLOGY — THE 4 Ts")) story.append(sp()) story.append(info_box("🔴 TONE (most common, >70%)", [ "Uterine atony — failure of uterus to contract after placental delivery", "Results in open sinusoids at placental site", ], accent=CORAL)) story.append(sp(4)) story.append(info_box("🔵 TISSUE (~20%)", [ "Retained placental fragments (whole or partial)", "Retained membranes", "Abnormal placentation: accreta / increta / percreta", ], accent=TEAL)) story.append(sp(4)) story.append(info_box("🟡 TRAUMA (~10%)", [ "Cervical, vaginal, perineal lacerations", "Uterine rupture", "Uterine inversion (rare but dramatic)", "Post-caesarean / hysterectomy bleeding", "Uterine AVM (rare)", ], accent=GOLD)) story.append(sp(4)) story.append(info_box("🟣 THROMBIN (<5%)", [ "Coagulopathy — DIC (from abruption, IUFD, AFE, sepsis)", "Pre-existing hereditary coagulopathy (vWD, haemophilia carrier)", "Iatrogenic anticoagulation", ], accent=NAVY)) story.append(sp(8)) # ── SECTION 4: RISK FACTORS ─────────────────────────────────────────────────── story.append(h1_block("4. RISK FACTORS")) story.append(sp()) story.append(h2_block("Risk Factors for Uterine Atony")) rf_atony = [ "Uterine overdistension — polyhydramnios, multiple gestation, fetal macrosomia", "Grand multiparity (≥5 deliveries)", "Prolonged or precipitate labour", "Intra-amniotic infection (chorioamnionitis)", "Oxytocin augmentation (desensitisation)", "Uterine-relaxing agents (MgSO₄, tocolytics, volatile anaesthetics)", "Previous PPH", ] for r in rf_atony: story.append(bullet(r)) story.append(sp(4)) story.append(h2_block("Risk Factors for Caesarean PPH")) for r in ["Pre-eclampsia", "Active phase arrest", "General anaesthesia", "Obesity", "Intra-amniotic infection", "History of previous PPH"]: story.append(bullet(r)) story.append(sp(8)) # ── SECTION 5: CLINICAL FEATURES ───────────────────────────────────────────── story.append(h1_block("5. CLINICAL FEATURES & DIAGNOSIS")) story.append(sp()) # Blood loss estimation table headers = [Paragraph(h, KEY_S) for h in ["Class", "Blood Loss (mL)", "% Blood Vol", "BP", "HR", "Signs"]] rows = [ [Paragraph("I", BODY_S), Paragraph("≤750", BODY_S), Paragraph("<15%", BODY_S), Paragraph("Normal", BODY_S), Paragraph("<100", BODY_S), Paragraph("Normal", BODY_S)], [Paragraph("II", BODY_S), Paragraph("750–1500", BODY_S), Paragraph("15–30%", BODY_S), Paragraph("Normal", BODY_S), Paragraph("100–120", BODY_S), Paragraph("Anxiety, pallor", BODY_S)], [Paragraph("III", BODY_S), Paragraph("1500–2000", BODY_S), Paragraph("30–40%", BODY_S), Paragraph("↓↓", BODY_S), Paragraph("120–140", BODY_S), Paragraph("Confusion, oliguria", BODY_S)], [Paragraph("IV", BODY_S), Paragraph(">2000", BODY_S), Paragraph(">40%", BODY_S), Paragraph("Very ↓", BODY_S), Paragraph(">140", BODY_S), Paragraph("Lethargy, anuria, shock", BODY_S)], ] story.append(Paragraph("<b>Haemorrhagic Shock Classification</b>", H3_S)) story.append(drug_table(headers, rows)) story.append(sp(4)) story.append(warn_box( "Blood loss is consistently under-estimated clinically. A patient with anaemia or hypovolaemia " "may decompensate at smaller volumes. Treat early!")) story.append(sp(4)) story.append(h2_block("Diagnosis of Uterine Atony")) story.append(bullet("Uterus palpably boggy and not well-contracted on fundal palpation")) story.append(bullet("Excessive bright-red bleeding per vaginum")) story.append(bullet("Real-time ultrasound: identifies retained placental tissue / clots in uterine cavity")) story.append(sp(8)) # ── SECTION 6: MANAGEMENT ──────────────────────────────────────────────────── story.append(h1_block("6. MANAGEMENT")) story.append(sp()) story.append(h2_block("A. Immediate Resuscitation (simultaneous)")) for step in [ "Call for help — obstetrician, anaesthetist, senior midwife", "Establish 2 large-bore IV lines (14–16 G)", "Draw blood: FBC, coagulation screen, fibrinogen, blood group & cross-match", "Infuse crystalloid (Lactated Ringer / Normal Saline) rapidly", "Supplemental oxygen by face mask", "Urinary catheter — monitor hourly urine output", "Keep patient warm, prevent hypothermia", "Activate massive transfusion protocol if ≥1500 mL loss or ongoing haemorrhage", ]: story.append(bullet(step)) story.append(sp(4)) story.append(h2_block("B. Active Management of Third Stage of Labour (AMTSL) — Prevention")) story.append(Paragraph( "AMTSL reduces PPH incidence by up to <b>two-thirds</b>. Components:", BODY_S)) for step in [ "Oxytocin 10 IU IM immediately after delivery of anterior shoulder (or within 1 min of birth)", "Early cord clamping and cutting", "Controlled cord traction (Brandt-Andrews manoeuvre) with uterine counter-pressure", ]: story.append(bullet(step)) story.append(sp(4)) story.append(h2_block("C. Stepwise Management of Established PPH")) story.append(Paragraph("<b>Step 1: Uterotonic Therapy</b>", H3_S)) # Drug table d_headers = [Paragraph(h, KEY_S) for h in ["Drug", "Dose / Route", "Mechanism", "Contraindications / Cautions"]] d_rows = [ [Paragraph("Oxytocin\n(1st line)", BODY_S), Paragraph("20–30 IU in 1 L Ringer's lactate IV infusion\n(max 100 mU/min)\nNever IV bolus", BODY_S), Paragraph("Oxytocin receptor agonist →\nUterine contraction", BODY_S), Paragraph("Risk of water retention/hyponatraemia with high doses; hypotension with bolus", BODY_S)], [Paragraph("Ergometrine /\nMethylergono-vine", BODY_S), Paragraph("0.2 mg IM\n(repeat q2–4h PRN)", BODY_S), Paragraph("α-adrenergic & serotonin agonist → sustained contraction", BODY_S), Paragraph("CONTRAINDICATED in hypertension, pre-eclampsia, cardiac disease (causes vasoconstriction)", BODY_S)], [Paragraph("Carboprost\n(15-methyl PGF2α)\nHemabate", BODY_S), Paragraph("250 mcg IM q15–90 min\n(max 8 doses = 2 mg)", BODY_S), Paragraph("PG F2α analogue →\npowerful myometrial contraction", BODY_S), Paragraph("Avoid in asthma, cardiovascular disease. Side effects: bronchospasm, diarrhoea, flushing", BODY_S)], [Paragraph("Misoprostol\n(PGE1)", BODY_S), Paragraph("600–1000 mcg sublingual / rectal / intrauterine", BODY_S), Paragraph("PGE1 analogue → uterotonic", BODY_S), Paragraph("Useful when parenterals unavailable. Fever, shivering common side effects", BODY_S)], [Paragraph("Tranexamic\nAcid (TXA)", BODY_S), Paragraph("1 g IV over 10 min\n(repeat after 30 min if needed)\nGive within 3 hours", BODY_S), Paragraph("Antifibrinolytic — inhibits plasminogen activation", BODY_S), Paragraph("Early use (within 3 h) reduces mortality (WOMAN Trial). No thromboembolic excess", BODY_S)], ] story.append(drug_table(d_headers, d_rows)) story.append(sp(4)) story.append(Paragraph("<b>Step 2: Bimanual Uterine Compression</b>", H3_S)) story.append(Paragraph( "One hand in vagina (forming fist in anterior fornix), other hand on abdomen compressing posterior " "wall of uterus between the two hands. Maintains while uterotonics are given.", BODY_S)) story.append(sp(4)) story.append(Paragraph("<b>Step 3: Mechanical / Tamponade Procedures</b>", H3_S)) for p in [ "Uterine packing with sterile gauze — temporary measure", "Intrauterine balloon tamponade (Bakri balloon, Foley catheter) — success rates up to 91%; first-line if abdomen not open", "Uterine compression suture — B-Lynch suture (or Hayman, Cho square sutures) if abdomen is already open", ]: story.append(bullet(p)) story.append(sp(4)) story.append(Paragraph("<b>Step 4: Radiological Intervention</b>", H3_S)) story.append(Paragraph( "Selective <b>uterine artery embolisation (UAE)</b> — indicated when pharmacological and mechanical measures fail, " "in centres with interventional radiology facilities. Preferred over hysterectomy to preserve fertility. " "Bilateral embolisation often required due to pelvic collateral circulation.", BODY_S)) story.append(sp(4)) story.append(Paragraph("<b>Step 5: Surgical Management</b>", H3_S)) for p in [ "Exploratory laparotomy — place patient in semilithotomy for concurrent vaginal examination", "Uterine artery ligation (O'Leary suture) — bilateral", "Hypogastric (internal iliac) artery ligation — no long-term sequelae; women can deliver subsequently", "B-Lynch brace suture — compresses uterine blood supply; fertility preserved", "Peripartum hysterectomy — definitive last resort when all else fails; life-saving", ]: story.append(bullet(p)) story.append(sp(8)) # ── SECTION 7: UTERINE ATONY SPECIFIC ──────────────────────────────────────── story.append(h1_block("7. UTERINE ATONY — SPECIFIC MANAGEMENT")) story.append(sp()) story.append(Paragraph( "Uterine atony is <b>responsible for &gt;50% of PPH cases</b>. Diagnosis is by exclusion of other causes " "and by finding a boggy uterus.", BODY_S)) story.append(sp(4)) story.append(h2_block("Algorithm")) steps = [ ("1", "Vigorous fundal massage + oxytocin 10–30 IU IV in 1L fluid"), ("2", "Bimanual uterine compression"), ("3", "Add ergometrine 0.2 mg IM (if no hypertension)"), ("4", "Add carboprost 250 mcg IM (if no asthma)"), ("5", "Intrauterine balloon tamponade (Bakri/Foley)"), ("6", "UAE (if facility available)"), ("7", "Laparotomy → uterine/hypogastric artery ligation or B-Lynch suture"), ("8", "Peripartum hysterectomy"), ] for num, txt in steps: tbl = Table([[Paragraph(num, KEY_S), Paragraph(txt, BODY_S)]], colWidths=[1.2*cm, 15.8*cm]) tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (0,0), NAVY), ("TEXTCOLOR", (0,0), (0,0), WHITE), ("ALIGN", (0,0), (0,0), "CENTER"), ("VALIGN", (0,0), (-1,-1), "MIDDLE"), ("FONTNAME", (0,0), (0,0), "Helvetica-Bold"), ("FONTSIZE", (0,0), (0,0), 10), ("TOPPADDING", (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4), ("LEFTPADDING", (0,0), (-1,-1), 6), ("BOX", (0,0), (-1,-1), 0.5, MGRAY), ])) story.append(tbl) story.append(sp(2)) story.append(sp(8)) # ── SECTION 8: UTERINE INVERSION ───────────────────────────────────────────── story.append(h1_block("8. UTERINE INVERSION")) story.append(sp()) story.append(Paragraph( "Rare but life-threatening. Uterus turns inside-out, usually from fundal placental implantation.", BODY_S)) story.append(sp(4)) story.append(h2_block("Types")) story.append(bullet("<b>Incomplete</b> — inverted fundus does not extend beyond cervical os")) story.append(bullet("<b>Complete</b> — inverted fundus protrudes beyond cervix (beefy-red mass at introitus)")) story.append(sp(4)) story.append(h2_block("Causes / Predisposing Factors")) story.append(bullet("Fundal placental implantation (present in virtually all reported cases)")) story.append(bullet("Excessive cord traction or vigorous fundal pressure")) story.append(bullet("Fundal pressure during delivery")) story.append(sp(4)) story.append(h2_block("Management")) story.append(bullet("Call anaesthetist immediately — massive haemorrhage and shock common")) story.append(bullet("Do NOT remove placenta first if still attached")) story.append(bullet("Tocolysis: MgSO₄, β-mimetics, or nitroglycerin IV (to relax uterus for reinversion)")) story.append(bullet("Manual reinversion — gentle but firm and persistent pressure on inverted fundus")) story.append(bullet("Uterotonic drugs given AFTER successful reinversion to prevent recurrence")) story.append(sp(8)) # ── SECTION 9: SECONDARY PPH ───────────────────────────────────────────────── story.append(h1_block("9. SECONDARY PPH")) story.append(sp()) story.append(h2_block("Causes (24 h to 12 weeks postpartum)")) for c in [ "Retained placental fragments (most common)", "Subinvolution of placental bed", "Endometritis / puerperal infection", "Hereditary coagulopathy", "Arteriovenous malformation (AVM)", ]: story.append(bullet(c)) story.append(sp(4)) story.append(h2_block("Management")) story.append(bullet("USS pelvis — identify retained products")) story.append(bullet("Broad-spectrum antibiotics if infection suspected")) story.append(bullet("Surgical evacuation of retained products (ERPC) if confirmed")) story.append(bullet("Uterotonics (misoprostol / oxytocin) as adjunct")) story.append(sp(8)) # ── SECTION 10: ABNORMAL PLACENTATION ──────────────────────────────────────── story.append(h1_block("10. ABNORMAL PLACENTATION (Morbidly Adherent Placenta)")) story.append(sp()) story.append(h2_block("Spectrum")) story.append(Paragraph( "Defective decidua basalis → chorionic villi invade myometrium. Incidence has <b>10× in 50 years</b> " "due to rising caesarean section rates.", BODY_S)) story.append(sp(4)) p_headers = [Paragraph(h, KEY_S) for h in ["Type", "Invasion", "Incidence"]] p_rows = [ [Paragraph("Placenta Accreta", BODY_S), Paragraph("Superficial myometrium", BODY_S), Paragraph("84%", BODY_S)], [Paragraph("Placenta Increta", BODY_S), Paragraph("Deep myometrium → serosa", BODY_S), Paragraph("13%", BODY_S)], [Paragraph("Placenta Percreta", BODY_S), Paragraph("Beyond serosa (bladder, bowel)", BODY_S), Paragraph("3%", BODY_S)], ] story.append(drug_table(p_headers, p_rows)) story.append(sp(4)) story.append(h2_block("Key Risk Factors")) story.append(bullet("Previous caesarean section + anterior placenta praevia (<b>most important combination</b>)")) story.append(bullet("Prior uterine surgery, myomectomy, endometrial ablation")) story.append(sp(4)) story.append(h2_block("Antenatal Diagnosis")) story.append(bullet("USS (sensitivity 33–95%) — loss of clear zone, myometrial thinning, lacunae")) story.append(bullet("MRI — useful for posterior placenta and assessing depth of invasion")) story.append(sp(4)) story.append(h2_block("Management")) story.append(bullet("Planned preterm delivery (35–36 weeks) at tertiary centre")) story.append(bullet("Multidisciplinary team: obstetrician, urologist, interventional radiologist")) story.append(bullet("If accreta: attempt manual removal; if fails → hysterectomy")) story.append(bullet("Percreta with bladder invasion: pre-operative ureteric stents; caesarean hysterectomy")) story.append(sp(8)) # ── SECTION 11: BLOOD PRODUCTS ─────────────────────────────────────────────── story.append(h1_block("11. BLOOD TRANSFUSION & MASSIVE TRANSFUSION PROTOCOL")) story.append(sp()) story.append(h2_block("Goals of Resuscitation")) for g in [ "Haemoglobin >8 g/dL", "Platelet count >50 × 10⁹/L", "Fibrinogen >2 g/L (ideally >3 g/L in obstetric haemorrhage)", "PT/APTT <1.5× normal", "Temperature >35°C, pH >7.2, ionised calcium >1.1 mmol/L", ]: story.append(bullet(g)) story.append(sp(4)) story.append(h2_block("Massive Transfusion Protocol (MTP)")) story.append(Paragraph("Ratio-based transfusion: <b>Packed RBC : FFP : Platelets = 1 : 1 : 1</b>", BODY_S)) story.append(bullet("Cryoprecipitate (fibrinogen source) early if fibrinogen <2 g/L")) story.append(bullet("Cell salvage where available (e.g. in caesarean section)")) story.append(bullet("Avoid hypothermia, acidosis, and hypocalcaemia — the 'lethal triad'")) story.append(sp(4)) story.append(warn_box( "Tranexamic acid (TXA) 1 g IV must be given within 3 hours of PPH onset. " "The WOMAN Trial (2017) demonstrated 19% reduction in death from bleeding.")) story.append(sp(8)) # ── SECTION 12: MONITORING & ICU ───────────────────────────────────────────── story.append(h1_block("12. MONITORING & CRITICAL CARE")) story.append(sp()) story.append(bullet("Hourly urine output (target >30 mL/h)")) story.append(bullet("Continuous pulse oximetry and ECG")) story.append(bullet("Consider arterial line for invasive BP monitoring")) story.append(bullet("Central venous pressure (CVP) line for accurate fluid management")) story.append(bullet("Swan-Ganz catheter in extensive haemorrhage — avoids pulmonary oedema")) story.append(bullet("Serial haematological monitoring: FBC, clotting, fibrinogen, lactate")) story.append(sp(8)) # ── SECTION 13: HIGH YIELD POINTS ──────────────────────────────────────────── story.append(h1_block("13. HIGH-YIELD EXAM POINTS")) story.append(sp()) hiy = [ "Most common cause of PPH = <b>Uterine atony (>70%)</b>", "Most common cause of maternal mortality globally = <b>PPH</b>", "First-line uterotonic = <b>Oxytocin</b> (never IV bolus — risk of hypotension)", "Ergometrine is <b>contraindicated</b> in hypertension / pre-eclampsia", "Carboprost is <b>contraindicated</b> in asthma", "Tranexamic acid — give within <b>3 hours</b> (WOMAN Trial proven benefit)", "Bakri balloon success rate = up to <b>91%</b>", "B-Lynch suture — fertility-preserving uterine compression suture", "UAE preferred over hysterectomy to <b>preserve fertility</b>", "Placenta percreta = <b>3%</b> of spectrum; highest morbidity (bladder invasion)", "Risk factors for accreta: prior CS + <b>placenta praevia</b>", "Uterine inversion: do NOT remove placenta first — tocolysis then reinversion", "Secondary PPH: 24 h–12 weeks; commonest cause = retained products", "Active management of 3rd stage reduces PPH by <b>two-thirds</b>", "Oxytocin + early cord clamping + controlled cord traction = <b>AMTSL</b>", ] for i, point in enumerate(hiy, 1): tbl = Table([[Paragraph(str(i), KEY_S), Paragraph(point, BODY_S)]], colWidths=[0.8*cm, 16.2*cm]) tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (0,0), TEAL), ("TEXTCOLOR", (0,0), (0,0), WHITE), ("ALIGN", (0,0), (0,0), "CENTER"), ("VALIGN", (0,0), (-1,-1), "MIDDLE"), ("FONTNAME", (0,0), (0,0), "Helvetica-Bold"), ("TOPPADDING", (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4), ("LEFTPADDING", (1,0), (-1,-1), 8), ("LINEBELOW", (0,0), (-1,-1), 0.3, MGRAY), ])) story.append(tbl) story.append(sp(2)) story.append(sp(8)) # ── SECTION 14: MNEMONIC ───────────────────────────────────────────────────── story.append(h1_block("14. QUICK MNEMONICS")) story.append(sp()) story.append(h2_block("Causes of PPH: 4 Ts")) for t in [("TONE", "Uterine atony (>70%)"), ("TISSUE", "Retained placenta / abnormal placentation"), ("TRAUMA", "Lacerations, rupture, inversion"), ("THROMBIN", "Coagulopathy / DIC")]: tbl = Table([[Paragraph(t[0], KEY_S), Paragraph(t[1], BODY_S)]], colWidths=[3.5*cm, 13.5*cm]) tbl.setStyle(TableStyle([ ("BACKGROUND", (0,0), (0,0), GOLD), ("TEXTCOLOR", (0,0), (0,0), NAVY), ("ALIGN", (0,0), (0,0), "CENTER"), ("VALIGN", (0,0), (-1,-1), "MIDDLE"), ("FONTNAME", (0,0), (0,0), "Helvetica-Bold"), ("FONTSIZE", (0,0), (0,0), 9), ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5), ("LEFTPADDING", (1,0), (-1,-1), 8), ("BOX", (0,0), (-1,-1), 0.5, MGRAY), ])) story.append(tbl) story.append(sp(2)) story.append(sp(4)) story.append(h2_block("Uterotonics: O-E-C-M")) for d in [("O", "xytocin — 1st line"), ("E", "rgometrine — avoid in HTN"), ("C", "arboprost (Hemabate) — avoid in asthma"), ("M", "isoprostol — oral/rectal/SL backup")]: story.append(bullet(f"<b>{d[0]}</b>{d[1]}")) story.append(sp(8)) # ── FOOTER NOTE ─────────────────────────────────────────────────────────────── story.append(HRFlowable(width="100%", thickness=1, color=MGRAY)) story.append(sp(4)) story.append(Paragraph( "Sources: DC Dutta's Textbook of Obstetrics 9e • Creasy & Resnik's Maternal-Fetal Medicine • " "Grainger & Allison's Diagnostic Radiology • Textbook of Family Medicine 9e", NOTE_S)) # ── BUILD ───────────────────────────────────────────────────────────────────── doc.build(story) print("PDF generated successfully:", OUTPUT) PYEOF python3 /home/daytona/workspace/pph-notes/generate_notes.py

ls -lh /home/daytona/workspace/pph-notes/PPH_Notes_DC_Dutta.pdf