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, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import KeepInFrame

OUTPUT = "/home/daytona/workspace/antenatal-assessment/Antenatal_Assessment_5_Cases.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=1.8*cm, leftMargin=1.8*cm,
    topMargin=1.5*cm, bottomMargin=1.5*cm
)

styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle('Title', parent=styles['Title'],
    fontSize=14, spaceAfter=4, alignment=TA_CENTER, textColor=colors.HexColor('#1a1a5e'), fontName='Helvetica-Bold')

case_style = ParagraphStyle('Case', parent=styles['Title'],
    fontSize=12, spaceAfter=4, spaceBefore=6, alignment=TA_CENTER,
    textColor=colors.white, backColor=colors.HexColor('#1a1a5e'), fontName='Helvetica-Bold')

section_style = ParagraphStyle('Section', parent=styles['Normal'],
    fontSize=10, spaceAfter=3, spaceBefore=6, fontName='Helvetica-Bold',
    textColor=colors.white, backColor=colors.HexColor('#4472C4'), leftIndent=4)

subsection_style = ParagraphStyle('SubSection', parent=styles['Normal'],
    fontSize=9.5, spaceAfter=2, spaceBefore=4, fontName='Helvetica-Bold',
    textColor=colors.HexColor('#1a1a5e'))

body_style = ParagraphStyle('Body', parent=styles['Normal'],
    fontSize=9, spaceAfter=2, spaceBefore=1, leading=13, fontName='Helvetica')

bullet_style = ParagraphStyle('Bullet', parent=styles['Normal'],
    fontSize=9, spaceAfter=1, spaceBefore=1, leading=12,
    leftIndent=12, fontName='Helvetica', bulletText='•')

complication_style = ParagraphStyle('Comp', parent=styles['Normal'],
    fontSize=11, spaceAfter=4, spaceBefore=2, alignment=TA_CENTER,
    fontName='Helvetica-BoldOblique', textColor=colors.HexColor('#C00000'))

def hline():
    return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor('#4472C4'), spaceAfter=3, spaceBefore=3)

def sec(text):
    return Paragraph(f"  {text}", section_style)

def subsec(text):
    return Paragraph(text, subsection_style)

def body(text):
    return Paragraph(text, body_style)

def bullet(text):
    return Paragraph(text, bullet_style)

def sp(h=4):
    return Spacer(1, h)

def tbl(data, col_widths, header_row=True):
    t = Table(data, colWidths=col_widths)
    style_cmds = [
        ('FONTNAME', (0,0), (-1,-1), 'Helvetica'),
        ('FONTSIZE', (0,0), (-1,-1), 8),
        ('GRID', (0,0), (-1,-1), 0.4, colors.HexColor('#B0B0B0')),
        ('ROWBACKGROUNDS', (0,0), (-1,-1), [colors.HexColor('#F5F8FF'), colors.white]),
        ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
        ('LEFTPADDING', (0,0), (-1,-1), 4),
        ('RIGHTPADDING', (0,0), (-1,-1), 4),
        ('TOPPADDING', (0,0), (-1,-1), 3),
        ('BOTTOMPADDING', (0,0), (-1,-1), 3),
    ]
    if header_row:
        style_cmds += [
            ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#4472C4')),
            ('TEXTCOLOR', (0,0), (-1,0), colors.white),
            ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
            ('FONTSIZE', (0,0), (-1,0), 8.5),
        ]
    t.setStyle(TableStyle(style_cmds))
    return t

def kv_table(rows, col1=7*cm, col2=10.5*cm):
    data = [[Paragraph(f"<b>{k}</b>", body_style), Paragraph(v, body_style)] for k, v in rows]
    t = Table(data, colWidths=[col1, col2])
    t.setStyle(TableStyle([
        ('FONTNAME', (0,0), (-1,-1), 'Helvetica'),
        ('FONTSIZE', (0,0), (-1,-1), 8.5),
        ('GRID', (0,0), (-1,-1), 0.3, colors.HexColor('#D0D0D0')),
        ('ROWBACKGROUNDS', (0,0), (-1,-1), [colors.HexColor('#F5F8FF'), colors.white]),
        ('VALIGN', (0,0), (-1,-1), 'TOP'),
        ('LEFTPADDING', (0,0), (-1,-1), 4),
        ('RIGHTPADDING', (0,0), (-1,-1), 4),
        ('TOPPADDING', (0,0), (-1,-1), 3),
        ('BOTTOMPADDING', (0,0), (-1,-1), 3),
    ]))
    return t

story = []

# ═══════════════════════════════════════════════════════════════
# COVER PAGE
# ═══════════════════════════════════════════════════════════════
story.append(Spacer(1, 2*cm))
story.append(Paragraph("ANTENATAL ASSESSMENT", title_style))
story.append(Paragraph("Five Clinical Case Studies with Different Obstetric Complications", complication_style))
story.append(sp(8))
story.append(hline())
story.append(sp(8))

cover_data = [
    ["Case No.", "Patient Name", "Age/Gravida", "Complication", "Risk Level"],
    ["Case 1", "Mrs. Priya Sharma", "28 yrs / G2P1", "Pregnancy-Induced Hypertension (PIH) / Preeclampsia", "HIGH RISK"],
    ["Case 2", "Mrs. Sunita Patel", "32 yrs / G3P2", "Gestational Diabetes Mellitus (GDM)", "HIGH RISK"],
    ["Case 3", "Mrs. Kavitha Reddy", "22 yrs / G1P0", "Severe Iron Deficiency Anemia", "HIGH RISK"],
    ["Case 4", "Mrs. Fatima Begum", "34 yrs / G4P3", "Placenta Previa (Antepartum Haemorrhage)", "HIGH RISK"],
    ["Case 5", "Mrs. Deepa Menon", "30 yrs / G2P1A1", "Preterm Labour (32 Weeks)", "HIGH RISK"],
]
story.append(tbl(cover_data, [1.5*cm, 4*cm, 3*cm, 6.5*cm, 2.5*cm]))
story.append(sp(20))
story.append(hline())
story.append(Paragraph("Nursing Practical Record — Antenatal Assessment Forms", body_style))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════
# HELPER FUNCTION FOR EACH CASE
# ═══════════════════════════════════════════════════════════════

def add_case(story, case_no, complication, patient):
    p = patient  # shorthand

    story.append(Paragraph(f"ANTENATAL ASSESSMENT — CASE NO. {case_no}", case_style))
    story.append(sp(2))
    story.append(Paragraph(f"Complication: {complication}", complication_style))
    story.append(sp(4))

    # ── IDENTIFICATION PROFILE ──
    story.append(sec("IDENTIFICATION PROFILE"))
    story.append(kv_table([
        ("Name", p['name']),
        ("W/o", p['wo']),
        ("Age", p['age']),
        ("Religion", p['religion']),
        ("IP/OPD Registration No.", p['reg_no']),
        ("Hospital", p['hospital']),
        ("Date of Admission / Visit", p['date']),
        ("Address", p['address']),
    ]))
    story.append(sp(4))
    story.append(subsec("Obstetrical Score:"))
    story.append(kv_table([
        ("Gravida / Parity / Living / Abortion", p['obs_score']),
        ("LMP / EDD", p['lmp_edd']),
        ("Gestational Period / Married for", p['gest_married']),
    ]))

    # ── HISTORY ──
    story.append(sp(4))
    story.append(sec("HISTORY"))
    story.append(kv_table([
        ("Education (Wife / Husband)", p['education']),
        ("Occupation (Wife / Husband)", p['occupation']),
        ("Family Income", p['income']),
        ("Type of House / Rooms / Ventilation", p['house']),
        ("Sanitation Facilities", p['sanitation']),
    ]))
    story.append(sp(4))
    story.append(subsec("Family History:"))
    story.append(kv_table([
        ("Type of Family / Members / Adults / Children", p['family_type']),
        ("Hereditary Diseases", p['hereditary']),
        ("History of Twins", p['twins']),
        ("Any Other Significant History", p['fam_other']),
    ]))
    story.append(sp(4))
    story.append(subsec("Personal History:"))
    story.append(kv_table([
        ("Sleep / Appetite / Allergy", p['sleep_appetite']),
        ("Habits / Addiction / Bladder & Bowel", p['habits']),
        ("Diet / Meals per Day", p['diet']),
        ("Significant Diet Habits in Pregnancy", p['diet_habits']),
    ]))

    # ── PAST MEDICAL & SURGICAL HISTORY ──
    story.append(sp(4))
    story.append(sec("PAST MEDICAL AND SURGICAL HISTORY"))
    story.append(subsec("Previous Medical Illness and Treatment:"))
    story.append(kv_table([
        ("Childhood illness / Hepatitis / TB / Communicable diseases / Diabetes", p['childhood']),
        ("Thyroid / Asthma / Epilepsy", p['thyroid']),
        ("Long term drugs / Blood transfusion", p['long_term_drugs']),
        ("Any Other Significant Illness", p['other_illness']),
    ]))
    story.append(sp(2))
    story.append(subsec("Any Previous Surgery (Specify if any):"))
    story.append(kv_table([("Abdominal / Pelvic / Orthopedic Operation", p['surgery'])]))

    # ── MENSTRUAL HISTORY ──
    story.append(sp(4))
    story.append(sec("MENSTRUAL HISTORY"))
    story.append(kv_table([
        ("Age of Menarche / Cycle / Interval", p['menarche']),
        ("Amount of Bleeding / Associated Problems", p['bleeding']),
        ("Treatment Taken", p['mens_treatment']),
    ]))

    # ── MARITAL HISTORY ──
    story.append(sp(4))
    story.append(sec("MARITAL HISTORY"))
    story.append(kv_table([
        ("Marital Status / Age at Marriage", p['marital_status']),
        ("Years of Marital Life", p['marital_years']),
        ("Consanguineous Marriage", p['consanguineous']),
        ("Use of Contraceptive", p['contraceptive']),
        ("Treatment for Infertility", p['infertility']),
    ]))

    # ── OBSTETRIC HISTORY ──
    story.append(sp(4))
    story.append(sec("OBSTETRIC HISTORY"))
    story.append(subsec("Past Obstetric History:"))
    story.append(kv_table([
        ("No. of Living Children / Girls / Boys", p['living_children']),
        ("Abortions / Spontaneous / MTP", p['abortions']),
        ("Age of First Child / Last Child", p['child_ages']),
        ("Any Congenital Abnormality / Disease in Children", p['congenital']),
    ]))
    story.append(sp(4))
    story.append(subsec("History of Previous Pregnancies:"))
    story.append(tbl(p['prev_preg_table'], p['prev_preg_widths']))
    story.append(sp(4))
    story.append(subsec("Present Obstetric History:"))
    story.append(kv_table([
        ("General Health during Present Pregnancy", p['gen_health']),
        ("Complaints during Pregnancy", p['complaints']),
        ("Morning Sickness", p['morning_sickness']),
        ("Minor Ailments", p['minor_ailments']),
        ("Date of First Visit / Registration for ANC", p['first_visit']),
        ("Gestational Age at First Visit", p['ga_first_visit']),
        ("Immunization (T/T) / Dose / Dates", p['immunization']),
        ("Calcium, Iron & Folic Acid Supplements", p['supplements']),
        ("Any Other Medications During Pregnancy", p['other_meds']),
    ]))

    # ── ANTENATAL EVENTS ──
    story.append(sp(4))
    story.append(sec("ANTENATAL EVENTS DURING PRESENT PREGNANCY"))

    for trimester_name, trimester_data in [
        ("First Trimester:", p['trimester1']),
        ("Second Trimester:", p['trimester2']),
        ("Third Trimester:", p['trimester3']),
    ]:
        story.append(subsec(trimester_name))
        story.append(kv_table(trimester_data))

    # ── ANC VISIT RECORDS TABLE ──
    story.append(sp(4))
    story.append(subsec("Antenatal Visits / Records:"))
    story.append(tbl(p['anc_visits'], [2*cm, 2.5*cm, 2*cm, 2.5*cm, 2*cm, 3.5*cm, 3*cm]))

    # ── LAB INVESTIGATIONS ──
    story.append(sp(4))
    story.append(sec("LABORATORY INVESTIGATIONS"))
    story.append(tbl(p['lab_table'], [2*cm, 5*cm, 4*cm, 4.5*cm]))

    # ── EXAMINATION OF THE MOTHER ──
    story.append(sp(4))
    story.append(sec("EXAMINATION OF THE MOTHER"))
    story.append(subsec("General Appearance / Vital Signs:"))
    story.append(kv_table([
        ("Body Built / Appearance / Nourishment", p['general_app']),
        ("Height / Weight / BMI", p['ht_wt']),
        ("Temperature / Pulse", p['temp_pulse']),
        ("Respiration / Blood Pressure", p['resp_bp']),
    ]))
    story.append(sp(4))
    story.append(subsec("Head-to-Toe Examination:"))
    story.append(kv_table(p['head_to_toe']))
    story.append(sp(4))
    story.append(subsec("Abdomen — Inspection:"))
    story.append(kv_table(p['abdomen_inspection']))
    story.append(sp(4))
    story.append(subsec("Abdomen — Palpation (Leopold's Maneuvers):"))
    story.append(kv_table(p['abdomen_palpation']))
    story.append(sp(4))
    story.append(subsec("Lower Extremities & Genitalia:"))
    story.append(kv_table(p['lower_ext']))

    # ── DRUGS PRESCRIBED ──
    story.append(sp(4))
    story.append(sec("DRUGS PRESCRIBED"))
    story.append(tbl(p['drugs'], [4*cm, 4*cm, 4*cm, 5.5*cm]))

    # ── RISK FACTORS ──
    story.append(sp(4))
    story.append(sec("ANY RISK FACTORS IDENTIFIED"))
    story.append(kv_table([
        ("Risk Factors", p['risk_factors']),
        ("High Risk", p['high_risk']),
        ("Low Risk", p['low_risk']),
        ("Remarks", p['remarks']),
    ]))

    # ── ANTENATAL TEACHING ──
    story.append(sp(4))
    story.append(sec("ANTENATAL TEACHING / ADVICES"))
    story.append(kv_table(p['teaching']))
    story.append(sp(4))
    story.append(subsec("Nursing Problems Discussed / Nursing Care Provided:"))
    story.append(body(p['nursing_problems']))
    story.append(sp(8))
    story.append(hline())
    sig_data = [["Signature of Student: ___________________________",
                 "Signature of Supervisor/CI: ___________________________"]]
    sig_t = Table(sig_data, colWidths=[8.5*cm, 9*cm])
    sig_t.setStyle(TableStyle([
        ('FONTNAME', (0,0), (-1,-1), 'Helvetica'),
        ('FONTSIZE', (0,0), (-1,-1), 9),
        ('ALIGN', (0,0), (-1,-1), 'LEFT'),
        ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
        ('LEFTPADDING', (0,0), (-1,-1), 0),
    ]))
    story.append(sig_t)
    story.append(PageBreak())


# ═══════════════════════════════════════════════════════════════
# CASE 1 DATA — PIH / PREECLAMPSIA
# ═══════════════════════════════════════════════════════════════
case1 = {
    'name': 'Mrs. Priya Sharma',
    'wo': 'Mr. Rajesh Sharma',
    'age': '28 years',
    'religion': 'Hindu',
    'reg_no': 'OPD/2026/0312',
    'hospital': 'District General Hospital, Jaipur',
    'date': '10/07/2026',
    'address': '45, Shanti Nagar, Jaipur, Rajasthan',
    'obs_score': 'G2 / P1 / Living: 1 / Abortion: 0',
    'lmp_edd': 'LMP: 10/10/2025 | EDD: 17/07/2026',
    'gest_married': 'Gestational Period: 39 weeks | Married for: 4 Years',
    'education': 'Wife: Graduation | Husband: Post-Graduation',
    'occupation': 'Wife: Housewife | Husband: Clerk',
    'income': 'Rs. 18,000 per month',
    'house': 'Pacca | 3 Rooms | Ventilation: Adequate',
    'sanitation': 'Indoor toilet, running water available',
    'family_type': 'Nuclear | 4 Members | 3 Adults | 1 Child',
    'hereditary': 'Hypertension (Mother-in-law)',
    'twins': 'Nil',
    'fam_other': 'Nil',
    'sleep_appetite': 'Sleep: 7–8 hrs/day | Appetite: Reduced | Allergy: Nil',
    'habits': 'Habits: Nil | Addiction: Nil | Bladder & Bowel: Normal',
    'diet': 'Vegetarian | 3 Meals per Day',
    'diet_habits': 'Low-salt diet advised, poor compliance; sweets occasionally',
    'childhood': 'Nil',
    'thyroid': 'Nil',
    'long_term_drugs': 'Nil',
    'other_illness': 'Mild hypertension in 1st pregnancy, resolved postpartum',
    'surgery': 'Nil',
    'menarche': 'Age: 13 years | Cycle: Regular | Interval: 28 days',
    'bleeding': 'Moderate | Associated Problems: Nil',
    'mens_treatment': 'No',
    'marital_status': 'Married | Age at Marriage: 24 years',
    'marital_years': '4 years (stays with husband)',
    'consanguineous': 'No',
    'contraceptive': 'Yes – OCP (stopped after 1st delivery, used 1 year)',
    'infertility': 'No',
    'living_children': '1 | Girls: 1 | Boys: 0',
    'abortions': '0 | Spontaneous: 0 | MTP: 0',
    'child_ages': 'Age of First Child: 3 years | Age of Last Child: 3 years',
    'congenital': 'Nil',
    'prev_preg_table': [
        ['S.No', 'Date/Year', 'Pregnancy Events', 'Labour Events', 'Mode of Delivery', 'Puerperium', 'Baby (Sex/Wt/Health)'],
        ['1', 'June 2023', 'Pre-term (36 wks), mild oedema', 'Normal onset', 'NVD', 'Uneventful', 'Girl, 2.4 kg, healthy, immunized'],
    ],
    'prev_preg_widths': [1*cm, 2*cm, 3.5*cm, 2.5*cm, 2.5*cm, 2.5*cm, 3.5*cm],
    'gen_health': 'Fair',
    'complaints': 'Headache, blurred vision, pedal oedema ++ for 3 weeks',
    'morning_sickness': 'Yes – mild (1st trimester)',
    'minor_ailments': 'Heartburn, leg cramps',
    'first_visit': '15/11/2025',
    'ga_first_visit': '6 weeks',
    'immunization': 'Yes | Dose: 2 | 1st: 20/12/2025 | 2nd: 20/01/2026',
    'supplements': 'Calcium 500mg BD | Ferrous Sulfate 200mg OD | Folic Acid 5mg OD',
    'other_meds': 'Labetalol 100mg BD (from 34 weeks)',
    'trimester1': [
        ('Morning Sickness', 'Yes – Mild | T/t: Ondansetron 4mg SOS'),
        ('Bleeding P/V', 'No'),
        ('Any Other Significant Problems', 'Nil'),
        ('Height / Weight', '158 cm / 57 kg'),
        ('Hb%', '11.2 g/dl'),
        ('BP', '110/70 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / Nil'),
        ('USG Report/Findings', 'Single live intrauterine pregnancy, 8 weeks, normal'),
    ],
    'trimester2': [
        ('Minor Ailments', 'Heartburn, ankle oedema (mild) | T/t: Antacids, limb elevation'),
        ('Hospitalisation', 'No'),
        ('Quickening', '18 weeks'),
        ('Fetal Movements', 'Present, good'),
        ('Any Other Significant Problems', 'Nil'),
        ('Height / Weight', '158 cm / 64 kg'),
        ('Hb%', '10.8 g/dl'),
        ('BP', '130/85 mmHg'),
        ('Urine – Albumin / Sugar', 'Trace / Nil'),
        ('USG Report/Findings', '22 weeks, cephalic, placenta posterior, AFI normal'),
    ],
    'trimester3': [
        ('Minor Ailments', 'Severe headache, visual disturbances, pedal oedema ++'),
        ('Hospitalisation', 'Yes | T/t: Labetalol, MgSO₄ prophylaxis'),
        ('Fetal Movements', 'Present, good (10 in 12 hrs)'),
        ('Any Other Significant Problems', 'Proteinuria ++'),
        ('Height / Weight', '158 cm / 74 kg'),
        ('Hb%', '10.2 g/dl'),
        ('BP', '158/104 mmHg'),
        ('Urine – Albumin / Sugar', '++ / Nil'),
        ('USG Report/Findings', '38 weeks, cephalic, AFI 8 cm, BPP 8/10, placenta posterior grade III'),
    ],
    'anc_visits': [
        ['Date', 'Ht & Wt', 'B.P', 'Gest. Weeks', 'Fundal Ht', 'Presentation, FHS, Rate', 'Urine Alb/Sugar; Hb%'],
        ['15/11/25', '158/57', '110/70', '6 wks', '—', '—', 'Nil/Nil; 11.2'],
        ['15/01/26', '158/61', '118/76', '14 wks', '14 cm', 'Cephalic, FHS 148', 'Nil/Nil; 11.0'],
        ['10/03/26', '158/64', '130/85', '22 wks', '22 cm', 'Cephalic, FHS 146', 'Trace/Nil; 10.8'],
        ['05/05/26', '158/69', '140/90', '30 wks', '30 cm', 'Cephalic, FHS 144', '+/Nil; 10.5'],
        ['10/07/26', '158/74', '158/104', '39 wks', '38 cm', 'Cephalic, FHS 140', '++/Nil; 10.2'],
    ],
    'lab_table': [
        ['Date', 'Investigations', 'Value in Patient', 'Normal Values'],
        ['15/11/25', 'Hb%', '11.2 g/dl', '11–14 g/dl'],
        ['15/11/25', 'ABO Rh', 'B Positive', '—'],
        ['15/11/25', 'VDRL', 'Non-reactive', 'Non-reactive'],
        ['15/11/25', 'HIV', 'Non-reactive', 'Non-reactive'],
        ['15/11/25', 'HBsAg', 'Negative', 'Negative'],
        ['10/07/26', 'Urine R/E, Alb & Sugar', 'Albumin ++, RBC present', 'Nil'],
        ['10/07/26', 'TC DC', 'TC 9800, DC N70 L26', 'TC 4000–11000'],
        ['10/07/26', 'BT, CT, PT', 'BT 2 min, CT 5 min, PT 13 sec', 'Normal'],
        ['10/07/26', 'Blood Sugar Fasting', '88 mg/dl', '70–100 mg/dl'],
        ['10/07/26', 'Serum Creatinine', '1.1 mg/dl', '0.6–1.1 mg/dl'],
    ],
    'general_app': 'Average built | Anxious, normal gait | Nourishment: Average',
    'ht_wt': 'Height: 158 cm | Weight: 74 kg | BMI: 29.6 (overweight)',
    'temp_pulse': 'Temperature: 98.6°F (37°C) | Pulse: 88 bpm, regular',
    'resp_bp': 'Respiration: 18/min | Blood Pressure: 158/104 mmHg',
    'head_to_toe': [
        ('Hair & Scalp', 'Normal texture, black; Scalp clean'),
        ('Eyes', 'Periorbital oedema ++ present; conjunctiva pale'),
        ('Face', 'Facial puffiness present; no chloasma'),
        ('Mouth', 'Teeth – no caries; Gums – normal; Tongue – moist; Lips – pale, moist'),
        ('Neck', 'No thyroid enlargement; no lymphadenopathy'),
        ('Chest', 'Lungs – clear; Heart sounds – S1 S2 heard, no murmur'),
        ('Breast', 'Symmetrical; Montgomery\'s tubercles present; Nipples erectile; Colostrum on palpation'),
    ],
    'abdomen_inspection': [
        ('Size', 'Large, corresponding to POG (39 wks)'),
        ('Shape', 'Longitudinal / Ovoid'),
        ('Umbilicus', 'Protrudes'),
        ('Bladder', 'Not full'),
        ('Skin Changes', 'Linea nigra, striae gravidarum present'),
        ('Visible Fetal Movements', 'Present'),
    ],
    'abdomen_palpation': [
        ('Abdominal Girth', '97 cm'),
        ('Fundal Height (SFH)', '38 cm | Fundal Height in Weeks: 38 weeks'),
        ('Fundal Palpation (Lie / Presentation)', 'Lie: Longitudinal | Presentation: Cephalic'),
        ('Lateral Palpation (Position)', 'LOA — fetal back on left, limbs on right'),
        ('Auscultation of FHS (Rate / Location)', '140 bpm, regular | Located: LLQ'),
        ('Pelvic Palpation (4th Maneuver)', 'Head 2/5 palpable above pelvic brim – Engaging'),
        ('Pawlic Maneuver (3rd Maneuver)', 'Fixed, Flexed'),
    ],
    'lower_ext': [
        ('Varicose Veins', 'Absent'),
        ('Ankle Oedema', '++ bilateral pitting oedema'),
        ('Genitalia – Discharge', 'Nil'),
        ('Genitalia – Bleeding/Show', 'Nil'),
        ('Vulval Oedema', 'Mild'),
        ('Vulval Varicosity', 'Nil'),
    ],
    'drugs': [
        ['Name of Drug', 'Generic Name', 'Dosage', 'Action'],
        ['Labetalol', 'Labetalol HCl', '100mg BD oral', 'Antihypertensive'],
        ['Ferrous Sulfate', 'Iron', '200mg OD oral', 'Haematinic'],
        ['Calcium Sandoz', 'Calcium carbonate', '500mg BD oral', 'Calcium supplement'],
        ['Folic Acid', 'Folic acid', '5mg OD oral', 'Prevent neural tube defect'],
        ['MgSO₄', 'Magnesium Sulphate', '4g IV loading (if eclampsia)', 'Anticonvulsant prophylaxis'],
    ],
    'risk_factors': 'Hypertension in pregnancy, proteinuria ++, periorbital and pedal oedema, weight gain 17 kg',
    'high_risk': 'YES – Preeclampsia (BP 158/104 + Proteinuria ++)',
    'low_risk': 'Nil',
    'remarks': 'High-risk pregnancy; close monitoring needed; plan for delivery at 39 weeks; MgSO₄ prophylaxis ready',
    'teaching': [
        ('Nutrition', 'Low-salt diet; high protein; increased fluid intake; fresh fruits & vegetables; avoid processed foods'),
        ('Follow Up', 'Every 3 days or immediately if symptoms worsen; daily BP monitoring at home'),
        ('Rest & Sleep', 'Complete bed rest in left lateral position; 8–10 hrs sleep'),
        ('Exercise & Work', 'Avoid strenuous work; light ambulation only'),
        ('Use of Comfort Devices', 'Elevation of legs above heart level; loose, comfortable clothing'),
        ('Warning Signs Explained', 'Severe headache, blurred vision, epigastric pain, decreased fetal movements, convulsions – go to hospital IMMEDIATELY'),
        ('Minor Discomforts & Remedies', 'Leg elevation for oedema; antacids for heartburn as prescribed'),
        ('Sex', 'Abstain until BP is controlled and physician advises'),
        ('Signs & Symptoms of True Labour', 'Regular painful contractions increasing in frequency; blood-stained mucus show; rupture of membranes'),
    ],
    'nursing_problems': (
        '1. Anxiety related to high-risk status and imminent delivery — reassurance and information provided. '
        '2. Knowledge deficit about danger signs of eclampsia — health education given with written handout. '
        '3. Potential for injury (eclamptic seizure) — MgSO₄ protocol at bedside; side rails up; quiet environment. '
        '4. Altered tissue perfusion related to sustained hypertension — BP monitoring every 2 hours; antihypertensives on time. '
        '5. Impaired fetal oxygenation — fetal kick count chart taught; CTG monitoring arranged.'
    ),
}

# ═══════════════════════════════════════════════════════════════
# CASE 2 DATA — GDM
# ═══════════════════════════════════════════════════════════════
case2 = {
    'name': 'Mrs. Sunita Patel',
    'wo': 'Mr. Dinesh Patel',
    'age': '32 years',
    'religion': 'Hindu',
    'reg_no': 'OPD/2026/0487',
    'hospital': 'Civil Hospital, Ahmedabad',
    'date': '08/07/2026',
    'address': '12, Navrangpura, Ahmedabad, Gujarat',
    'obs_score': 'G3 / P2 / Living: 2 / Abortion: 0',
    'lmp_edd': 'LMP: 01/10/2025 | EDD: 08/07/2026',
    'gest_married': 'Gestational Period: 40 weeks | Married for: 10 Years',
    'education': 'Wife: HSC (12th) | Husband: Graduation',
    'occupation': 'Wife: Housewife | Husband: Businessman',
    'income': 'Rs. 35,000 per month',
    'house': 'Pacca | 4 Rooms | Ventilation: Good',
    'sanitation': 'Indoor toilet, safe drinking water, good hygiene',
    'family_type': 'Joint | 8 Members | 5 Adults | 3 Children',
    'hereditary': 'Diabetes Mellitus Type 2 (Father, Maternal Uncle)',
    'twins': 'Nil',
    'fam_other': 'Nil',
    'sleep_appetite': 'Sleep: 7 hrs/day | Appetite: Increased | Allergy: Nil',
    'habits': 'Habits: Nil | Addiction: Nil | Bladder & Bowel: Polyuria noted, normal bowel',
    'diet': 'Vegetarian | 4–5 Meals per Day (frequent small meals)',
    'diet_habits': 'High carbohydrate intake; frequent sweets; poor glycaemic diet control',
    'childhood': 'Nil',
    'thyroid': 'Hypothyroid — on Levothyroxine 50mcg since 2022',
    'long_term_drugs': 'Levothyroxine 50mcg OD',
    'other_illness': 'GDM in 2nd pregnancy (2023) – resolved postpartum; 1 baby 3.9 kg',
    'surgery': 'LSCS (2023) – for fetal macrosomia / failed induction',
    'menarche': 'Age: 12 years | Cycle: Irregular | Interval: 35–40 days',
    'bleeding': 'Heavy | Associated Problems: Dysmenorrhoea',
    'mens_treatment': 'Yes – Mefenamic acid SOS',
    'marital_status': 'Married | Age at Marriage: 22 years',
    'marital_years': '10 years (stays with husband)',
    'consanguineous': 'No',
    'contraceptive': 'Yes – OCP (between pregnancies)',
    'infertility': 'No',
    'living_children': '2 | Girls: 1 | Boys: 1',
    'abortions': '0 | Spontaneous: 0 | MTP: 0',
    'child_ages': 'Age of First Child: 6 years | Age of Last Child: 3 years',
    'congenital': 'Nil',
    'prev_preg_table': [
        ['S.No', 'Date/Year', 'Pregnancy Events', 'Labour Events', 'Mode of Delivery', 'Puerperium', 'Baby (Sex/Wt/Health)'],
        ['1', 'Sept 2020', 'Normal, no GDM', 'Normal', 'NVD', 'Uneventful', 'Boy, 3.2 kg, healthy'],
        ['2', 'July 2023', 'GDM at 26 wks', 'Induction failed at 40 wks', 'LSCS (macrosomia)', 'Uneventful, wound healed', 'Girl, 3.9 kg, healthy'],
    ],
    'prev_preg_widths': [1*cm, 2*cm, 3.5*cm, 2.5*cm, 2.5*cm, 2.5*cm, 3.5*cm],
    'gen_health': 'Fair',
    'complaints': 'Polyuria, polydipsia, excessive fatigue, blurred vision for 2 weeks',
    'morning_sickness': 'Yes – mild (1st trimester)',
    'minor_ailments': 'Fungal vaginal discharge, leg cramps',
    'first_visit': '08/11/2025',
    'ga_first_visit': '6 weeks',
    'immunization': 'Yes | Dose: 2 | 1st: 10/12/2025 | 2nd: 10/01/2026',
    'supplements': 'Calcium 500mg BD | Ferrous Sulfate 200mg OD | Folic Acid 5mg OD',
    'other_meds': 'Levothyroxine 50mcg OD; Insulin (Regular) from 28 weeks',
    'trimester1': [
        ('Morning Sickness', 'Yes – Mild | T/t: Dietary advice'),
        ('Bleeding P/V', 'No'),
        ('Any Other Significant Problems', 'Nil'),
        ('Height / Weight', '162 cm / 78 kg'),
        ('Hb%', '11.8 g/dl'),
        ('BP', '116/74 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / Nil'),
        ('USG Report/Findings', 'Single live intrauterine pregnancy, 8 weeks; NT scan normal'),
    ],
    'trimester2': [
        ('Minor Ailments', 'Fungal vaginitis, polyuria | T/t: Clotrimazole pessary; glucose monitoring started'),
        ('Hospitalisation', 'Yes – 2 days for OGTT & insulin initiation'),
        ('Quickening', '18 weeks'),
        ('Fetal Movements', 'Good'),
        ('Any Other Significant Problems', 'OGTT at 24 wks: Fasting 110, 2hr 185 mg/dl — GDM confirmed'),
        ('Height / Weight', '162 cm / 83 kg'),
        ('Hb%', '11.4 g/dl'),
        ('BP', '118/76 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / + (glucosuria)'),
        ('USG Report/Findings', '26 wks; cephalic; AFI 18 cm (borderline polyhydramnios); EFW 980g'),
    ],
    'trimester3': [
        ('Minor Ailments', 'Excessive weight gain, pedal oedema, blurred vision'),
        ('Hospitalisation', 'Yes – for glucose control and fetal monitoring'),
        ('Fetal Movements', 'Good (10/12 hrs)'),
        ('Any Other Significant Problems', 'Macrosomia on USG (EFW 4.1 kg at 38 wks); polyhydramnios confirmed'),
        ('Height / Weight', '162 cm / 93 kg'),
        ('Hb%', '10.8 g/dl'),
        ('BP', '128/82 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / ++ (glucosuria)'),
        ('USG Report/Findings', '40 wks; cephalic; AFI 22 cm (polyhydramnios); EFW 4.2 kg (macrosomia)'),
    ],
    'anc_visits': [
        ['Date', 'Ht & Wt', 'B.P', 'Gest. Weeks', 'Fundal Ht', 'Presentation, FHS, Rate', 'Urine Alb/Sugar; Hb%'],
        ['08/11/25', '162/78', '116/74', '6 wks', '—', '—', 'Nil/Nil; 11.8'],
        ['10/01/26', '162/81', '118/76', '15 wks', '15 cm', 'Cephalic, FHS 152', 'Nil/Nil; 11.6'],
        ['12/03/26', '162/83', '118/76', '24 wks', '25 cm', 'Cephalic, FHS 148', 'Nil/+; 11.4'],
        ['08/05/26', '162/88', '122/80', '32 wks', '35 cm', 'Cephalic, FHS 144', 'Nil/++; 11.0'],
        ['08/07/26', '162/93', '128/82', '40 wks', '42 cm', 'Cephalic, FHS 138', 'Nil/++; 10.8'],
    ],
    'lab_table': [
        ['Date', 'Investigations', 'Value in Patient', 'Normal Values'],
        ['08/11/25', 'Hb%', '11.8 g/dl', '11–14 g/dl'],
        ['08/11/25', 'ABO Rh', 'O Positive', '—'],
        ['08/11/25', 'VDRL', 'Non-reactive', 'Non-reactive'],
        ['08/11/25', 'HIV', 'Non-reactive', 'Non-reactive'],
        ['08/11/25', 'HBsAg', 'Negative', 'Negative'],
        ['12/03/26', 'Blood Sugar Fasting', '110 mg/dl', '<92 mg/dl (pregnancy)'],
        ['12/03/26', 'OGTT (75g, 2hr)', '185 mg/dl', '<153 mg/dl'],
        ['12/03/26', 'HbA1c', '6.8%', '<5.7% normal'],
        ['08/07/26', 'Urine R/E', 'Sugar ++; Albumin Nil', 'Nil'],
        ['08/07/26', 'TSH', '2.1 mIU/L', '0.1–2.5 (pregnancy)'],
    ],
    'general_app': 'Obese built | Well-oriented, normal gait | Nourishment: Good',
    'ht_wt': 'Height: 162 cm | Weight: 93 kg | BMI: 35.4 (Obese)',
    'temp_pulse': 'Temperature: 98.6°F | Pulse: 90 bpm, regular',
    'resp_bp': 'Respiration: 18/min | Blood Pressure: 128/82 mmHg',
    'head_to_toe': [
        ('Hair & Scalp', 'Normal texture, black; Scalp clean'),
        ('Eyes', 'No pallor; no periorbital oedema; slight blurring of vision reported'),
        ('Face', 'No puffiness; no chloasma'),
        ('Mouth', 'Teeth – mild caries; Gums – bleeding (gestational gingivitis); Tongue – moist; Lips – moist'),
        ('Neck', 'No thyroid enlargement (on levothyroxine); no lymphadenopathy'),
        ('Chest', 'Lungs – clear; Heart – S1 S2 normal'),
        ('Breast', 'Symmetrical; areola pigmented; Colostrum present on palpation'),
    ],
    'abdomen_inspection': [
        ('Size', 'Large (larger than dates – macrosomia/polyhydramnios)'),
        ('Shape', 'Longitudinal, globular'),
        ('Umbilicus', 'Protruded'),
        ('Skin Changes', 'Linea nigra, striae gravidarum present'),
        ('Visible Fetal Movements', 'Present'),
    ],
    'abdomen_palpation': [
        ('Abdominal Girth', '108 cm'),
        ('Fundal Height (SFH)', '42 cm | Fundal Height in Weeks: >40 weeks (larger than dates)'),
        ('Fundal Palpation (Lie / Presentation)', 'Lie: Longitudinal | Presentation: Cephalic'),
        ('Lateral Palpation (Position)', 'ROA'),
        ('Auscultation of FHS (Rate / Location)', '138 bpm, regular | Located: RLQ'),
        ('Pelvic Palpation (4th Maneuver)', 'Head Free – not engaged (macrosomia)'),
        ('Pawlic Maneuver (3rd Maneuver)', 'Mobile, Flexed'),
    ],
    'lower_ext': [
        ('Varicose Veins', 'Absent'),
        ('Ankle Oedema', '+ bilateral'),
        ('Genitalia – Discharge', 'Whitish, curdy (fungal vaginitis)'),
        ('Genitalia – Bleeding/Show', 'Nil'),
        ('Vulval Oedema', 'Nil'),
        ('Vulval Varicosity', 'Nil'),
    ],
    'drugs': [
        ['Name of Drug', 'Generic Name', 'Dosage', 'Action'],
        ['Insulin (Regular)', 'Human Insulin', '10 units SC before meals', 'Hypoglycaemic'],
        ['Levothyroxine', 'Thyroxine sodium', '50mcg OD empty stomach', 'Thyroid hormone'],
        ['Clotrimazole', 'Clotrimazole', '100mg pessary HS', 'Antifungal'],
        ['Ferrous Sulfate', 'Iron', '200mg OD oral', 'Haematinic'],
        ['Calcium Sandoz', 'Calcium', '500mg BD oral', 'Calcium supplement'],
    ],
    'risk_factors': 'GDM, previous GDM, macrosomia (4.2 kg), polyhydramnios (AFI 22 cm), obesity (BMI 35.4), previous LSCS, hypothyroidism',
    'high_risk': 'YES – GDM with macrosomia; previous LSCS (trial of scar vs repeat LSCS pending)',
    'low_risk': 'Nil',
    'remarks': 'Plan for elective LSCS; neonatology team present for macrosomic baby; blood glucose monitoring every 4 hrs',
    'teaching': [
        ('Nutrition', 'Low glycaemic index diet; small frequent meals; avoid refined sugars; carbohydrate counting taught'),
        ('Follow Up', 'Every week in 3rd trimester; blood glucose log twice daily at home'),
        ('Rest & Sleep', 'Adequate rest; left lateral position; avoid prolonged standing'),
        ('Exercise & Work', 'Mild walking 30 min/day as tolerated'),
        ('Use of Comfort Devices', 'Support stockings for oedema; insulin pen device taught'),
        ('Warning Signs Explained', 'Decreased fetal movements; hypoglycaemic episodes (trembling, sweating, dizziness); signs of labour'),
        ('Minor Discomforts & Remedies', 'Frequent urination expected; antifungal for discharge; flushing — normal with some medications'),
        ('Sex', 'As comfortable; avoid if discharge persists'),
        ('Signs & Symptoms of True Labour', 'Regular contractions; show; spontaneous rupture of membranes'),
    ],
    'nursing_problems': (
        '1. Knowledge deficit regarding insulin self-injection technique — demonstration given; return demonstration done. '
        '2. Risk for fetal macrosomia and birth trauma — LSCS plan discussed. '
        '3. Anxiety regarding LSCS — reassurance; pre-operative teaching given. '
        '4. Self-monitoring of blood glucose taught with logbook. '
        '5. Diet counselling: dietitian referral made; 1800 kcal ADA diet chart provided.'
    ),
}

# ═══════════════════════════════════════════════════════════════
# CASE 3 DATA — SEVERE ANAEMIA
# ═══════════════════════════════════════════════════════════════
case3 = {
    'name': 'Mrs. Kavitha Reddy',
    'wo': 'Mr. Suresh Reddy',
    'age': '22 years',
    'religion': 'Hindu',
    'reg_no': 'OPD/2026/0198',
    'hospital': 'Govt. Maternity Hospital, Hyderabad',
    'date': '07/07/2026',
    'address': 'Bhainsa, Nizamabad District, Telangana',
    'obs_score': 'G1 / P0 / Living: 0 / Abortion: 0',
    'lmp_edd': 'LMP: 20/10/2025 | EDD: 27/07/2026',
    'gest_married': 'Gestational Period: 37 weeks | Married for: 1 Year 6 Months',
    'education': 'Wife: SSC (10th Standard) | Husband: SSC (10th Standard)',
    'occupation': 'Wife: Housewife | Husband: Agricultural Labourer',
    'income': 'Rs. 6,500 per month',
    'house': 'Kacha | 2 Rooms | Ventilation: Inadequate',
    'sanitation': 'Open defecation area; no piped water; borewell',
    'family_type': 'Joint | 7 Members | 4 Adults | 3 Children',
    'hereditary': 'Nil',
    'twins': 'Nil',
    'fam_other': 'Nil',
    'sleep_appetite': 'Sleep: 6 hrs/day | Appetite: Poor | Allergy: Nil',
    'habits': 'Habits: Pica – Geophagia (eating mud/clay) | Addiction: Nil | Bowel: Constipation',
    'diet': 'Vegetarian | 2 Meals per Day',
    'diet_habits': 'Inadequate diet; low protein; low iron; frequent tea consumption with meals (inhibits iron absorption)',
    'childhood': 'Recurrent worm infestations (Hookworm – history)',
    'thyroid': 'Nil',
    'long_term_drugs': 'Nil',
    'other_illness': 'Nil',
    'surgery': 'Nil',
    'menarche': 'Age: 14 years | Cycle: Regular | Interval: 28 days',
    'bleeding': 'Heavy (5–7 days) | Associated Problems: Dysmenorrhoea; fatigue during menses',
    'mens_treatment': 'No',
    'marital_status': 'Married | Age at Marriage: 20 years',
    'marital_years': '1 year 6 months (stays with husband)',
    'consanguineous': 'No',
    'contraceptive': 'No',
    'infertility': 'No',
    'living_children': '0 | Primigravida',
    'abortions': '0 | Spontaneous: 0 | MTP: 0',
    'child_ages': 'Primigravida – NA',
    'congenital': 'Nil',
    'prev_preg_table': [
        ['S.No', 'Date/Year', 'Pregnancy Events', 'Labour Events', 'Mode of Delivery', 'Puerperium', 'Baby (Sex/Wt/Health)'],
        ['—', 'Primigravida', '—', '—', '—', '—', '—'],
    ],
    'prev_preg_widths': [1*cm, 2*cm, 3.5*cm, 2.5*cm, 2.5*cm, 2.5*cm, 3.5*cm],
    'gen_health': 'Poor',
    'complaints': 'Extreme fatigue, breathlessness on exertion, palpitations, dizziness, pallor for 3 months',
    'morning_sickness': 'Yes – severe (1st trimester)',
    'minor_ailments': 'Constipation, leg cramps, headache',
    'first_visit': '20/01/2026 (late registration – 13 weeks)',
    'ga_first_visit': '13 weeks',
    'immunization': 'Yes | Dose: 2 | 1st: 25/01/2026 | 2nd: 25/02/2026',
    'supplements': 'IFA 200mg BD | Calcium 500mg OD – poor compliance reported',
    'other_meds': 'Albendazole 400mg single dose (given at 14 weeks)',
    'trimester1': [
        ('Morning Sickness', 'Yes – Severe | T/t: Ondansetron 4mg BD; dietary advice'),
        ('Bleeding P/V', 'No'),
        ('Any Other Significant Problems', 'Very poor appetite; pica (clay eating)'),
        ('Height / Weight', '152 cm / 42 kg'),
        ('Hb%', '8.2 g/dl'),
        ('BP', '100/64 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / Nil'),
        ('USG Report/Findings', 'Single live intrauterine pregnancy, 10 weeks, normal'),
    ],
    'trimester2': [
        ('Minor Ailments', 'Severe fatigue, pallor, palpitations | T/t: IFA increased; dietary counselling'),
        ('Hospitalisation', 'Yes – 2 days for IV Iron Sucrose infusion (2 doses)'),
        ('Quickening', '20 weeks'),
        ('Fetal Movements', 'Present but reduced'),
        ('Any Other Significant Problems', 'Hb 7.4 g/dl at 24 weeks — Severe anaemia confirmed'),
        ('Height / Weight', '152 cm / 46 kg'),
        ('Hb%', '7.4 g/dl'),
        ('BP', '98/64 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / Nil'),
        ('USG Report/Findings', '24 wks; cephalic; FGR suspected (EFW below 10th percentile); AFI 10 cm'),
    ],
    'trimester3': [
        ('Minor Ailments', 'Breathlessness at rest, oedema feet, extreme pallor'),
        ('Hospitalisation', 'Yes – blood transfusion (1 unit PRBC)'),
        ('Fetal Movements', 'Reduced (6–8 in 12 hrs)'),
        ('Any Other Significant Problems', 'FGR confirmed; Hb not improving adequately despite supplements'),
        ('Height / Weight', '152 cm / 50 kg'),
        ('Hb%', '8.8 g/dl (post-transfusion)'),
        ('BP', '100/68 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / Nil'),
        ('USG Report/Findings', '37 wks; cephalic; AFI 7 cm; EFW 2.1 kg (FGR); BPP 6/10'),
    ],
    'anc_visits': [
        ['Date', 'Ht & Wt', 'B.P', 'Gest. Weeks', 'Fundal Ht', 'Presentation, FHS, Rate', 'Urine Alb/Sugar; Hb%'],
        ['20/01/26', '152/42', '100/64', '13 wks', '13 cm', 'Cephalic, FHS 158', 'Nil/Nil; 8.2'],
        ['10/03/26', '152/44', '98/62', '20 wks', '20 cm', 'Cephalic, FHS 156', 'Nil/Nil; 7.8'],
        ['05/05/26', '152/46', '98/64', '28 wks', '26 cm', 'Cephalic, FHS 154', 'Nil/Nil; 7.4'],
        ['07/07/26', '152/50', '100/68', '37 wks', '33 cm', 'Cephalic, FHS 148', 'Nil/Nil; 8.8'],
    ],
    'lab_table': [
        ['Date', 'Investigations', 'Value in Patient', 'Normal Values'],
        ['20/01/26', 'Hb%', '8.2 g/dl', '11–14 g/dl'],
        ['20/01/26', 'ABO Rh', 'A Positive', '—'],
        ['20/01/26', 'VDRL', 'Non-reactive', 'Non-reactive'],
        ['20/01/26', 'HIV', 'Non-reactive', 'Non-reactive'],
        ['20/01/26', 'HBsAg', 'Negative', 'Negative'],
        ['20/01/26', 'Peripheral Smear', 'Microcytic hypochromic anaemia', 'Normocytic normochromic'],
        ['20/01/26', 'Serum Ferritin', '6 ng/ml', '15–150 ng/ml'],
        ['20/01/26', 'Serum Iron', '42 mcg/dl', '60–170 mcg/dl'],
        ['07/07/26', 'Hb% (post-transfusion)', '8.8 g/dl', '11–14 g/dl'],
        ['07/07/26', 'TC DC', 'TC 8200, DC N68 L28', 'Normal'],
    ],
    'general_app': 'Thin built | Weak, pallor +++, slow gait | Nourishment: Poor',
    'ht_wt': 'Height: 152 cm | Weight: 50 kg | BMI: 21.6',
    'temp_pulse': 'Temperature: 98°F | Pulse: 102 bpm, weak and thready',
    'resp_bp': 'Respiration: 22/min (tachypnoea) | Blood Pressure: 100/68 mmHg',
    'head_to_toe': [
        ('Hair & Scalp', 'Brittle, thin, dull hair; Scalp clean'),
        ('Eyes', 'Conjunctiva pale +++; no periorbital oedema'),
        ('Face', 'Pale; no chloasma'),
        ('Mouth', 'Teeth – no caries; Gums – pale; Tongue – pale, smooth (atrophic glossitis); Lips – pallor ++, angular cheilosis'),
        ('Neck', 'No enlargement'),
        ('Chest', 'Lungs – clear; mild dyspnoea; Heart – soft systolic flow murmur (high-output state due to severe anaemia)'),
        ('Breast', 'Symmetrical; Nipples – erectile; minimal colostrum'),
    ],
    'abdomen_inspection': [
        ('Size', 'Small for dates (FGR suspected)'),
        ('Shape', 'Longitudinal'),
        ('Umbilicus', 'Flat'),
        ('Skin Changes', 'Linea nigra faint; mild striae gravidarum'),
        ('Visible Fetal Movements', 'Present but sluggish'),
    ],
    'abdomen_palpation': [
        ('Abdominal Girth', '82 cm'),
        ('Fundal Height (SFH)', '33 cm | Fundal Height in Weeks: ~33 weeks (less than dates for 37 weeks)'),
        ('Fundal Palpation (Lie / Presentation)', 'Lie: Longitudinal | Presentation: Cephalic'),
        ('Lateral Palpation (Position)', 'LOA'),
        ('Auscultation of FHS (Rate / Location)', '148 bpm, regular | Located: LLQ'),
        ('Pelvic Palpation (4th Maneuver)', 'Engaging'),
        ('Pawlic Maneuver (3rd Maneuver)', 'Fixed, Flexed'),
    ],
    'lower_ext': [
        ('Varicose Veins', 'Absent'),
        ('Ankle Oedema', '+ bilateral'),
        ('Genitalia – Discharge', 'Nil'),
        ('Genitalia – Bleeding/Show', 'Nil'),
        ('Vulval Oedema', 'Nil'),
        ('Vulval Varicosity', 'Nil'),
    ],
    'drugs': [
        ['Name of Drug', 'Generic Name', 'Dosage', 'Action'],
        ['IFA (Iron Folic Acid)', 'Ferrous Sulfate + Folic Acid', '200mg BD oral', 'Haematinic'],
        ['IV Iron Sucrose', 'Iron Sucrose', '200mg IV (3 doses planned)', 'Parenteral iron'],
        ['Calcium Sandoz', 'Calcium carbonate', '500mg OD oral', 'Calcium supplement'],
        ['Albendazole', 'Albendazole', '400mg single dose (given)', 'Anthelmintic'],
        ['Vitamin C', 'Ascorbic acid', '500mg OD (with iron)', 'Enhances iron absorption'],
    ],
    'risk_factors': 'Severe anaemia (Hb 7.4 g/dl), FGR, young age, poor nutrition, low socioeconomic status, late ANC registration, poor compliance, history of hookworm',
    'high_risk': 'YES – Severe iron deficiency anaemia with FGR; high risk of PPH postpartum',
    'low_risk': 'Nil',
    'remarks': 'Blood transfusion given; close fetal monitoring with NST; post-delivery Hb recheck; FGR: plan for early delivery if BPP worsens',
    'teaching': [
        ('Nutrition', 'Iron-rich foods: green leafy vegetables, jaggery, dates, dried fruits; Vitamin C with meals; avoid tea/coffee 1 hr before/after iron tablets'),
        ('Follow Up', 'Twice weekly; Hb monitoring weekly until delivery'),
        ('Rest & Sleep', 'Adequate rest 8–10 hrs; left lateral position; avoid heavy work'),
        ('Exercise & Work', 'Avoid strenuous physical labour; rest between tasks'),
        ('Use of Comfort Devices', 'Comfortable clothing; supportive pillow'),
        ('Warning Signs Explained', 'Decreased / absent fetal movements; heavy bleeding; breathlessness at rest; convulsions – report IMMEDIATELY'),
        ('Minor Discomforts & Remedies', 'Iron may cause black stools (normal); constipation – increase fluids, fibre, gentle activity'),
        ('Sex', 'As comfortable; avoid if fatigued'),
        ('Signs & Symptoms of True Labour', 'Contractions; show (blood-stained mucus); spontaneous rupture of membranes'),
    ],
    'nursing_problems': (
        '1. Activity intolerance related to severe anaemia — planned activities; bed rest with assistance for mobility. '
        '2. Inadequate tissue oxygenation to fetus (FGR) — fetal kick count chart taught; CTG arranged. '
        '3. Knowledge deficit about nutrition and IFA compliance — counselling; picture-based nutrition card given. '
        '4. Poor social support — referral to social worker and Anganwadi worker done. '
        '5. Risk of PPH postpartum — oxytocin standby; blood group & crossmatch done; family informed.'
    ),
}

# ═══════════════════════════════════════════════════════════════
# CASE 4 DATA — PLACENTA PREVIA
# ═══════════════════════════════════════════════════════════════
case4 = {
    'name': 'Mrs. Fatima Begum',
    'wo': 'Mr. Mohammed Irfan',
    'age': '34 years',
    'religion': 'Muslim',
    'reg_no': 'IP/2026/0756',
    'hospital': 'Govt. Medical College Hospital, Bhopal',
    'date': '11/07/2026 (Emergency Admission)',
    'address': '7, Peer Gate Area, Bhopal, Madhya Pradesh',
    'obs_score': 'G4 / P3 / Living: 3 / Abortion: 0',
    'lmp_edd': 'LMP: 15/10/2025 | EDD: 22/07/2026',
    'gest_married': 'Gestational Period: 38 weeks | Married for: 14 Years',
    'education': 'Wife: Nil (Illiterate) | Husband: Middle School',
    'occupation': 'Wife: Housewife | Husband: Rickshaw Puller',
    'income': 'Rs. 8,000 per month',
    'house': 'Kacha/Pacca | 2 Rooms | Ventilation: Moderate',
    'sanitation': 'Community toilet; borewell water',
    'family_type': 'Nuclear | 5 Members | 2 Adults | 3 Children',
    'hereditary': 'Nil',
    'twins': 'Nil',
    'fam_other': 'Nil',
    'sleep_appetite': 'Sleep: 6–7 hrs/day | Appetite: Average | Allergy: Nil',
    'habits': 'Habits: Nil | Addiction: Nil | Bladder & Bowel: Normal',
    'diet': 'Non-Vegetarian | 3 Meals per Day',
    'diet_habits': 'Adequate diet; no specific habits',
    'childhood': 'Nil',
    'thyroid': 'Nil',
    'long_term_drugs': '1 Blood transfusion post-delivery (2nd pregnancy – PPH)',
    'other_illness': 'Nil',
    'surgery': 'LSCS (2022) – lower uterine segment scar present; indication: Placenta Previa Type II',
    'menarche': 'Age: 13 years | Cycle: Regular | Interval: 28–30 days',
    'bleeding': 'Moderate | Associated Problems: Nil',
    'mens_treatment': 'No',
    'marital_status': 'Married | Age at Marriage: 20 years',
    'marital_years': '14 years (stays with husband)',
    'consanguineous': 'No',
    'contraceptive': 'No (does not use contraception)',
    'infertility': 'No',
    'living_children': '3 | Girls: 2 | Boys: 1',
    'abortions': '0 | Spontaneous: 0 | MTP: 0',
    'child_ages': 'Age of First Child: 14 years | Age of Last Child: 4 years',
    'congenital': 'Nil',
    'prev_preg_table': [
        ['S.No', 'Date/Year', 'Pregnancy Events', 'Labour Events', 'Mode of Delivery', 'Puerperium', 'Baby (Sex/Wt/Health)'],
        ['1', '2012', 'Normal', 'Normal', 'NVD', 'Uneventful', 'Girl, 2.8 kg'],
        ['2', '2018', 'Normal', 'Prolonged 2nd stage', 'NVD (Forceps)', 'PPH, blood transfusion', 'Boy, 3.0 kg'],
        ['3', '2022', 'Low-lying placenta on USG', '—', 'LSCS (Placenta Previa Type II)', 'Uneventful; wound healed', 'Girl, 2.9 kg'],
    ],
    'prev_preg_widths': [0.8*cm, 1.8*cm, 3*cm, 2.5*cm, 3*cm, 3*cm, 3.4*cm],
    'gen_health': 'Fair',
    'complaints': 'Sudden painless bright red vaginal bleeding – 3 episodes; last episode (heavy) this morning',
    'morning_sickness': 'Yes – mild',
    'minor_ailments': 'Backache, mild oedema',
    'first_visit': '10/12/2025',
    'ga_first_visit': '8 weeks',
    'immunization': 'Yes | Dose: 2 | 1st: 15/12/2025 | 2nd: 15/01/2026',
    'supplements': 'Iron | Calcium | Folic Acid (as prescribed)',
    'other_meds': 'None',
    'trimester1': [
        ('Morning Sickness', 'Yes – Mild | T/t: Dietary advice'),
        ('Bleeding P/V', 'Nil'),
        ('Any Other Significant Problems', 'Nil'),
        ('Height / Weight', '154 cm / 62 kg'),
        ('Hb%', '10.4 g/dl'),
        ('BP', '112/72 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / Nil'),
        ('USG Report/Findings', 'Single live intrauterine pregnancy, 9 weeks; low implantation noted – repeat scan at 28 wks advised'),
    ],
    'trimester2': [
        ('Minor Ailments', 'Backache | T/t: Rest advised'),
        ('Hospitalisation', 'No'),
        ('Quickening', '20 weeks'),
        ('Fetal Movements', 'Good'),
        ('Any Other Significant Problems', 'USG 24 wks: Placenta anterior, low-lying, reaching internal os (Type III Placenta Previa)'),
        ('Height / Weight', '154 cm / 67 kg'),
        ('Hb%', '10.0 g/dl'),
        ('BP', '114/72 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / Nil'),
        ('USG Report/Findings', '24 wks; Type III Placenta Previa (anterior); normal fetal growth'),
    ],
    'trimester3': [
        ('Minor Ailments', '3 episodes painless bright red P/V bleeding'),
        ('Hospitalisation', 'Yes – 2 admissions for APH management'),
        ('Fetal Movements', 'Good (10 in 12 hrs)'),
        ('Any Other Significant Problems', 'Major degree placenta previa (Type IV); LSCS scar – risk of Placenta Accreta Spectrum'),
        ('Height / Weight', '154 cm / 72 kg'),
        ('Hb%', '8.6 g/dl (post-bleeding)'),
        ('BP', '110/70 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / Nil'),
        ('USG Report/Findings', '38 wks; cephalic high floating; Placenta anterior completely covering OS (Type IV); EFW 2.8 kg'),
    ],
    'anc_visits': [
        ['Date', 'Ht & Wt', 'B.P', 'Gest. Weeks', 'Fundal Ht', 'Presentation, FHS, Rate', 'Urine Alb/Sugar; Hb%'],
        ['10/12/25', '154/62', '112/72', '8 wks', '—', '—', 'Nil/Nil; 10.4'],
        ['15/02/26', '154/65', '114/72', '18 wks', '18 cm', 'Cephalic high, FHS 154', 'Nil/Nil; 10.2'],
        ['10/04/26', '154/67', '114/72', '26 wks', '26 cm', 'Cephalic high, FHS 150', 'Nil/Nil; 10.0'],
        ['20/06/26', '154/70', '112/70', '35 wks', '34 cm', 'Cephalic high, FHS 146', 'Nil/Nil; 9.2'],
        ['11/07/26', '154/72', '110/70', '38 wks', '36 cm', 'Cephalic high floating, FHS 144', 'Nil/Nil; 8.6'],
    ],
    'lab_table': [
        ['Date', 'Investigations', 'Value in Patient', 'Normal Values'],
        ['10/12/25', 'Hb%', '10.4 g/dl', '11–14 g/dl'],
        ['10/12/25', 'ABO Rh', 'AB Positive', '—'],
        ['10/12/25', 'VDRL', 'Non-reactive', 'Non-reactive'],
        ['10/12/25', 'HIV', 'Non-reactive', 'Non-reactive'],
        ['10/12/25', 'HBsAg', 'Negative', 'Negative'],
        ['11/07/26', 'Hb%', '8.6 g/dl', '11–14 g/dl'],
        ['11/07/26', 'BT, CT, PT', 'BT 2 min, CT 4 min, PT 12 sec', 'Normal'],
        ['11/07/26', 'TC DC', 'TC 9200, DC N72', 'Normal'],
        ['11/07/26', 'Blood Group (Crossmatch)', 'AB+ – 2 units reserved', '—'],
        ['11/07/26', 'Urine R/E', 'Normal', 'Normal'],
    ],
    'general_app': 'Average built | Anxious, pale, restless | Nourishment: Average',
    'ht_wt': 'Height: 154 cm | Weight: 72 kg | BMI: 30.4',
    'temp_pulse': 'Temperature: 98.4°F | Pulse: 96 bpm, regular',
    'resp_bp': 'Respiration: 20/min | Blood Pressure: 110/70 mmHg',
    'head_to_toe': [
        ('Hair & Scalp', 'Normal; Scalp clean'),
        ('Eyes', 'Conjunctiva pale +; no periorbital oedema'),
        ('Face', 'Anxious expression; pale; no facial puffiness'),
        ('Mouth', 'Tongue moist; Lips pale, dry'),
        ('Neck', 'No enlargement'),
        ('Chest', 'Lungs clear; Heart S1 S2 normal'),
        ('Breast', 'Symmetrical; Montgomery\'s tubercles present; Nipples – erectile; Colostrum present'),
    ],
    'abdomen_inspection': [
        ('Size', 'Corresponding to POG (38 wks)'),
        ('Shape', 'Longitudinal'),
        ('Umbilicus', 'Protrudes'),
        ('Skin Changes', 'Linea nigra; striae gravidarum; Pfannenstiel LSCS scar visible on lower abdomen'),
        ('Visible Fetal Movements', 'Present'),
    ],
    'abdomen_palpation': [
        ('Abdominal Girth', '94 cm'),
        ('Fundal Height (SFH)', '36 cm | Fundal Height in Weeks: 36 weeks (slightly smaller – head floating high)'),
        ('Fundal Palpation (Lie / Presentation)', 'Lie: Longitudinal | Presentation: Cephalic – head HIGH, not at fundus'),
        ('Lateral Palpation (Position)', 'ROA'),
        ('Auscultation of FHS (Rate / Location)', '144 bpm, regular | Located: RLQ'),
        ('Pelvic Palpation (4th Maneuver)', 'Head FREE – not engaged (floating high due to placenta previa occupying lower segment)'),
        ('Pawlic Maneuver', 'Mobile (head floating – not engaged)'),
        ('NOTE', 'Per Vaginal Examination CONTRAINDICATED in Placenta Previa'),
    ],
    'lower_ext': [
        ('Varicose Veins', 'Absent'),
        ('Ankle Oedema', '+ mild bilateral'),
        ('Genitalia – Discharge', 'Blood-stained – fresh bright red blood; painless APH'),
        ('Genitalia – Bleeding/Show', 'YES – bright red, painless antepartum haemorrhage'),
        ('Vulval Oedema', 'Nil'),
        ('Vulval Varicosity', 'Nil'),
    ],
    'drugs': [
        ['Name of Drug', 'Generic Name', 'Dosage', 'Action'],
        ['IV Fluid NS', 'Normal Saline 0.9%', '500 ml IV stat', 'Volume replacement'],
        ['Ferrous Sulfate', 'Iron', '200mg TDS oral', 'Haematinic'],
        ['Betamethasone', 'Betamethasone', '12mg IM x 2 doses', 'Fetal lung maturity (if preterm)'],
        ['IV Oxytocin', 'Oxytocin', 'Post LSCS infusion', 'Uterotonic – prevent PPH'],
        ['Injection Morphine', 'Morphine sulphate', '10mg IV (pre-op)– per protocol', 'Analgesia'],
    ],
    'risk_factors': 'Grand multipara (G4P3); previous LSCS; major degree placenta previa (Type IV); repeated APH; anaemia (Hb 8.6); risk of placenta accreta spectrum (PAS)',
    'high_risk': 'YES – Major Placenta Previa Type IV + previous LSCS; risk of massive PPH; possible emergency hysterectomy',
    'low_risk': 'Nil',
    'remarks': 'Elective LSCS planned; 2 units blood crossmatched; ICU standby; anaesthesia team informed; risk of PAS and hysterectomy discussed with family; consent obtained',
    'teaching': [
        ('Nutrition', 'Iron-rich diet; high protein; avoid constipation (Valsalva worsens bleeding)'),
        ('Follow Up', 'Inpatient – NO discharge until delivery; no home follow-up'),
        ('Rest & Sleep', 'Complete bed rest; no ambulation without assistance; bed pan use'),
        ('Exercise & Work', 'Strictly avoid all exertion'),
        ('Use of Comfort Devices', 'Side rails up; call bell within reach; IV line care'),
        ('Warning Signs Explained', 'Any fresh bleeding – press emergency buzzer IMMEDIATELY; no P/V exam at home'),
        ('Minor Discomforts & Remedies', 'Backache – positioning with pillow support; avoid constipation'),
        ('Sex', 'Absolutely CONTRAINDICATED (placenta previa)'),
        ('Signs & Symptoms of True Labour', 'If contractions become regular/strong – inform nurse immediately; do NOT push'),
    ],
    'nursing_problems': (
        '1. Fear and anxiety about maternal and fetal outcome — counselling given; family support involved. '
        '2. Risk of haemorrhagic shock — IV access secured (16G); blood crossmatched; continuous BP and pulse monitoring. '
        '3. Altered uteroplacental perfusion — fetal heart monitoring every 30 min; oxygen via mask. '
        '4. Risk of PPH post-LSCS — oxytocin infusion planned; blood transfusion ready. '
        '5. Family counselling done regarding possibility of hysterectomy; informed consent obtained for LSCS.'
    ),
}

# ═══════════════════════════════════════════════════════════════
# CASE 5 DATA — PRETERM LABOUR
# ═══════════════════════════════════════════════════════════════
case5 = {
    'name': 'Mrs. Deepa Menon',
    'wo': 'Mr. Arun Menon',
    'age': '30 years',
    'religion': 'Christian',
    'reg_no': 'IP/2026/0612',
    'hospital': 'Amrita Institute of Medical Sciences, Kochi',
    'date': '09/07/2026 (Emergency Admission)',
    'address': 'Thrippunithura, Ernakulam District, Kerala',
    'obs_score': 'G2 / P1 / Living: 0 / Abortion: 1',
    'lmp_edd': 'LMP: 25/11/2025 | EDD: 01/09/2026',
    'gest_married': 'Gestational Period: 32 weeks | Married for: 5 Years',
    'education': 'Wife: B.Sc. Nursing | Husband: B.Tech',
    'occupation': 'Wife: Staff Nurse (on maternity leave) | Husband: IT Engineer',
    'income': 'Rs. 65,000 per month',
    'house': 'Pacca | 3 BHK | Ventilation: Excellent',
    'sanitation': 'Indoor toilet; purified water; excellent hygiene',
    'family_type': 'Nuclear | 2 Members | 2 Adults | 0 Children',
    'hereditary': 'Nil',
    'twins': 'Maternal (maternal aunt – twins)',
    'fam_other': 'Nil',
    'sleep_appetite': 'Sleep: 8 hrs/day | Appetite: Good | Allergy: Penicillin',
    'habits': 'Habits: Nil | Addiction: Nil | Bladder & Bowel: Normal',
    'diet': 'Non-Vegetarian | 4 balanced meals per day',
    'diet_habits': 'Well-balanced nutritious diet throughout pregnancy; folic acid before conception',
    'childhood': 'Nil',
    'thyroid': 'Hypothyroid – on Levothyroxine 25mcg',
    'long_term_drugs': 'Levothyroxine 25mcg OD',
    'other_illness': 'Uterine fibroid (intramural 2 cm) diagnosed 2023 – conservative management; no cavity distortion',
    'surgery': 'D&C for missed abortion (2024)',
    'menarche': 'Age: 13 years | Cycle: Regular | Interval: 28 days',
    'bleeding': 'Moderate | Associated Problems: Mild dysmenorrhoea',
    'mens_treatment': 'No',
    'marital_status': 'Married | Age at Marriage: 25 years',
    'marital_years': '5 years (stays with husband)',
    'consanguineous': 'No',
    'contraceptive': 'Yes – Condom (between pregnancies)',
    'infertility': 'No (conceived spontaneously)',
    'living_children': '0 (previous pregnancy – missed abortion)',
    'abortions': '1 | Spontaneous: 1 (missed abortion at 10 weeks, 2024) | MTP: 0',
    'child_ages': 'No living children',
    'congenital': 'Nil',
    'prev_preg_table': [
        ['S.No', 'Date/Year', 'Pregnancy Events', 'Labour Events', 'Mode of Delivery', 'Puerperium', 'Baby (Sex/Wt/Health)'],
        ['1', '2024', 'Missed abortion at 10 weeks', '—', 'D&C done', 'Uneventful; recovered well', 'No viable baby'],
    ],
    'prev_preg_widths': [1*cm, 2*cm, 3.5*cm, 2.5*cm, 2.5*cm, 2.5*cm, 3.5*cm],
    'gen_health': 'Good until current admission',
    'complaints': 'Low backache; mild lower abdominal cramps (every 10–12 min); watery vaginal discharge since morning',
    'morning_sickness': 'Yes – mild (1st trimester)',
    'minor_ailments': 'Round ligament pain, constipation, heartburn',
    'first_visit': '02/01/2026',
    'ga_first_visit': '6 weeks',
    'immunization': 'Yes | Dose: 2 | 1st: 10/01/2026 | 2nd: 10/02/2026',
    'supplements': 'Calcium 1000mg OD | Ferrous Sulfate 200mg OD | Folic Acid 5mg OD | Progesterone pessary 200mg HS (up to 28 wks)',
    'other_meds': 'Levothyroxine 25mcg OD; 17-OHP injections from 16–28 weeks (preterm prevention)',
    'trimester1': [
        ('Morning Sickness', 'Yes – Mild | T/t: ORS, ginger tea'),
        ('Bleeding P/V', 'Slight spotting at 6 weeks | T/t: Progesterone 200mg HS; rest advised'),
        ('Any Other Significant Problems', 'Anxiety due to previous abortion'),
        ('Height / Weight', '163 cm / 58 kg'),
        ('Hb%', '12.2 g/dl'),
        ('BP', '108/68 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / Nil'),
        ('USG Report/Findings', 'Single live intrauterine pregnancy, 7 wks; heartbeat present; fibroid noted (intramural 2 cm, not distorting cavity)'),
    ],
    'trimester2': [
        ('Minor Ailments', 'Round ligament pain; constipation | T/t: Dietary fibre; mild analgesic'),
        ('Hospitalisation', 'No'),
        ('Quickening', '18 weeks'),
        ('Fetal Movements', 'Good, regular'),
        ('Any Other Significant Problems', 'Cervical length 28 mm at 22 wks (short cervix – high risk for PTL)'),
        ('Height / Weight', '163 cm / 63 kg'),
        ('Hb%', '12.0 g/dl'),
        ('BP', '110/70 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / Nil'),
        ('USG Report/Findings', '22 wks; single live fetus; normal growth; fibroid stable; cervical length 28 mm'),
    ],
    'trimester3': [
        ('Minor Ailments', 'Low backache; increased watery vaginal discharge'),
        ('Hospitalisation', 'YES – current admission: threatened preterm labour at 32 weeks'),
        ('Fetal Movements', 'Good (10 in 12 hrs)'),
        ('Any Other Significant Problems', 'Contractions every 10 min; cervix dilated 2 cm; SROM suspected (fern test positive); fFN positive'),
        ('Height / Weight', '163 cm / 70 kg'),
        ('Hb%', '11.8 g/dl'),
        ('BP', '110/72 mmHg'),
        ('Urine – Albumin / Sugar', 'Nil / Nil'),
        ('USG Report/Findings', '32 wks; cephalic; AFI 12 cm; EFW 1.8 kg (appropriate); BPP 8/10; cervical length 18 mm'),
    ],
    'anc_visits': [
        ['Date', 'Ht & Wt', 'B.P', 'Gest. Weeks', 'Fundal Ht', 'Presentation, FHS, Rate', 'Urine Alb/Sugar; Hb%'],
        ['02/01/26', '163/58', '108/68', '6 wks', '—', '—', 'Nil/Nil; 12.2'],
        ['01/03/26', '163/61', '110/70', '14 wks', '14 cm', 'Cephalic, FHS 160', 'Nil/Nil; 12.0'],
        ['30/04/26', '163/64', '110/70', '22 wks', '22 cm', 'Cephalic, FHS 156', 'Nil/Nil; 12.0'],
        ['25/06/26', '163/68', '110/72', '29 wks', '28 cm', 'Cephalic, FHS 152', 'Nil/Nil; 11.8'],
        ['09/07/26', '163/70', '110/72', '32 wks', '30 cm', 'Cephalic, FHS 150', 'Nil/Nil; 11.8'],
    ],
    'lab_table': [
        ['Date', 'Investigations', 'Value in Patient', 'Normal Values'],
        ['02/01/26', 'Hb%', '12.2 g/dl', '11–14 g/dl'],
        ['02/01/26', 'ABO Rh', 'O Positive', '—'],
        ['02/01/26', 'VDRL', 'Non-reactive', 'Non-reactive'],
        ['02/01/26', 'HIV', 'Non-reactive', 'Non-reactive'],
        ['02/01/26', 'HBsAg', 'Negative', 'Negative'],
        ['02/01/26', 'TSH', '1.8 mIU/L', '0.1–2.5 (pregnancy)'],
        ['09/07/26', 'High Vaginal Swab (HVS)', 'No growth', 'No growth (normal)'],
        ['09/07/26', 'Fetal Fibronectin (fFN)', 'POSITIVE', 'Negative (negative = <1% PTL risk)'],
        ['09/07/26', 'CRP', '6 mg/L', '<5 mg/L'],
        ['09/07/26', 'TC DC', 'TC 11,200 (borderline)', '4000–11,000'],
    ],
    'general_app': 'Average built | Alert, anxious; mild distress during contractions | Nourishment: Good',
    'ht_wt': 'Height: 163 cm | Weight: 70 kg | BMI: 26.3 (overweight)',
    'temp_pulse': 'Temperature: 99.0°F (37.2°C – borderline) | Pulse: 92 bpm, regular',
    'resp_bp': 'Respiration: 18/min | Blood Pressure: 110/72 mmHg',
    'head_to_toe': [
        ('Hair & Scalp', 'Normal; Scalp clean'),
        ('Eyes', 'Conjunctiva pink; well hydrated; no oedema'),
        ('Face', 'No puffiness; mild anxiety expression'),
        ('Mouth', 'Moist tongue; lips moist; no pallor'),
        ('Neck', 'No enlargement'),
        ('Chest', 'Lungs – clear; Heart – normal'),
        ('Breast', 'Symmetrical; Montgomery\'s tubercles present; Nipples – erectile; No colostrum yet (32 wks)'),
    ],
    'abdomen_inspection': [
        ('Size', 'Small for a term pregnancy (32 weeks – preterm)'),
        ('Shape', 'Longitudinal'),
        ('Umbilicus', 'Flat'),
        ('Skin Changes', 'Mild linea nigra; early striae gravidarum'),
        ('Visible Fetal Movements', 'Present'),
        ('Uterine Contractions', 'Visible mild tightening every 10–12 min'),
    ],
    'abdomen_palpation': [
        ('Abdominal Girth', '86 cm'),
        ('Fundal Height (SFH)', '30 cm | Fundal Height in Weeks: 30–32 weeks'),
        ('Fundal Palpation (Lie / Presentation)', 'Lie: Longitudinal | Presentation: Cephalic'),
        ('Lateral Palpation (Position)', 'LOA'),
        ('Uterine Contractions on Palpation', 'Mild, every 10–12 min; duration 20–25 seconds; uterus relaxes between'),
        ('Auscultation of FHS (Rate / Location)', '150 bpm, regular | Located: LLQ (recovery after contraction – normal)'),
        ('Pelvic Palpation (4th Maneuver)', 'Head Free – not engaged (32 weeks)'),
        ('Pawlic Maneuver (3rd Maneuver)', 'Free, Flexed'),
    ],
    'lower_ext': [
        ('Varicose Veins', 'Absent'),
        ('Ankle Oedema', 'Nil'),
        ('Genitalia – Discharge', 'Watery, thin, clear (liquor amnii – SROM suspected; fern test positive)'),
        ('Genitalia – Bleeding/Show', 'Nil'),
        ('Vulval Oedema', 'Nil'),
        ('Vulval Varicosity', 'Nil'),
    ],
    'drugs': [
        ['Name of Drug', 'Generic Name', 'Dosage', 'Action'],
        ['Nifedipine (Tocolytic)', 'Nifedipine SR', '20mg oral stat; then 10mg TDS', 'Tocolysis – suppress PTL'],
        ['Betamethasone', 'Betamethasone', '12mg IM x 2 doses (24 hrs apart)', 'Fetal lung surfactant maturation'],
        ['Magnesium Sulphate', 'MgSO₄', '4g IV loading; 1g/hr maintenance', 'Neuroprotection of preterm fetus'],
        ['Levothyroxine', 'Thyroxine sodium', '25mcg OD (continue)', 'Thyroid hormone'],
        ['IV Ringer\'s Lactate', 'Ringer\'s Lactate', '100 ml/hr IV', 'Hydration'],
    ],
    'risk_factors': 'Threatened preterm labour at 32 weeks; SROM suspected; uterine fibroid; short cervix (history); previous D&C; positive fFN; borderline infection markers (CRP 6, WBC 11200)',
    'high_risk': 'YES – Imminent preterm delivery at 32 weeks; risk of preterm neonate needing NICU admission',
    'low_risk': 'Nil',
    'remarks': 'NICU team informed; neonatologist on standby; steroids completed; tocolysis ongoing; infection screen in progress; CTG every 4 hrs',
    'teaching': [
        ('Nutrition', 'High protein; calcium-rich diet; balanced meals; adequate hydration (oral if tolerated)'),
        ('Follow Up', 'Continuous inpatient monitoring; CTG every 4 hours; fetal movements charted'),
        ('Rest & Sleep', 'Complete bed rest; left lateral position; minimal movement'),
        ('Exercise & Work', 'Absolutely restricted – complete bed rest'),
        ('Use of Comfort Devices', 'IV line care; position support pillows; warm compression for backache'),
        ('Warning Signs Explained', 'Increased contraction frequency; gush of fluid; fever; decreased fetal movements – inform IMMEDIATELY'),
        ('Minor Discomforts & Remedies', 'Nifedipine may cause flushing/headache (normal, transient); IV site care; anxiety counselling'),
        ('Sex', 'Absolutely CONTRAINDICATED (SROM suspected; preterm labour)'),
        ('Signs & Symptoms of True Labour', 'Contractions every 5 min or less; strong, increasing duration; push urge – inform team immediately'),
    ],
    'nursing_problems': (
        '1. Anxiety about preterm baby outcome — NICU tour arranged; neonatologist counselled couple about prognosis at 32 wks. '
        '2. Risk of chorioamnionitis (SROM) — temperature every 2 hrs; FHS monitoring; white cell count; foul discharge watch. '
        '3. Importance of completing betamethasone 2 doses explained; timing documented. '
        '4. Fetal heart monitoring after every contraction — CTG strip attached; pathological trace protocol ready. '
        '5. Partner counselling done; informed consent for neonatal interventions (CPAP, surfactant) obtained.'
    ),
}

# Build the document
add_case(story, 1, "Pregnancy-Induced Hypertension (PIH) / Preeclampsia", case1)
add_case(story, 2, "Gestational Diabetes Mellitus (GDM)", case2)
add_case(story, 3, "Severe Iron Deficiency Anaemia in Pregnancy", case3)
add_case(story, 4, "Placenta Previa (Antepartum Haemorrhage)", case4)
add_case(story, 5, "Preterm Labour at 32 Weeks", case5)

doc.build(story)
print(f"PDF successfully created: {OUTPUT}")