"""
Clinical Decision Flowchart: Induction of Labour - Timing by Indication
Multi-page A4 PDF using ReportLab
"""

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_RIGHT
from reportlab.graphics.shapes import (
    Drawing, Rect, String, Line, Polygon, Arrow,
    Group, Circle
)
from reportlab.graphics import renderPDF
from reportlab.platypus import Flowable
import os

OUTPUT = "/tmp/workspace/iol-flowchart/IOL_Clinical_Decision_Flowchart.pdf"

# ─── Colour palette ────────────────────────────────────────────────────────
C_HEADER_BG  = colors.HexColor("#1A3557")   # deep navy
C_HEADER_TXT = colors.white
C_SECTION_A  = colors.HexColor("#2166AC")   # blue  – hypertension
C_SECTION_B  = colors.HexColor("#D6604D")   # red   – urgent/severe
C_SECTION_C  = colors.HexColor("#4DAC26")   # green – diabetes
C_SECTION_D  = colors.HexColor("#7B3294")   # purple – PROM
C_SECTION_E  = colors.HexColor("#E08214")   # orange – FGR
C_SECTION_F  = colors.HexColor("#35978F")   # teal  – other
C_DECISION   = colors.HexColor("#FFF3B0")   # pale yellow – decision nodes
C_ACTION_GR  = colors.HexColor("#D4EDDA")   # pale green  – safe/deliver
C_ACTION_OR  = colors.HexColor("#FFF3CD")   # pale amber  – monitor
C_ACTION_RD  = colors.HexColor("#F8D7DA")   # pale red    – urgent
C_RULE       = colors.HexColor("#AAAAAA")
C_BODY_BG    = colors.HexColor("#F7F9FC")
C_ALT_ROW    = colors.HexColor("#EBF2FA")
C_BORDER     = colors.HexColor("#CCDDEE")

# ─── Document setup ─────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=1.5*cm, rightMargin=1.5*cm,
    topMargin=1.8*cm,  bottomMargin=1.8*cm,
    title="IOL Clinical Decision Flowchart",
    author="Orris Medical Reference",
    subject="Induction of Labour – Timing by Indication"
)

W, H = A4
USABLE_W = W - 3*cm

styles = getSampleStyleSheet()

def S(name, **kw):
    """Create a paragraph style."""
    base = styles.get(name, styles["Normal"])
    return ParagraphStyle(name + str(id(kw)), parent=base, **kw)

title_style   = S("Normal", fontSize=18, leading=22, textColor=C_HEADER_TXT,
                  alignment=TA_CENTER, fontName="Helvetica-Bold")
sub_style     = S("Normal", fontSize=10, leading=13, textColor=C_HEADER_TXT,
                  alignment=TA_CENTER, fontName="Helvetica")
h1_style      = S("Normal", fontSize=13, leading=16, textColor=C_HEADER_TXT,
                  alignment=TA_LEFT, fontName="Helvetica-Bold", spaceBefore=4)
h2_style      = S("Normal", fontSize=11, leading=14, textColor=colors.white,
                  alignment=TA_LEFT, fontName="Helvetica-Bold")
body_style    = S("Normal", fontSize=9, leading=12, textColor=colors.HexColor("#1a1a1a"),
                  alignment=TA_LEFT, fontName="Helvetica")
small_style   = S("Normal", fontSize=7.5, leading=10, textColor=colors.HexColor("#444444"),
                  alignment=TA_LEFT, fontName="Helvetica")
bold_style    = S("Normal", fontSize=9, leading=12, textColor=colors.HexColor("#1a1a1a"),
                  alignment=TA_LEFT, fontName="Helvetica-Bold")
center_style  = S("Normal", fontSize=9, leading=12, textColor=colors.HexColor("#1a1a1a"),
                  alignment=TA_CENTER, fontName="Helvetica")
warn_style    = S("Normal", fontSize=8, leading=11, textColor=colors.HexColor("#7B0000"),
                  alignment=TA_LEFT, fontName="Helvetica-Bold")
note_style    = S("Normal", fontSize=8, leading=11, textColor=colors.HexColor("#333333"),
                  alignment=TA_LEFT, fontName="Helvetica-Oblique")
footer_style  = S("Normal", fontSize=7, leading=9, textColor=colors.HexColor("#888888"),
                  alignment=TA_CENTER, fontName="Helvetica")

# ─── Helper: section header banner ──────────────────────────────────────────
def section_banner(text, bg_color, text_color=colors.white, number=None):
    label = f"<b>{number}  {text}</b>" if number else f"<b>{text}</b>"
    data = [[Paragraph(label, S("Normal", fontSize=11, leading=14,
                                textColor=text_color, fontName="Helvetica-Bold"))]]
    t = Table(data, colWidths=[USABLE_W])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg_color),
        ("LEFTPADDING",  (0,0), (-1,-1), 10),
        ("RIGHTPADDING", (0,0), (-1,-1), 10),
        ("TOPPADDING",   (0,0), (-1,-1), 6),
        ("BOTTOMPADDING",(0,0), (-1,-1), 6),
        ("ROUNDEDCORNERS", [4]),
    ]))
    return t

# ─── Helper: decision table (condition → timing → action → notes) ────────────
def decision_table(rows, col_widths=None, header=True):
    """
    rows: list of (condition, timing, action_text, action_color, note)
    """
    if col_widths is None:
        col_widths = [USABLE_W*0.30, USABLE_W*0.20, USABLE_W*0.22, USABLE_W*0.28]

    hdr = [
        Paragraph("<b>Clinical Scenario</b>", bold_style),
        Paragraph("<b>Deliver by / at</b>", bold_style),
        Paragraph("<b>Action</b>", bold_style),
        Paragraph("<b>Key Notes</b>", bold_style),
    ]
    table_data = [hdr]

    for i, (cond, timing, action, acolor, note) in enumerate(rows):
        row = [
            Paragraph(cond, body_style),
            Paragraph(f"<b>{timing}</b>", S("Normal", fontSize=9, leading=12,
                                            textColor=colors.HexColor("#1a1a1a"),
                                            alignment=TA_CENTER, fontName="Helvetica-Bold")),
            Paragraph(action, S("Normal", fontSize=8.5, leading=11,
                                textColor=colors.HexColor("#1a1a1a"),
                                alignment=TA_CENTER, fontName="Helvetica-Bold")),
            Paragraph(note, small_style),
        ]
        table_data.append(row)

    t = Table(table_data, colWidths=col_widths, repeatRows=1)

    style_cmds = [
        ("BACKGROUND",    (0,0), (-1,0),  C_HEADER_BG),
        ("TEXTCOLOR",     (0,0), (-1,0),  colors.white),
        ("GRID",          (0,0), (-1,-1), 0.4, C_BORDER),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_BODY_BG, C_ALT_ROW]),
        ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("RIGHTPADDING",  (0,0), (-1,-1), 6),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,0),  9),
    ]
    # Colour the action column cells individually
    for i, (_, _, _, acolor, _) in enumerate(rows, start=1):
        style_cmds.append(("BACKGROUND", (2,i), (2,i), acolor))

    t.setStyle(TableStyle(style_cmds))
    return t

# ─── Helper: flowchart node drawing ─────────────────────────────────────────
class FlowNode(Flowable):
    """A simple diamond or rectangle node for flowchart."""
    def __init__(self, text, width, height, shape="rect",
                 fill=C_DECISION, border=C_RULE, fontsize=9):
        Flowable.__init__(self)
        self.text = text
        self.width = width
        self.height = height
        self.shape = shape
        self.fill = fill
        self.border = border
        self.fontsize = fontsize

    def draw(self):
        c = self.canv
        w, h = self.width, self.height
        c.saveState()
        c.setFillColor(self.fill)
        c.setStrokeColor(self.border)
        c.setLineWidth(1.2)
        if self.shape == "diamond":
            path = c.beginPath()
            path.moveTo(w/2, h); path.lineTo(w, h/2)
            path.lineTo(w/2, 0); path.lineTo(0, h/2)
            path.close()
            c.drawPath(path, fill=1, stroke=1)
        else:
            c.roundRect(0, 0, w, h, 6, fill=1, stroke=1)
        c.setFont("Helvetica-Bold", self.fontsize)
        c.setFillColor(colors.HexColor("#1a1a1a"))
        # word wrap roughly
        words = self.text.split()
        lines, line = [], []
        for w_ in words:
            if len(" ".join(line + [w_])) * self.fontsize * 0.55 < self.width - 10:
                line.append(w_)
            else:
                if line: lines.append(" ".join(line))
                line = [w_]
        if line: lines.append(" ".join(line))
        total_h = len(lines) * (self.fontsize + 2)
        y_start = (h + total_h) / 2 - self.fontsize
        for i, l in enumerate(lines):
            c.drawCentredString(self.width/2, y_start - i*(self.fontsize+2), l)
        c.restoreState()

    def wrap(self, aw, ah):
        return self.width, self.height

# ─── Build the main flowchart drawing (page 2) ──────────────────────────────
def build_algorithm_drawing():
    """Draw the main decision algorithm as a ReportLab Drawing."""
    dw, dh = USABLE_W, 19*cm
    d = Drawing(dw, dh)
    
    NW = USABLE_W - 10   # node width
    NH = 1.1*cm          # normal node height
    DH = 1.4*cm          # diamond height
    cx = dw / 2          # centre x
    fs = 8               # font size for nodes

    def rect_node(x, y, w, h, text, fill, border=C_RULE, fontsize=8):
        d.add(Rect(x, y, w, h, rx=5, ry=5,
                   fillColor=fill, strokeColor=border, strokeWidth=1.2))
        # simple centred text
        d.add(String(x + w/2, y + h/2 - fontsize/2 + 1, text,
                     fontSize=fontsize, fontName="Helvetica-Bold",
                     fillColor=colors.HexColor("#1a1a1a"),
                     textAnchor="middle"))

    def arrow(x1, y1, x2, y2):
        d.add(Line(x1, y1, x2, y2, strokeColor=C_RULE, strokeWidth=1.0))
        # arrowhead
        d.add(Polygon([x2, y2, x2-4, y2+7, x2+4, y2+7],
                      fillColor=C_RULE, strokeColor=C_RULE, strokeWidth=0.5))

    y = dh - 0.5*cm

    # ── START ──
    y -= NH
    rect_node(cx - NW/2, y, NW, NH,
              "PATIENT REQUIRES DELIVERY DECISION", C_HEADER_BG, C_HEADER_BG, fontsize=9)
    arrow(cx, y, cx, y - 0.4*cm); y -= 0.4*cm

    # ── Diamond: Contraindications? ──
    y -= DH
    d.add(Rect(cx - NW/2, y, NW, DH, rx=5, ry=5,
               fillColor=C_DECISION, strokeColor=colors.HexColor("#CC8800"), strokeWidth=1.5))
    d.add(String(cx, y + DH/2 - 4, "Any ABSOLUTE CONTRAINDICATION to IOL?",
                 fontSize=8, fontName="Helvetica-Bold",
                 fillColor=colors.HexColor("#7B3800"), textAnchor="middle"))
    d.add(String(cx, y + DH/2 - 14, "(Placenta praevia | Prior classical CS | Cord prolapse | Transverse lie)",
                 fontSize=7, fontName="Helvetica",
                 fillColor=colors.HexColor("#555555"), textAnchor="middle"))

    # YES branch right
    y_ci = y + DH/2
    d.add(Line(cx + NW/2, y_ci, cx + NW/2 + 1.5*cm, y_ci,
               strokeColor=C_SECTION_B, strokeWidth=1.2))
    d.add(String(cx + NW/2 + 0.2*cm, y_ci + 2, "YES", fontSize=7,
                 fontName="Helvetica-Bold", fillColor=C_SECTION_B))
    rw = 2.5*cm; rh = 0.9*cm
    rx = cx + NW/2 + 1.5*cm - rw/2
    d.add(Rect(rx, y_ci - rh/2, rw, rh, rx=4, ry=4,
               fillColor=C_ACTION_RD, strokeColor=C_SECTION_B, strokeWidth=1))
    d.add(String(rx + rw/2, y_ci - 4, "CAESAREAN SECTION",
                 fontSize=7.5, fontName="Helvetica-Bold",
                 fillColor=C_SECTION_B, textAnchor="middle"))

    # NO arrow down
    arrow(cx, y, cx, y - 0.35*cm)
    d.add(String(cx + 4, y - 0.15*cm, "NO", fontSize=7,
                 fontName="Helvetica-Bold", fillColor=colors.HexColor("#1a7a1a")))
    y -= 0.35*cm

    # ── Diamond: Indication? ──
    y -= DH*1.1
    d.add(Rect(cx - NW/2, y, NW, DH*1.1, rx=5, ry=5,
               fillColor=C_DECISION, strokeColor=C_RULE, strokeWidth=1.2))
    d.add(String(cx, y + DH*1.1/2, "IDENTIFY PRIMARY INDICATION",
                 fontSize=9, fontName="Helvetica-Bold",
                 fillColor=colors.HexColor("#1A3557"), textAnchor="middle"))

    arrow(cx, y, cx, y - 0.4*cm); y -= 0.4*cm

    # ── Branch row: 4 categories ──
    cats = [
        ("HYPERTENSIVE\nDISORDER", C_SECTION_A),
        ("DIABETES /\nMACROSOMIA", C_SECTION_C),
        ("PROM / PPROM", C_SECTION_D),
        ("FGR / IUGR", C_SECTION_E),
    ]
    cat_w = NW / 4 - 4
    cat_h = 1.3*cm
    y -= cat_h + 0.3*cm
    cat_x_start = cx - NW/2
    cat_ys = []
    for i, (label, col) in enumerate(cats):
        bx = cat_x_start + i*(cat_w + 4) + 2
        d.add(Rect(bx, y, cat_w, cat_h, rx=4, ry=4,
                   fillColor=col, strokeColor=col, strokeWidth=0))
        lines = label.split("\n")
        for j, l in enumerate(lines):
            d.add(String(bx + cat_w/2, y + cat_h/2 + (len(lines)-1-j)*9 - 4,
                         l, fontSize=7.5, fontName="Helvetica-Bold",
                         fillColor=colors.white, textAnchor="middle"))
        cat_ys.append((bx + cat_w/2, y))

    # arrows from decision to categories
    for bx_mid, by in cat_ys:
        d.add(Line(cx, y + cat_h + 0.4*cm, bx_mid, by + cat_h,
                   strokeColor=C_RULE, strokeWidth=0.8))

    arrow(cx, y + cat_h + 0.4*cm + 0.3*cm, cx, y + cat_h + 0.4*cm)

    y -= 0.3*cm

    # ── Sub-decision boxes per category ──
    sub_font = 6.5
    sub_h = 2.8*cm
    y -= sub_h + 0.2*cm

    sub_data = [
        # HYPERTENSION
        ("≥37 wks → Deliver\n34-37 wks → Consider\n  planned delivery\n<34 wks → Expectant\n  (if stable)\nSevere/HELLP → ANY\n  gestation: DELIVER",
         C_SECTION_A),
        # DIABETES
        ("Diet-controlled GDM\n→ 40-41 wks\nInsulin GDM / T1/T2\n→ 38-39 wks\nPoor control /\n  vascular Dz\n→ 36-37 wks",
         C_SECTION_C),
        # PROM
        ("PROM ≥37 wks\n→ Induce <24 hrs\nPPROM 34-36+6\n→ Deliver\nPPROM 32-34 wks\n→ Individualise\nPPROM <32 wks\n→ Expectant",
         C_SECTION_D),
        # FGR
        ("Normal Dopplers\n→ 37 wks\nAbnormal UA (no ED)\n→ 37 wks, monitor\nAbsent ED flow\n→ 34 wks\nReversed ED flow\n→ ≥30 wks: DELIVER",
         C_SECTION_E),
    ]

    for i, ((text, col), (bx_mid, _)) in enumerate(zip(sub_data, cat_ys)):
        bx = bx_mid - cat_w/2
        d.add(Rect(bx, y, cat_w, sub_h, rx=4, ry=4,
                   fillColor=colors.HexColor("#F0F6FF"),
                   strokeColor=col, strokeWidth=1.5))
        lines = text.split("\n")
        for j, l in enumerate(lines):
            d.add(String(bx + 4, y + sub_h - 12 - j*9.5, l,
                         fontSize=sub_font, fontName="Helvetica",
                         fillColor=colors.HexColor("#1a1a1a")))
        # arrow from category box
        d.add(Line(bx_mid, y + sub_h, bx_mid, y + sub_h + 0.3*cm,
                   strokeColor=col, strokeWidth=1))
        d.add(Polygon([bx_mid, y+sub_h, bx_mid-3, y+sub_h+5, bx_mid+3, y+sub_h+5],
                      fillColor=col, strokeColor=col, strokeWidth=0.5))

    y -= 0.6*cm

    # ── "Other indications" banner ──
    arrow(cx, y + 0.6*cm, cx, y + 0.15*cm)
    y -= 0.9*cm
    d.add(Rect(cx - NW/2, y, NW, 0.85*cm, rx=4, ry=4,
               fillColor=C_SECTION_F, strokeColor=C_SECTION_F, strokeWidth=0))
    others = "OTHER: Postterm ≥41+0 wks  |  Cholestasis: 37 wks (mild) / 35 wks (severe)  |  Twins (DCDA 38w, MCDA 36w, MCMA 32-34w)  |  IUFD: any gestation"
    d.add(String(cx, y + 0.3*cm, others,
                 fontSize=6.8, fontName="Helvetica-Bold",
                 fillColor=colors.white, textAnchor="middle"))

    y -= 0.55*cm
    arrow(cx, y + 0.55*cm, cx, y + 0.1*cm)

    # ── Bishop Score Assessment ──
    y -= NH*1.1
    d.add(Rect(cx - NW/2, y, NW, NH*1.1, rx=5, ry=5,
               fillColor=colors.HexColor("#FFF9E6"),
               strokeColor=colors.HexColor("#CC8800"), strokeWidth=1.5))
    d.add(String(cx, y + NH*1.1/2 + 2,
                 "ASSESS CERVIX  →  Calculate Bishop Score",
                 fontSize=9, fontName="Helvetica-Bold",
                 fillColor=colors.HexColor("#7B4800"), textAnchor="middle"))
    d.add(String(cx, y + NH*1.1/2 - 9,
                 "(Dilation · Effacement · Station · Consistency · Position)",
                 fontSize=7, fontName="Helvetica",
                 fillColor=colors.HexColor("#555555"), textAnchor="middle"))

    arrow(cx, y, cx, y - 0.35*cm); y -= 0.35*cm

    # ── Two branches: favourable vs unfavourable ──
    bscore_y = y
    bh = 1.2*cm; bw = NW/2 - 8
    # Favourable ≥6 (left)
    d.add(Line(cx, bscore_y, cx - bw/2 - 4, bscore_y - 0.3*cm,
               strokeColor=C_RULE, strokeWidth=0.8))
    d.add(Rect(cx - bw - 8, bscore_y - 0.3*cm - bh, bw, bh, rx=4, ry=4,
               fillColor=C_ACTION_GR, strokeColor=colors.HexColor("#218c33"), strokeWidth=1.2))
    d.add(String(cx - bw/2 - 8, bscore_y - 0.3*cm - bh/2 + 2,
                 "Bishop ≥6 (FAVOURABLE)",
                 fontSize=7.5, fontName="Helvetica-Bold",
                 fillColor=colors.HexColor("#155724"), textAnchor="middle"))
    d.add(String(cx - bw/2 - 8, bscore_y - 0.3*cm - bh/2 - 6,
                 "Amniotomy + Oxytocin",
                 fontSize=7, fontName="Helvetica",
                 fillColor=colors.HexColor("#155724"), textAnchor="middle"))

    # Unfavourable <6 (right)
    d.add(Line(cx, bscore_y, cx + bw/2 + 4, bscore_y - 0.3*cm,
               strokeColor=C_RULE, strokeWidth=0.8))
    d.add(Rect(cx + 8, bscore_y - 0.3*cm - bh, bw, bh, rx=4, ry=4,
               fillColor=C_ACTION_OR, strokeColor=colors.HexColor("#856404"), strokeWidth=1.2))
    d.add(String(cx + bw/2 + 8, bscore_y - 0.3*cm - bh/2 + 2,
                 "Bishop <6 (UNFAVOURABLE)",
                 fontSize=7.5, fontName="Helvetica-Bold",
                 fillColor=colors.HexColor("#533f03"), textAnchor="middle"))
    d.add(String(cx + bw/2 + 8, bscore_y - 0.3*cm - bh/2 - 6,
                 "Cervical ripening first",
                 fontSize=7, fontName="Helvetica",
                 fillColor=colors.HexColor("#533f03"), textAnchor="middle"))

    y = bscore_y - 0.3*cm - bh - 0.5*cm
    arrow(cx, y + 0.5*cm, cx, y + 0.15*cm)

    # ── Final action bar ──
    y -= 0.9*cm
    d.add(Rect(cx - NW/2, y, NW, 0.85*cm, rx=4, ry=4,
               fillColor=C_HEADER_BG, strokeColor=C_HEADER_BG, strokeWidth=0))
    d.add(String(cx, y + 0.3*cm,
                 "PROCEED WITH INDUCTION  ·  Continuous CTG  ·  IV access  ·  Analgesia plan  ·  Obstetric review",
                 fontSize=7.5, fontName="Helvetica-Bold",
                 fillColor=colors.white, textAnchor="middle"))

    return d


# ─── Assemble PDF story ──────────────────────────────────────────────────────
story = []

# ── PAGE 1: Cover header + Reference tables ──────────────────────────────────

# Header block
header_data = [[
    Paragraph("INDUCTION OF LABOUR", title_style),
    Paragraph("Clinical Decision Guide: Timing by Indication", sub_style),
    Paragraph("Based on Creasy &amp; Resnik's MFM · ACOG/SMFM Guidelines · HYPITAT Trial · ARRIVE Trial",
              S("Normal", fontSize=8, textColor=colors.HexColor("#AACCEE"),
                alignment=TA_CENTER, fontName="Helvetica-Oblique")),
]]
header_table = Table([[p] for p in header_data[0]], colWidths=[USABLE_W])
header_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), C_HEADER_BG),
    ("LEFTPADDING",  (0,0), (-1,-1), 12),
    ("RIGHTPADDING", (0,0), (-1,-1), 12),
    ("TOPPADDING",   (0,0), (-1,-1), 10),
    ("BOTTOMPADDING",(0,0), (-1,-1), 10),
    ("ROUNDEDCORNERS", [6]),
]))
story.append(header_table)
story.append(Spacer(1, 0.4*cm))

# ── SECTION 1: Hypertensive Disorders ────────────────────────────────────────
story.append(section_banner("HYPERTENSIVE DISORDERS OF PREGNANCY", C_SECTION_A, number="1"))
story.append(Spacer(1, 2*mm))

htn_rows = [
    ("Pre-eclampsia ≥37+0 wks",
     "≥ 37+0 wks",
     "DELIVER",
     C_ACTION_RD,
     "HYPITAT: maternal risk ↓ significantly after 37 wks. Induction or CS depending on cervix/fetal presentation."),
    ("Pre-eclampsia 34+0 – 36+6 wks",
     "34–37 wks\n(consider)",
     "PLAN DELIVERY",
     C_ACTION_OR,
     "Planned delivery ↓ severe HTN & maternal morbidity. ~75% progress to severe PE expectantly. Weigh prematurity risk. Shared decision-making."),
    ("Severe features / HELLP\n(any gestation)",
     "URGENT\n(any gestation)",
     "DELIVER\nURGENTLY",
     C_ACTION_RD,
     "After maternal stabilisation (MgSO₄, antihypertensives). Steroids if <34 wks and clinically safe to wait 24-48 hrs. If <24 wks: discuss prognosis."),
    ("Pre-eclampsia 24–33+6 wks\n(stable, no severe features)",
     "Expectant\nthen 34 wks",
     "EXPECTANT\nMONITOR",
     C_ACTION_OR,
     "Deliver if: deteriorating organ function, uncontrolled BP, non-reassuring fetal testing, abruption. Antenatal corticosteroids + MgSO₄ neuroprotection."),
    ("Pre-eclampsia <24 wks",
     "< 24 wks",
     "COUNSEL /\nTERMINATE",
     C_ACTION_RD,
     "Perinatal mortality >80% even with prolongation. Maternal complications common. Termination usually recommended."),
    ("Chronic hypertension\n(on antihypertensives, uncomplicated)",
     "38+0 – 38+6 wks",
     "ELECTIVE IOL",
     C_ACTION_GR,
     "Optimal: 38+0–38+6 (lowest perinatal morbidity). Delivery <36 wks ↑ perinatal risk. Delivery >39 wks ↑ superimposed PE risk."),
    ("Gestational hypertension ≥37 wks",
     "≥ 37+0 wks",
     "DELIVER",
     C_ACTION_RD,
     "Similar to pre-eclampsia guidance; aim not to exceed 41 wks."),
]
story.append(decision_table(htn_rows))
story.append(Spacer(1, 0.4*cm))

# ── SECTION 2: Diabetes ───────────────────────────────────────────────────────
story.append(section_banner("DIABETES IN PREGNANCY", C_SECTION_C, number="2"))
story.append(Spacer(1, 2*mm))

dm_rows = [
    ("GDM – diet controlled, well managed",
     "40+0 – 41+0 wks",
     "ELECTIVE IOL",
     C_ACTION_GR,
     "Low additional risk. Can await spontaneous labour but do not allow postterm. Fetal surveillance from 40 wks."),
    ("GDM – insulin or metformin,\nwell controlled",
     "38+0 – 39+0 wks",
     "ELECTIVE IOL",
     C_ACTION_GR,
     "Standard ACOG/SMFM recommendation. Reduces unexplained stillbirth risk that rises steeply after 38–39 wks."),
    ("Pre-gestational diabetes (T1/T2),\nwell controlled, no complications",
     "38+0 – 39+0 wks",
     "ELECTIVE IOL",
     C_ACTION_GR,
     "HbA1c target maintained. Assess for macrosomia (USS). Consider CS if EFW >4.5 kg."),
    ("Pre-gestational diabetes,\npoorly controlled / vascular disease",
     "36+0 – 37+6 wks",
     "EARLIER IOL",
     C_ACTION_OR,
     "Autonomic neuropathy, nephropathy, retinopathy, or suboptimal glycaemic control → earlier delivery. Individualize."),
    ("Any diabetic + macrosomia /\noligohydramnios / deteriorating tests",
     "Promptly",
     "DELIVER",
     C_ACTION_RD,
     "EFW >4.5 kg: discuss elective CS. Oligohydramnios or BPP decline → immediate delivery."),
]
story.append(decision_table(dm_rows))
story.append(Spacer(1, 0.4*cm))

# ── SECTION 3: PROM / PPROM ───────────────────────────────────────────────────
story.append(section_banner("PRELABOUR RUPTURE OF MEMBRANES (PROM / PPROM)", C_SECTION_D, number="3"))
story.append(Spacer(1, 2*mm))

prom_rows = [
    ("PROM at term ≥37+0 wks",
     "Within 12–24 hrs",
     "INDUCE",
     C_ACTION_RD,
     "Reduces chorioamnionitis & neonatal infection. Oxytocin first-line. GBS status: give prophylaxis if positive."),
    ("PPROM 34+0 – 36+6 wks\n(late preterm)",
     "34–36+6 wks:\nDeliver",
     "DELIVER",
     C_ACTION_RD,
     "Lung maturity generally sufficient; ongoing infection risk outweighs prematurity. Steroids may be considered."),
    ("PPROM 32+0 – 33+6 wks",
     "Individualise\n(32–34 wks)",
     "INDIVIDUALISE",
     C_ACTION_OR,
     "Corticosteroids. Deliver if: pulmonary maturity confirmed, infection, abruption, fetal compromise. Otherwise expectant."),
    ("PPROM 24+0 – 31+6 wks",
     "Expectant until\n≥34 wks",
     "EXPECTANT\nMONITOR",
     C_ACTION_OR,
     "IV antibiotics (latency – erythromycin). Antenatal corticosteroids + MgSO₄ (neuroprotection <32 wks). Daily fetal surveillance. Deliver on deterioration."),
    ("PPROM previable <24 wks",
     "< 24 wks",
     "COUNSEL",
     C_ACTION_RD,
     "Survival extremely poor (<50% even in tertiary centres). Offer expectant management or termination after detailed counselling. Pulmonary hypoplasia risk ~25%."),
    ("PROM + chorioamnionitis\n(any gestation)",
     "URGENT",
     "DELIVER\nPROMPTLY",
     C_ACTION_RD,
     "IV broad-spectrum antibiotics immediately. Deliver by most expedient route. Ongoing fetal monitoring."),
]
story.append(decision_table(prom_rows))

# ── PAGE BREAK ────────────────────────────────────────────────────────────────
from reportlab.platypus import PageBreak
story.append(PageBreak())

# Header repeat on page 2
story.append(header_table)
story.append(Spacer(1, 0.4*cm))

# ── SECTION 4: FGR / IUGR ────────────────────────────────────────────────────
story.append(section_banner("FETAL GROWTH RESTRICTION (FGR / IUGR)", C_SECTION_E, number="4"))
story.append(Spacer(1, 2*mm))

fgr_rows = [
    ("FGR, normal umbilical artery Dopplers",
     "37+0 wks",
     "ELECTIVE IOL",
     C_ACTION_GR,
     "Serial growth scans every 2–3 weeks. Twice-weekly antenatal testing from 36 wks. Deliver once term."),
    ("FGR, abnormal UA (↑ PI)\nbut end-diastolic flow present",
     "37+0 wks",
     "ELECTIVE IOL",
     C_ACTION_GR,
     "Intensify surveillance (twice weekly BPP/NST). Deliver at 37 wks or earlier if fetal status deteriorates."),
    ("FGR, absent end-diastolic flow\n(AEDF) in UA",
     "34+0 wks",
     "DELIVER",
     C_ACTION_OR,
     "Inpatient surveillance. Daily testing from 25 wks. Deliver at 34 wks. Earlier if BPP <4 or DV abnormal."),
    ("FGR, reversed end-diastolic flow\n(REDF) in UA, 25–30 wks",
     "Individualise\n≥28–30 wks",
     "DELIVER\n(CONSIDER)",
     C_ACTION_OR,
     "DV reversed a-wave or BPP ≤4 → deliver immediately regardless of gestation. Weigh extreme prematurity risks."),
    ("FGR, reversed UA flow >30 wks",
     "≥ 30+0 wks",
     "DELIVER",
     C_ACTION_RD,
     "Reversed UA flow after 30 wks = indication for delivery. Maximise corticosteroids before delivery if feasible."),
    ("FGR + abnormal MCA-PSV\n(>1.5 MoM – consider isoimmunisation)",
     "34–37 wks",
     "INDIVIDUALIS\nE",
     C_ACTION_OR,
     "Evaluate for anaemia. Cordocentesis ± IUT if before 34 wks. Deliver at 34–37 wks depending on response."),
]
story.append(decision_table(fgr_rows))
story.append(Spacer(1, 0.4*cm))

# ── SECTION 5: Other Indications ────────────────────────────────────────────
story.append(section_banner("OTHER COMMON INDICATIONS", C_SECTION_F, number="5"))
story.append(Spacer(1, 2*mm))

other_rows = [
    ("POSTTERM pregnancy\n(≥41+0 wks)",
     "41+0 – 42+0 wks\n(by 42+6 at latest)",
     "INDUCE",
     C_ACTION_RD,
     "Risk of stillbirth, meconium aspiration, macrosomia increases. NNT 527 at 41 wks vs 195 at 43 wks to prevent 1 death. Foetal surveillance from 41 wks."),
    ("Intrahepatic cholestasis –\nMild (bile acids <40 µmol/L)",
     "37+0 – 38+0 wks",
     "ELECTIVE IOL",
     C_ACTION_GR,
     "Unexplained stillbirth risk. UDCA may reduce pruritus but does not eliminate fetal risk. Do not allow postterm."),
    ("Intrahepatic cholestasis –\nSevere (bile acids ≥40 µmol/L)",
     "35+0 – 37+0 wks",
     "EARLIER IOL",
     C_ACTION_OR,
     "Bile acids ≥100 µmol/L: consider delivery at 35 wks. Prior IUFD history: deliver even earlier."),
    ("Dichorionic diamniotic (DCDA) twins\nuncomplicated",
     "38+0 wks",
     "ELECTIVE IOL",
     C_ACTION_GR,
     "Risk of IUFD rises after 38 wks. Confirm presentation of leading twin."),
    ("Monochorionic diamniotic (MCDA) twins\nuncomplicated",
     "36+0 – 37+0 wks",
     "ELECTIVE IOL",
     C_ACTION_OR,
     "Higher risk of IUFD from placental sharing. Weekly surveillance from 16 wks."),
    ("Monochorionic monoamniotic (MCMA)\ntwins",
     "32+0 – 34+0 wks",
     "DELIVER\n(usually CS)",
     C_ACTION_RD,
     "Cord entanglement risk. Inpatient surveillance from 28 wks with continuous CTG. Usually by CS."),
    ("Intrauterine fetal death (IUFD)",
     "As soon as\nmother ready",
     "INDUCE",
     C_ACTION_OR,
     "<28 wks: misoprostol 200–400 mcg q4h.  >28 wks: misoprostol 25–50 mcg q4h OR oxytocin. Check fibrinogen if >4 wks since death (DIC risk). RhD immunoglobulin if Rh-negative."),
    ("Chorioamnionitis / IAI",
     "URGENT",
     "DELIVER",
     C_ACTION_RD,
     "IV antibiotics immediately (ampicillin + gentamicin). Induction for vaginal delivery preferred unless obstetric contraindication. Neonatal team alert."),
    ("Elective (low-risk, nulliparous\nat 39+0 wks – ARRIVE trial)",
     "39+0 wks",
     "OFFER IOL",
     C_ACTION_GR,
     "ARRIVE trial: elective IOL at 39 wks ↓ CS rate (15% vs 20%) with no adverse neonatal outcomes. Discuss with patient; not mandatory."),
]
story.append(decision_table(other_rows))
story.append(Spacer(1, 0.4*cm))

# ── SECTION 6: Absolute Contraindications Table ──────────────────────────────
story.append(section_banner("CONTRAINDICATIONS TO IOL", C_SECTION_B, number="6"))
story.append(Spacer(1, 2*mm))

contra_data = [
    [Paragraph("<b>ABSOLUTE (IOL contraindicated → CS)</b>", warn_style),
     Paragraph("<b>RELATIVE (individualize; senior review)</b>",
               S("Normal", fontSize=8, fontName="Helvetica-Bold",
                 textColor=colors.HexColor("#533f03")))],
    [
        Paragraph(
            "• Placenta praevia / vasa praevia\n"
            "• Previous classical (vertical) uterine incision\n"
            "• Cord presentation or prolapse\n"
            "• Transverse / oblique lie\n"
            "• Acute severe fetal distress requiring immediate delivery\n"
            "• Floating / unengaged presenting part (floating)\n"
            "• Active primary genital herpes\n"
            "• Invasive cervical carcinoma",
            body_style),
        Paragraph(
            "• Previous low-transverse CS (TOLAC may be appropriate)\n"
            "• Grand multiparity (≥5 prior pregnancies >20 wks)\n"
            "• Multiple pregnancy\n"
            "• Suspected CPD / macrosomia\n"
            "• Breech presentation\n"
            "• Inability to adequately monitor FHR\n"
            "• Severe oligohydramnios",
            body_style),
    ]
]
contra_t = Table(contra_data, colWidths=[USABLE_W/2, USABLE_W/2])
contra_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (0,0), colors.HexColor("#F8D7DA")),
    ("BACKGROUND",    (1,0), (1,0), colors.HexColor("#FFF3CD")),
    ("BACKGROUND",    (0,1), (0,1), colors.HexColor("#FFF5F5")),
    ("BACKGROUND",    (1,1), (1,1), colors.HexColor("#FFFDF0")),
    ("GRID",          (0,0), (-1,-1), 0.5, C_BORDER),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ("TOPPADDING",    (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("RIGHTPADDING",  (0,0), (-1,-1), 8),
]))
story.append(contra_t)
story.append(Spacer(1, 0.4*cm))

# ── SECTION 7: Bishop Score Quick Reference ───────────────────────────────────
story.append(section_banner("BISHOP SCORE – QUICK REFERENCE", colors.HexColor("#CC8800"), number="7"))
story.append(Spacer(1, 2*mm))

bishop_data = [
    [Paragraph("<b>Factor</b>", bold_style),
     Paragraph("<b>0</b>", center_style),
     Paragraph("<b>1</b>", center_style),
     Paragraph("<b>2</b>", center_style),
     Paragraph("<b>3</b>", center_style)],
    ["Dilation (cm)", "0", "1–2", "3–4", "5–6"],
    ["Effacement (%)", "0–30", "40–50", "60–70", "80"],
    ["Station", "−3", "−2", "−1 / 0", "+1 / +2"],
    ["Consistency", "Firm", "Medium", "Soft", "—"],
    ["Position", "Posterior", "Mid", "Anterior", "—"],
]
bishop_t = Table(bishop_data,
                 colWidths=[USABLE_W*0.3, USABLE_W*0.175, USABLE_W*0.175,
                             USABLE_W*0.175, USABLE_W*0.175])
bishop_style_cmds = [
    ("BACKGROUND",    (0,0), (-1,0),  colors.HexColor("#CC8800")),
    ("TEXTCOLOR",     (0,0), (-1,0),  colors.white),
    ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 9),
    ("GRID",          (0,0), (-1,-1), 0.4, C_BORDER),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_BODY_BG, C_ALT_ROW]),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
    ("ALIGN",         (1,0), (-1,-1), "CENTER"),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("RIGHTPADDING",  (0,0), (-1,-1), 8),
]
bishop_t.setStyle(TableStyle(bishop_style_cmds))

# Interpretation alongside
interp_data = [
    [Paragraph("<b>Score</b>", bold_style),
     Paragraph("<b>Cervix</b>", bold_style),
     Paragraph("<b>Management</b>", bold_style)],
    ["≥ 9",  "Very favourable",  "Amniotomy alone may be sufficient"],
    ["6–8",  "Favourable",       "Amniotomy + oxytocin"],
    ["< 6",  "Unfavourable",     "Cervical ripening required first"],
    ["< 4",  "Unfavourable",     "Mechanical (Foley balloon) or PG preferred"],
]
interp_t = Table(interp_data,
                 colWidths=[USABLE_W*0.12, USABLE_W*0.23, USABLE_W*0.35])
interp_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  colors.HexColor("#CC8800")),
    ("TEXTCOLOR",     (0,0), (-1,0),  colors.white),
    ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 8.5),
    ("GRID",          (0,0), (-1,-1), 0.4, C_BORDER),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_BODY_BG, C_ALT_ROW]),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("RIGHTPADDING",  (0,0), (-1,-1), 8),
]))

bishop_row = Table([[bishop_t, Spacer(0.3*cm, 1), interp_t]],
                   colWidths=[USABLE_W*0.50, 0.3*cm, USABLE_W*0.70 - 0.3*cm])
bishop_row.setStyle(TableStyle([("VALIGN",(0,0),(-1,-1),"TOP"),("LEFTPADDING",(0,0),(-1,-1),0),("RIGHTPADDING",(0,0),(-1,-1),0)]))
story.append(bishop_row)
story.append(Spacer(1, 0.5*cm))

# ── PAGE 3: Algorithm Flowchart ────────────────────────────────────────────
story.append(PageBreak())
story.append(header_table)
story.append(Spacer(1, 0.3*cm))

story.append(section_banner("DECISION ALGORITHM OVERVIEW", C_HEADER_BG))
story.append(Spacer(1, 0.3*cm))

drawing = build_algorithm_drawing()
story.append(drawing)
story.append(Spacer(1, 0.4*cm))

# ── Method selection table ────────────────────────────────────────────────────
story.append(section_banner("METHOD SELECTION GUIDE", colors.HexColor("#555555")))
story.append(Spacer(1, 2*mm))

method_data = [
    [Paragraph("<b>Method</b>", bold_style),
     Paragraph("<b>Bishop Score</b>", bold_style),
     Paragraph("<b>Prior CS?</b>", bold_style),
     Paragraph("<b>Dose / Route</b>", bold_style),
     Paragraph("<b>Key Caution</b>", bold_style)],
    ["Oxytocin IV infusion",      "≥ 6 (favourable)", "Use with caution\n(no PG)",
     "Start 0.5–2 mU/min; ↑ by 1–2 mU/min q15–40 min",
     "Hyperstimulation; antidiuretic effect at high doses"],
    ["Misoprostol (PGE₁)\nvaginal / oral",
     "Any (<6 preferred)", "AVOID if prior CS\n(uterine rupture ↑)",
     "25–50 mcg vaginally q4–6 h\nOR 25 mcg oral q2 h",
     "Do not use within 4 hrs of oxytocin; T risk uterine rupture"],
    ["Dinoprostone (PGE₂)\ngel / insert",
     "< 6 (ripening)", "AVOID if prior CS",
     "Gel 0.5 mg endocervical q6 h (max 3×)\nInsert 10 mg × 12 h",
     "Remove insert if hyperstimulation; keep CTG ×30 min after"],
    ["Foley balloon catheter\n(mechanical)",
     "Any (<6 preferred)", "SAFE\n(preferred in prior CS)",
     "14–18 Fr; inflate 30–60 mL saline; leave in situ",
     "No systemic effect; cord prolapse risk if head high"],
    ["Amniotomy (ARM)",            "≥ 6",             "With caution",
     "Amniohook at ARM; confirm presentation first",
     "Cord prolapse; do not rupture if head floating"],
    ["Membrane sweep",             "Any",             "Yes (safe)",
     "Digital stretch of membranes at internal os",
     "Not formal IOL; preparatory; reduces formal IOL rate"],
    ["Mifepristone + Misoprostol\n(mainly pre-viability / IUFD)",
     "Any",             "See notes",
     "Mifepristone 200 mg PO then misoprostol 800 mcg\nvaginally 24–48 h later",
     "RCOG/WHO protocol. For prior CS at <28 wks may use standard doses."],
]

method_t = Table(method_data,
                 colWidths=[USABLE_W*0.20, USABLE_W*0.13, USABLE_W*0.12,
                             USABLE_W*0.30, USABLE_W*0.25],
                 repeatRows=1)
method_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  colors.HexColor("#555555")),
    ("TEXTCOLOR",     (0,0), (-1,0),  colors.white),
    ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 8),
    ("LEADING",       (0,0), (-1,-1), 10),
    ("GRID",          (0,0), (-1,-1), 0.4, C_BORDER),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_BODY_BG, C_ALT_ROW]),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
    ("TOPPADDING",    (0,0), (-1,-1), 4),
    ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ("LEFTPADDING",   (0,0), (-1,-1), 5),
    ("RIGHTPADDING",  (0,0), (-1,-1), 5),
]))
story.append(method_t)
story.append(Spacer(1, 0.4*cm))

# ── Footer / disclaimer ────────────────────────────────────────────────────────
story.append(HRFlowable(width=USABLE_W, thickness=0.5, color=C_RULE))
story.append(Spacer(1, 2*mm))
story.append(Paragraph(
    "Sources: Creasy &amp; Resnik's Maternal-Fetal Medicine (8e) · Comprehensive Clinical Nephrology (7e) · Brenner &amp; Rector's The Kidney · "
    "ACOG Practice Bulletin · SMFM Consult Series · HYPITAT Trial · ARRIVE Trial (Grobman et al. NEJM 2018)  |  "
    "This document is a clinical reference aid. Always apply local protocols and clinical judgement. August 2026.",
    footer_style))

# ─── Build ───────────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF created: {OUTPUT}")
print(f"Size: {os.path.getsize(OUTPUT):,} bytes")

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/iol-flowchart/build_flowchart.py'