📋 Management of Labour - Easy Notes

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, Image, PageBreak, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import ListFlowable, ListItem

PAGE_W, PAGE_H = A4
doc = SimpleDocTemplate(
    "Management_of_Labour_Notes.pdf",
    pagesize=A4,
    leftMargin=1.8*cm, rightMargin=1.8*cm,
    topMargin=2*cm, bottomMargin=2*cm
)

styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle(
    'MainTitle', fontSize=20, fontName='Helvetica-Bold',
    textColor=colors.HexColor('#1a237e'), alignment=TA_CENTER,
    spaceAfter=6, spaceBefore=4
)
subtitle_style = ParagraphStyle(
    'SubTitle', fontSize=11, fontName='Helvetica',
    textColor=colors.HexColor('#3949ab'), alignment=TA_CENTER,
    spaceAfter=12
)
h1_style = ParagraphStyle(
    'H1', fontSize=14, fontName='Helvetica-Bold',
    textColor=colors.white, alignment=TA_LEFT,
    spaceAfter=4, spaceBefore=10,
    backColor=colors.HexColor('#1565c0'),
    leftPadding=8, rightPadding=8, topPadding=5, bottomPadding=5
)
h2_style = ParagraphStyle(
    'H2', fontSize=12, fontName='Helvetica-Bold',
    textColor=colors.white, alignment=TA_LEFT,
    spaceAfter=3, spaceBefore=8,
    backColor=colors.HexColor('#1976d2'),
    leftPadding=6, rightPadding=6, topPadding=4, bottomPadding=4
)
h3_style = ParagraphStyle(
    'H3', fontSize=11, fontName='Helvetica-Bold',
    textColor=colors.HexColor('#0d47a1'), alignment=TA_LEFT,
    spaceAfter=3, spaceBefore=6,
    borderPad=3
)
body_style = ParagraphStyle(
    'Body', fontSize=9.5, fontName='Helvetica',
    textColor=colors.HexColor('#212121'),
    spaceAfter=3, spaceBefore=1, leading=14,
    leftIndent=0
)
bullet_style = ParagraphStyle(
    'Bullet', fontSize=9.5, fontName='Helvetica',
    textColor=colors.HexColor('#212121'),
    spaceAfter=2, spaceBefore=1, leading=13,
    leftIndent=12, bulletIndent=0
)
note_style = ParagraphStyle(
    'Note', fontSize=9, fontName='Helvetica-Oblique',
    textColor=colors.HexColor('#e65100'),
    spaceAfter=4, spaceBefore=4,
    backColor=colors.HexColor('#fff8e1'),
    leftPadding=8, rightPadding=8, topPadding=4, bottomPadding=4,
    borderColor=colors.HexColor('#ffa000'), borderWidth=1, borderPad=4
)
green_h1 = ParagraphStyle(
    'GreenH1', fontSize=14, fontName='Helvetica-Bold',
    textColor=colors.white, alignment=TA_LEFT,
    spaceAfter=4, spaceBefore=10,
    backColor=colors.HexColor('#2e7d32'),
    leftPadding=8, rightPadding=8, topPadding=5, bottomPadding=5
)
orange_h1 = ParagraphStyle(
    'OrangeH1', fontSize=14, fontName='Helvetica-Bold',
    textColor=colors.white, alignment=TA_LEFT,
    spaceAfter=4, spaceBefore=10,
    backColor=colors.HexColor('#e65100'),
    leftPadding=8, rightPadding=8, topPadding=5, bottomPadding=5
)

def bullet(text, indent=12):
    return Paragraph(f"• {text}", bullet_style)

def sub_bullet(text):
    s = ParagraphStyle('subbullet', parent=bullet_style, leftIndent=24)
    return Paragraph(f"– {text}", s)

def h1(text): return Paragraph(text, h1_style)
def h2(text): return Paragraph(text, h2_style)
def h3(text): return Paragraph(text, h3_style)
def body(text): return Paragraph(text, body_style)
def sp(n=6): return Spacer(1, n)
def hr(): return HRFlowable(width="100%", thickness=1, color=colors.HexColor('#bbdefb'), spaceAfter=4, spaceBefore=4)

content = []

# ─── COVER / TITLE ───
content.append(sp(20))
content.append(Paragraph("Management of Labour", title_style))
content.append(Paragraph("Complete Study Notes with Flowchart Poster", subtitle_style))
content.append(HRFlowable(width="100%", thickness=3, color=colors.HexColor('#1565c0'), spaceAfter=10, spaceBefore=2))
content.append(sp(8))

# AIM
content.append(h1("AIM OF MANAGEMENT OF LABOUR"))
content.append(sp(4))
content.append(bullet("Watch carefully with <b>minimum interference</b> in the natural process"))
content.append(bullet("Keep everything <b>normal</b> and catch any problem <b>as early as possible</b>"))
content.append(sp(4))

# INDICATIONS FOR VE
content.append(h1("INDICATIONS FOR VAGINAL EXAMINATION IN NORMAL LABOUR"))
content.append(sp(4))
content.append(body("<b>Keep vaginal exams to a minimum.</b> Do it only when:"))
content.append(sp(3))
content.append(bullet("<b>At onset of labour</b> – To confirm labour has started, find presenting part position"))
content.append(bullet("<b>During progress of labour</b> – Every <b>3–4 hours</b>: check cervical dilation and station"))
content.append(bullet("<b>After rupture of membranes</b> – To rule out cord prolapse"))
content.append(bullet("<b>To confirm 2nd stage</b> – Full dilatation (10 cm)"))
content.append(sp(6))

# 1ST STAGE
content.append(Paragraph("MANAGEMENT OF 1st STAGE OF LABOUR", h1_style))
content.append(sp(4))
content.append(h3("Principles"))
content.append(bullet("<b>Non-interference</b> – watchful expectancy for natural birth"))
content.append(bullet("<b>Monitor carefully</b> – labour progress, maternal (Pulse/BP), fetal (FHR), detect complications early"))
content.append(sp(4))

content.append(h2("PRELIMINARIES (On Admission)"))
content.append(bullet("Basic clinical evaluation of current condition"))
content.append(bullet("Ask about onset of labour pains / any leakage of liquor"))
content.append(bullet("Thorough general + obstetrical exam including vaginal exam – record all findings"))
content.append(bullet("Review antenatal visit records, investigation reports, medicines given"))
content.append(sp(4))

content.append(h2("ACTUAL MANAGEMENT"))
content.append(sp(3))
content.append(h3("A) General Care"))
content.append(bullet("Antiseptic dressing"))
content.append(bullet("Emotional support, encouragement and assurance to the mother"))
content.append(bullet("Constant supervision"))
content.append(sp(3))

content.append(h3("B) Position"))
content.append(bullet("In early normal labour, <b>mother need NOT stay in bed</b>"))
content.append(bullet("If in bed – use the <b>most comfortable position</b>"))
content.append(bullet("<b>Avoid dorsal supine position</b> (compresses major vessels)"))
content.append(sp(3))

content.append(h3("C) Bowel"))
content.append(bullet("<b>Enema is NOT recommended</b>"))
content.append(sp(3))

content.append(h3("D) Ambulation (Walking)"))
content.append(bullet("If membranes are intact → patient is <b>allowed to walk</b>"))
content.append(sp(3))

content.append(h3("E) Diet"))
content.append(bullet("<b>Early labour:</b> Plain water or fruit juice allowed"))
content.append(bullet("<b>Active labour:</b> Food is <b>withheld</b> (in case surgery is needed)"))
content.append(sp(3))

content.append(h3("F) Bladder Care"))
content.append(bullet("Encourage patient to pass urine regularly"))
content.append(bullet("If she cannot pass urine (esp. in late 1st stage) → <b>Catheterization</b>"))
content.append(sp(3))

content.append(h3("G) Pain Relief"))
content.append(bullet("<b>Epidural analgesia</b> recommended if mother asks for it (WHO recommendation)"))
content.append(sp(6))

# MONITORING TABLE
content.append(h2("ASSESSMENT OF PROGRESS & PARTOGRAPH RECORDING"))
content.append(sp(4))

monitor_data = [
    ['Parameter', 'Frequency / Details'],
    ['Pulse', 'Every 30 minutes'],
    ['Blood Pressure (BP)', 'Every 1 hour'],
    ['Temperature', 'Every 2 hours'],
    ['Urine Output', 'Volume, protein, acetone'],
    ['Any drug (e.g. Oxytocin)', 'Record immediately in partograph'],
    ['FHR (Fetal Heart Rate)', '1st stage: every 30 min | 2nd stage: every 15 min'],
]
t = Table(monitor_data, colWidths=[7*cm, 10.5*cm])
t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1565c0')),
    ('TEXTCOLOR', (0,0), (-1,0), colors.white),
    ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE', (0,0), (-1,-1), 9.5),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#e3f2fd'), colors.white]),
    ('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#90caf9')),
    ('PADDING', (0,0), (-1,-1), 6),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
]))
content.append(t)
content.append(sp(6))

content.append(h2("ABDOMINAL PALPATION"))
content.append(bullet("<b>a) Uterine contractions:</b> Frequency, intensity, duration – No. of contractions in 10 min and duration in seconds recorded in partograph"))
content.append(bullet("<b>Labour progress:</b> Cervical dilatation from 5 cm to 10 cm"))
content.append(bullet("<b>b) Pelvic grip:</b> Descent of fetal head in fifths above the brim"))
content.append(bullet("<b>c) Shifting of fetal heart beat:</b> Moves downward and medially = descending fetus"))
content.append(sp(4))

content.append(h2("VAGINAL EXAMINATION FINDINGS"))
content.append(bullet("<b>a)</b> Dilatation of cervix in cm"))
content.append(bullet("<b>b)</b> Position of head and degree of flexion"))
content.append(bullet("<b>c)</b> Station of head in relation to ischial spines"))
content.append(bullet("<b>d)</b> Colour of liquor – clear OR meconium-stained (if membranes ruptured)"))
content.append(bullet("<b>e)</b> Degree of moulding of the head"))
content.append(sp(4))

content.append(h2("SIGNS OF MATERNAL DISTRESS ⚠"))
content.append(Paragraph(
    "Watch for: Anxious look | Pulse ≥ 100/min | Dehydration, dry tongue | Hot dry vagina | "
    "Acetone smell in breath | Scanty high-coloured urine with acetone",
    note_style
))
content.append(sp(8))

# 2ND STAGE
content.append(Paragraph("MANAGEMENT OF 2nd STAGE OF LABOUR", green_h1))
content.append(sp(4))
content.append(h3("Signs of Transition from 1st to 2nd Stage"))
content.append(bullet("Stronger / more intense uterine contractions"))
content.append(bullet("Bearing down efforts (involuntary pushing urge)"))
content.append(bullet("Urge to push or defecate with descent of presenting part"))
content.append(bullet("Complete dilatation of cervix (10 cm) on vaginal exam"))
content.append(sp(4))

content.append(h3("Principles"))
content.append(bullet("Help baby come out <b>slowly and steadily</b>"))
content.append(bullet("<b>Prevent perineal injuries</b>"))
content.append(sp(4))

content.append(h2("GENERAL MEASURES"))
content.append(bullet("Patient <b>must be in bed</b>"))
content.append(bullet("<b>Constant supervision</b> is mandatory; FHR recorded every <b>5 minutes</b>"))
content.append(bullet("Administer <b>inhalation analgesia</b> to relieve pain during contractions"))
content.append(bullet("<b>Vaginal exam at start of 2nd stage</b> – confirm onset, detect cord prolapse, note descent"))
content.append(sp(4))

content.append(h2("PREPARATION FOR DELIVERY"))
content.append(bullet("<b>Position:</b> Lateral, squatting or partial sitting (45°). Dorsal with <b>15° left lateral tilt</b> is commonly used"))
content.append(bullet("Attendant stands on the right side"))
content.append(bullet("Clean (toilet) external genitalia + inner thighs with cotton swabs in Savlon/Dettol"))
content.append(bullet("Place one sterile sheet under buttocks, one over abdomen"))
content.append(bullet("<b>Catheterize bladder</b> if full"))
content.append(sp(6))

content.append(h2("CONDUCTION OF DELIVERY – 3 PHASES"))
content.append(sp(4))

content.append(h3("Phase 1: Delivery of Head"))
content.append(body("<b>Principles:</b> Maintain flexion | Prevent early extension | Regulate slow escape through vulval outlet"))
content.append(sp(3))
content.append(bullet("Encourage mother to <b>bear down during contractions</b>"))
content.append(bullet("When scalp visible ~5 cm → maintain flexion using <b>thumb + index finger of left hand</b> on occiput"))
content.append(bullet("Press perineum with right palm + sterile vulval pad = <b>Ritgen's Manoeuvre</b> (prevents laceration)"))
content.append(bullet("Repeat until sub-occiput is under pubic symphysis → <b>Crowning</b>"))
content.append(bullet("When perineum fully stretched → <b>Episiotomy</b> after <b>10 ml of 1% Lignocaine</b>"))
content.append(bullet("<b>Slow delivery of head between contractions</b>"))
content.append(bullet("Forehead → nose → mouth → chin delivered by <b>extension</b>"))
content.append(sp(4))

content.append(h3("Care Immediately After Delivery of Head"))
content.append(bullet("Wipe <b>mucus and blood</b> from mouth and pharynx with sterile gauze on little finger"))
content.append(bullet("Wipe <b>eyelids</b> with dry sterile cotton swabs – medial to lateral canthus"))
content.append(bullet("Palpate <b>neck for nuchal cord:</b>"))
content.append(sub_bullet("Loose → slip it over the head"))
content.append(sub_bullet("Tight → cut between 2 Kocher's forceps placed 1 inch apart"))
content.append(sp(4))

content.append(h3("Prevention of Perineal Laceration"))
content.append(bullet("Avoid early extension of head"))
content.append(bullet("Avoid forcible/spontaneous rapid delivery"))
content.append(bullet("Deliver head <b>between contractions</b>"))
content.append(bullet("Perform <b>timely episiotomy</b> when indicated"))
content.append(bullet("Take care during delivery of shoulders"))
content.append(sp(4))

content.append(h3("Phase 2: Delivery of Shoulders"))
content.append(bullet("<b>Do NOT rush</b> – wait for next uterine contraction"))
content.append(bullet("Let <b>restitution and external rotation</b> of head occur naturally"))
content.append(bullet("Bisacromial diameter aligns with ant-post diameter of pelvis"))
content.append(bullet("Anterior shoulder born <b>spontaneously</b> with next contraction"))
content.append(bullet("If delayed → grasp head with both hands, draw <b>posteriorly</b> until anterior shoulder released from under pubis"))
content.append(bullet("Draw head <b>upward</b> → posterior shoulder delivered over perineum"))
content.append(sp(4))

content.append(h3("Phase 3: Delivery of Trunk"))
content.append(bullet("Insert <b>forefingers of each hand</b> under the axillae"))
content.append(bullet("Trunk delivered gently by <b>lateral flexion</b>"))
content.append(sp(6))

content.append(h2("IMMEDIATE CARE OF NEWBORN"))
content.append(bullet("Place baby on tray with clean dry linen, <b>head slightly down (15°)</b>"))
content.append(bullet("Tray at <b>lower level than uterus</b> – for gravitational blood flow from placenta to infant"))
content.append(bullet("<b>Clear the airway</b>"))
content.append(bullet("<b>Apgar score</b> at <b>1 minute</b> and <b>5 minutes</b>"))
content.append(sp(4))

content.append(h3("Clamping and Ligature of the Cord"))
content.append(bullet("Clamp with <b>2 Kocher's forceps</b> – nearer one <b>6–10 cm from umbilicus</b>, cut in between"))
content.append(bullet("Check for abnormality in cord vessels"))
content.append(bullet("<b>Delayed clamping:</b> Preterm neonates"))
content.append(bullet("<b>Early clamping:</b> Rh incompatibility, asphyxiated baby"))
content.append(bullet("Quick check for gross abnormalities"))
content.append(bullet("Wrap in <b>dry warm towel</b>"))
content.append(bullet("<b>Identification tape</b> on wrist of baby AND mother"))
content.append(sp(8))

# 3RD STAGE
content.append(Paragraph("MANAGEMENT OF 3rd STAGE OF LABOUR", orange_h1))
content.append(sp(4))
content.append(Paragraph(
    "⚠  MOST CRITICAL STAGE OF LABOUR – Highest risk of PPH (Postpartum Haemorrhage)",
    note_style
))
content.append(sp(4))
content.append(body("<b>Principle:</b> Strict vigilance + follow management guidelines to <b>prevent PPH</b>"))
content.append(sp(4))

content.append(h2("TWO METHODS OF MANAGEMENT"))
content.append(bullet("<b>1. Active Management (AMTSL) – Preferred</b>"))
content.append(bullet("2. Expectant Management"))
content.append(sp(4))

content.append(h3("Active Management of 3rd Stage of Labour (AMTSL)"))
content.append(body("<i>Involves: Separation of placenta → Controlled contraction → Delivery of placenta</i>"))
content.append(sp(3))
content.append(body("<b>Principle:</b> Stimulate powerful uterine contractions within <b>1 minute of baby's delivery</b> by giving <b>parenteral oxytocic drug</b>"))
content.append(sp(4))

amtsl_data = [
    ['AMTSL Steps'],
    ['1. Give oxytocin injection within 1 minute of delivery'],
    ['2. Controlled cord traction (Brandt-Andrews manoeuvre)'],
    ['3. Uterine massage after placental delivery'],
]
t2 = Table(amtsl_data, colWidths=[17.5*cm])
t2.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#e65100')),
    ('TEXTCOLOR', (0,0), (-1,0), colors.white),
    ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE', (0,0), (-1,-1), 9.5),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#fff3e0'), colors.HexColor('#ffe0b2')]),
    ('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#ffb74d')),
    ('PADDING', (0,0), (-1,-1), 7),
]))
content.append(t2)
content.append(sp(6))

content.append(h3("Advantages of AMTSL"))
content.append(bullet("Minimizes <b>blood loss</b> in 3rd stage"))
content.append(bullet("Shortens the <b>duration</b> of 3rd stage"))
content.append(bullet("Reduces <b>maternal anaemia</b>"))
content.append(bullet("Decreases <b>incidence of PPH</b>"))
content.append(sp(8))

# QUICK REVISION BOX
content.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor('#1565c0'), spaceAfter=6))
content.append(h2("⚡ QUICK REVISION – KEY POINTS"))
content.append(sp(4))

key_data = [
    ['Parameter', 'Value / Detail'],
    ['Vaginal exam interval (1st stage)', 'Every 3–4 hours'],
    ['Pulse monitoring', 'Every 30 minutes'],
    ['BP monitoring', 'Every 1 hour'],
    ['Temperature monitoring', 'Every 2 hours'],
    ['FHR – 1st stage', 'Every 30 minutes'],
    ['FHR – 2nd stage', 'Every 15 minutes (or after ROM)'],
    ['FHR – 2nd stage (delivery room)', 'Every 5 minutes'],
    ['Cord clamping distance', '6–10 cm from umbilicus'],
    ['Episiotomy anaesthesia', '10 ml of 1% Lignocaine'],
    ['Oxytocin timing (AMTSL)', 'Within 1 minute of baby delivery'],
    ['Apgar score timing', '1 minute and 5 minutes after birth'],
    ['Position in 2nd stage', 'Dorsal with 15° left lateral tilt'],
]
t3 = Table(key_data, colWidths=[9*cm, 8.5*cm])
t3.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#283593')),
    ('TEXTCOLOR', (0,0), (-1,0), colors.white),
    ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE', (0,0), (-1,-1), 9),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#e8eaf6'), colors.white]),
    ('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#9fa8da')),
    ('PADDING', (0,0), (-1,-1), 6),
    ('FONTNAME', (0,1), (0,-1), 'Helvetica-Bold'),
]))
content.append(t3)
content.append(sp(8))

# FLOWCHART PAGE
content.append(PageBreak())
content.append(Paragraph("VISUAL FLOWCHART: 3 Stages of Labour", title_style))
content.append(HRFlowable(width="100%", thickness=3, color=colors.HexColor('#1565c0'), spaceAfter=16, spaceBefore=4))

# Insert image
from PIL import Image as PILImage
img_path = "flowchart.png"
pil_img = PILImage.open(img_path)
iw, ih = pil_img.size
available_w = PAGE_W - 3.6*cm
available_h = PAGE_H - 8*cm
ratio = min(available_w / iw, available_h / ih)
draw_w = iw * ratio
draw_h = ih * ratio
img = Image(img_path, width=draw_w, height=draw_h)
img.hAlign = 'CENTER'
content.append(img)

doc.build(content)
print("PDF created successfully!")