History taking obs gynae

Reading File

Finding Sources

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Finding Sources

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Finding Sources

Reading File

Finding Sources

I now have enough from the textbooks combined with my comprehensive knowledge to give a thorough answer. Here is a structured guide to history taking in obstetrics and gynaecology (obs & gynae):

History Taking in Obstetrics & Gynaecology

A structured obs & gynae history has several components that differ from general medical history. The standard framework is as follows:

1. Patient Details

Name, age, date of birth
Parity/gravidity (noted at the start for context)

2. Presenting Complaint (PC)

One or two words describing the main problem in the patient's own words.

Common gynaecological complaints: abnormal bleeding, pelvic pain, vaginal discharge, prolapse, subfertility, vulval symptoms
Common obstetric complaints: bleeding in pregnancy, reduced fetal movements, abdominal pain, ruptured membranes, labour

3. History of Presenting Complaint (HPC)

Expand on the PC using the SOCRATES mnemonic or equivalent:

Site - localised or generalised (e.g. pelvic pain - unilateral or bilateral?)
Onset - sudden or gradual; relation to menstrual cycle
Character - type of pain, type of bleeding (fresh/dark, clots)
Radiation - pain to back, shoulder tip (diaphragmatic irritation - think ectopic)
Associations - nausea, vomiting, fever, urinary/bowel symptoms, dyspareunia
Timing - cyclical vs. constant; duration
Exacerbating/relieving factors
Severity - impact on daily life

For bleeding, specifically ask:

Amount (number of pads/tampons per day, flooding, clots)
Duration and frequency
Intermenstrual or postcoital bleeding
Postmenopausal bleeding

4. Menstrual History

This is unique to obs & gynae history:

Question	Detail
LMP (Last Menstrual Period)	Date; was it normal in character?
Menarche	Age at first period
Cycle length	Normal 21-35 days
Duration of flow	Normal 2-7 days
Amount	Heavy/light; number of pads; flooding; clots
Regularity	Regular, irregular, or absent (amenorrhoea)
Dysmenorrhoea	Primary or secondary; severity
IMB	Intermenstrual bleeding
PCB	Postcoital bleeding
PMB	Postmenopausal bleeding (in older women)
Menopause status	Age of menopause if applicable; HRT use

Abnormal uterine bleeding is classified by the PALM-COEIN system: Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia - Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not classified. - Rosen's Emergency Medicine

5. Obstetric History (GTPAL)

Record for every pregnancy in chronological order:

G - Gravida (total number of pregnancies, including current)
T - Term deliveries (≥37 weeks)
P - Preterm deliveries (24-36+6 weeks)
A - Abortions/miscarriages/terminations (<24 weeks)
L - Living children

For each previous pregnancy, document:

Year, gestation at delivery
Mode of delivery (SVD, instrumental, CS - and if CS, indication and type: lower segment/classical)
Complications in pregnancy (pre-eclampsia, GDM, APH, placenta praevia)
Complications in labour/delivery (PPH, perineal tears, shoulder dystocia)
Baby's weight, sex, condition at birth (Apgar, NICU admission)
Neonatal/postnatal complications

6. Gynaecological History

Cervical smear history - date of last smear, results, any colposcopy/treatment
Contraception - current and past methods; reason for stopping
STIs - history of sexually transmitted infections (ask sensitively)
Subfertility - duration of trying to conceive, any investigations or treatment
Pelvic inflammatory disease (PID) or previous pelvic surgery

7. Sexual History (ask sensitively, ensure privacy)

Sexually active? Gender of partners?
Dyspareunia (superficial or deep)
Postcoital bleeding
Screen for STIs if relevant

8. Past Medical History (PMH)

Medical conditions (diabetes, hypertension, thyroid disease, autoimmune conditions, coagulopathies - especially relevant for menstrual problems)
Surgical history (especially pelvic/abdominal surgery - risk of adhesions)
Previous anaesthetic problems

9. Drug History & Allergies

Current medications including over-the-counter drugs and herbal remedies
Hormonal medications: OCP, HRT, progestogens, anticoagulants
Folic acid and iron supplementation (in pregnancy)
Drug allergies with nature of reaction

10. Family History

Gynaecological cancers (ovarian, endometrial, breast - BRCA mutations)
Obstetric complications (pre-eclampsia, VTE)
Coagulopathies (Von Willebrand disease - relevant in menorrhagia)
Diabetes, hypertension, congenital anomalies

11. Social History

Occupation and impact of symptoms on work
Smoking (pack-years) - risk factor for ectopic pregnancy, cervical cancer, subfertility; also important for antenatal care
Alcohol intake (units/week) - teratogenicity in pregnancy
Recreational drug use
Relationship status, domestic violence screen (ask privately: "Do you feel safe at home?")
Living arrangements and social support
Country of origin (relevant for female genital mutilation, sickle cell/thalassaemia screening)

12. Review of Systems

Targeted systems relevant to obs & gynae:

Urinary: frequency, urgency, incontinence, dysuria, haematuria
Bowel: constipation, rectal bleeding, change in bowel habit (endometriosis, prolapse)
Thyroid: weight change, heat/cold intolerance (thyroid causes AUB)
Skin/hair: acne, hirsutism, weight gain (PCOS)
Breast: lumps, nipple discharge, galactorrhoea (hyperprolactinaemia)
Venous: leg swelling, DVT/PE history (VTE risk in pregnancy)

In the Antenatal Setting (Specific Additions)

Element	Detail
Gestational age	LMP, EDD (Naegele's rule: LMP + 9 months + 7 days), dating scan
Symptoms of pregnancy	Morning sickness, fetal movements (from ~18-20 weeks), breast changes
Booking bloods	Blood group, antibody screen, FBC, rubella, syphilis, HIV, HBsAg, haemoglobinopathy screen
Antenatal scans	Dating scan, anomaly scan (20 weeks), growth scans
Risk assessment	Pre-eclampsia risk, GDM screening (OGTT), VTE risk
Current pregnancy complications	Bleeding, pain, reduced movements, leaking fluid
Fetal movements	Established by ~18-24 weeks; reduced movements requires urgent assessment

Closing the History

"Is there anything else you would like to tell me or ask?"
Note any safeguarding concerns (domestic violence, FGM, child protection)
Establish the patient's ideas, concerns, and expectations (ICE)

Key sources: Berek & Novak's Gynecology (9th ed.); Rosen's Emergency Medicine (principles of AUB history)

Create a quick reference checklist PDF for obs & gynae history

Reading File

Running Command

ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace not found"

Running Command

mkdir -p /home/daytona/workspace/obs-gynae-checklist && python3 -c "import reportlab; print('reportlab ok')"

Writing File

~/obs-gynae-checklist/generate_checklist.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable
)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_LEFT, TA_CENTER

OUTPUT = "/home/daytona/workspace/obs-gynae-checklist/ObsGynae_History_Checklist.pdf"

# ── Colour palette ────────────────────────────────────────────────────────────
TEAL       = colors.HexColor("#1A6B6B")
TEAL_LIGHT = colors.HexColor("#E8F5F5")
PINK       = colors.HexColor("#C0395A")
PINK_LIGHT = colors.HexColor("#FDF0F3")
GREY_DARK  = colors.HexColor("#2D2D2D")
GREY_MID   = colors.HexColor("#555555")
GREY_LIGHT = colors.HexColor("#F4F4F4")
WHITE      = colors.white
AMBER      = colors.HexColor("#F5A623")
AMBER_LIGHT= colors.HexColor("#FFF8EE")

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=14*mm,
    rightMargin=14*mm,
    topMargin=12*mm,
    bottomMargin=12*mm,
)

W, H = A4
usable_w = W - 28*mm

styles = getSampleStyleSheet()

# Custom paragraph styles
def ps(name, size, color=GREY_DARK, bold=False, leading=None, alignment=TA_LEFT, space_before=0, space_after=2):
    return ParagraphStyle(
        name,
        fontName="Helvetica-Bold" if bold else "Helvetica",
        fontSize=size,
        textColor=color,
        leading=leading or (size * 1.35),
        alignment=alignment,
        spaceAfter=space_after,
        spaceBefore=space_before,
    )

title_style    = ps("title",    20, TEAL,      bold=True,  alignment=TA_CENTER, space_after=2)
subtitle_style = ps("subtitle", 10, GREY_MID,             alignment=TA_CENTER, space_after=1)
sec_style      = ps("sec",       9, WHITE,     bold=True,  leading=12)
item_style     = ps("item",      8, GREY_DARK,             leading=11, space_after=0)
note_style     = ps("note",      7, GREY_MID,              leading=10)
box_label      = ps("box_label", 7, GREY_MID,              leading=9,  alignment=TA_CENTER)
tag_style      = ps("tag",       7.5, WHITE,   bold=True,  leading=10, alignment=TA_CENTER)

CHECKBOX = "☐"
BULLET   = "•"

def checkbox(text, indent=0, bold_prefix=None):
    prefix = f"<b>{bold_prefix}</b> " if bold_prefix else ""
    ind = "&nbsp;" * (indent * 4)
    return Paragraph(f"{ind}{CHECKBOX} {prefix}{text}", item_style)

def bullet(text, indent=0):
    ind = "&nbsp;" * (indent * 4)
    return Paragraph(f"{ind}{BULLET} {text}", note_style)

def section_header(text, bg=TEAL):
    p = Paragraph(text.upper(), sec_style)
    t = Table([[p]], colWidths=[usable_w])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
        ("ROUNDEDCORNERS", [3]),
    ]))
    return t

def note_box(text, bg=TEAL_LIGHT, text_color=TEAL):
    p = Paragraph(text, ParagraphStyle("nb", fontName="Helvetica", fontSize=7.5,
                                        textColor=text_color, leading=10))
    t = Table([[p]], colWidths=[usable_w])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
        ("BOX", (0,0), (-1,-1), 0.5, text_color),
        ("ROUNDEDCORNERS", [3]),
    ]))
    return t

def two_col(left_items, right_items, left_header=None, right_header=None,
            left_bg=TEAL_LIGHT, right_bg=PINK_LIGHT,
            left_border=TEAL, right_border=PINK):
    """Two equal columns, each with optional header and list of flowables."""
    col_w = (usable_w - 4*mm) / 2

    def make_cell(header, items, bg, border):
        cell = []
        if header:
            h = Paragraph(f"<b>{header}</b>",
                          ParagraphStyle("ch", fontName="Helvetica-Bold", fontSize=8,
                                         textColor=border, leading=10))
            cell.append(h)
        cell.extend(items)
        t = Table([[cell]], colWidths=[col_w])
        t.setStyle(TableStyle([
            ("BACKGROUND",    (0,0), (-1,-1), bg),
            ("TOPPADDING",    (0,0), (-1,-1), 5),
            ("BOTTOMPADDING", (0,0), (-1,-1), 5),
            ("LEFTPADDING",   (0,0), (-1,-1), 6),
            ("RIGHTPADDING",  (0,0), (-1,-1), 6),
            ("BOX",           (0,0), (-1,-1), 0.8, border),
            ("ROUNDEDCORNERS", [3]),
        ]))
        return t

    left_cell  = make_cell(left_header,  left_items,  left_bg,  left_border)
    right_cell = make_cell(right_header, right_items, right_bg, right_border)
    outer = Table([[left_cell, right_cell]], colWidths=[col_w, col_w],
                  spaceBefore=2, spaceAfter=2)
    outer.setStyle(TableStyle([
        ("LEFTPADDING",   (0,0), (-1,-1), 0),
        ("RIGHTPADDING",  (0,0), (-1,-1), 0),
        ("TOPPADDING",    (0,0), (-1,-1), 0),
        ("BOTTOMPADDING", (0,0), (-1,-1), 0),
        ("ALIGN",         (0,0), (-1,-1), "LEFT"),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
        ("COLPADDING",    (0,0), (0,-1), 0),   # gap between cols handled by colWidths
    ]))
    return outer

# ── Build story ───────────────────────────────────────────────────────────────
story = []

# ── TITLE BANNER ─────────────────────────────────────────────────────────────
title_text = Paragraph("Obs &amp; Gynae History Taking", title_style)
subtitle_text = Paragraph("Quick Reference Checklist  |  Clinical OSCE Aid", subtitle_style)
banner = Table([[title_text], [subtitle_text]], colWidths=[usable_w])
banner.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), TEAL_LIGHT),
    ("TOPPADDING",    (0,0), (-1,-1), 8),
    ("BOTTOMPADDING", (0,0), (-1,-1), 8),
    ("LEFTPADDING",   (0,0), (-1,-1), 10),
    ("RIGHTPADDING",  (0,0), (-1,-1), 10),
    ("BOX",           (0,0), (-1,-1), 1.5, TEAL),
    ("LINEBELOW",     (0,0), (-1,0),  0.5, TEAL),
    ("ROUNDEDCORNERS", [4]),
]))
story.append(banner)
story.append(Spacer(1, 4*mm))

# ── ROW 1: Patient Details + Presenting Complaint ────────────────────────────
pd_items = [
    checkbox("Name, age, DOB"),
    checkbox("Gravidity / Parity (note at outset)"),
    checkbox("Occupation"),
    checkbox("Referring clinician / setting"),
]
pc_items = [
    checkbox("Chief complaint in patient's own words"),
    checkbox("Duration of complaint"),
    bullet("Common: bleeding, pain, discharge, prolapse,"),
    bullet("subfertility, vulval sx, reduced fetal movements"),
]
story.append(two_col(pd_items, pc_items,
                     left_header="1. PATIENT DETAILS",
                     right_header="2. PRESENTING COMPLAINT",
                     right_bg=AMBER_LIGHT, right_border=AMBER))
story.append(Spacer(1, 2*mm))

# ── SOCRATES HPC ─────────────────────────────────────────────────────────────
story.append(section_header("3. History of Presenting Complaint — SOCRATES"))
story.append(Spacer(1, 1.5*mm))

soc_data = [
    ["S — Site",      "Localised / generalised? Unilateral / bilateral?"],
    ["O — Onset",     "Sudden or gradual? Relation to menstrual cycle?"],
    ["C — Character", "Type of pain / bleeding (fresh, dark, clots, watery)"],
    ["R — Radiation", "To back, shoulder tip (diaphragm → ectopic), groin"],
    ["A — Associated","Fever, N&V, discharge, urinary sx, bowel sx, dyspareunia"],
    ["T — Timing",    "Cyclical vs constant; continuous vs intermittent; duration"],
    ["E — Exac/Relieve","Posture, activity, analgesia, menses, sex"],
    ["S — Severity",  "VAS 0-10; impact on work, daily life, sleep"],
]
col_w1 = 36*mm
col_w2 = usable_w - col_w1
soc_table = Table(
    [[Paragraph(f"<b>{r[0]}</b>", ParagraphStyle("sc", fontName="Helvetica-Bold",
                fontSize=8, textColor=TEAL, leading=11)),
      Paragraph(r[1], item_style)] for r in soc_data],
    colWidths=[col_w1, col_w2],
    spaceBefore=0, spaceAfter=2
)
soc_table.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), GREY_LIGHT),
    ("BACKGROUND",    (0,0), (0,-1), TEAL_LIGHT),
    ("TOPPADDING",    (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("ROWBACKGROUNDS", (0,0), (-1,-1), [TEAL_LIGHT, WHITE]),
    ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#CCCCCC")),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(soc_table)
story.append(Spacer(1, 3*mm))

# ── ROW 2: Menstrual History ──────────────────────────────────────────────────
story.append(section_header("4. Menstrual History", bg=PINK))
story.append(Spacer(1, 1.5*mm))

men_left = [
    checkbox("LMP — date and was it normal?"),
    checkbox("Age at menarche"),
    checkbox("Cycle length (normal 21–35 days)"),
    checkbox("Duration of flow (normal 2–7 days)"),
    checkbox("Amount — pads/tampons per day, flooding, clots"),
    checkbox("Regularity — regular / irregular / absent"),
]
men_right = [
    checkbox("Dysmenorrhoea — primary or secondary?"),
    checkbox("Intermenstrual bleeding (IMB)"),
    checkbox("Postcoital bleeding (PCB)"),
    checkbox("Postmenopausal bleeding (PMB)"),
    checkbox("Menopausal symptoms / HRT use"),
    note_box("PALM-COEIN: Polyp · Adenomyosis · Leiomyoma · Malignancy\n"
             "Coagulopathy · Ovulatory · Endometrial · Iatrogenic · NEC",
             bg=PINK_LIGHT, text_color=PINK),
]
story.append(two_col(men_left, men_right,
                     left_bg=PINK_LIGHT, right_bg=PINK_LIGHT,
                     left_border=PINK, right_border=PINK))
story.append(Spacer(1, 3*mm))

# ── ROW 3: Obstetric History ──────────────────────────────────────────────────
story.append(section_header("5. Obstetric History — GTPAL"))
story.append(Spacer(1, 1.5*mm))

gtpal_data = [
    ["G — Gravida",   "Total pregnancies (including current)"],
    ["T — Term",      "Deliveries ≥ 37 weeks"],
    ["P — Preterm",   "Deliveries 24–36+6 weeks"],
    ["A — Abortions", "Miscarriages / TOPs / ectopics (< 24 wks)"],
    ["L — Living",    "Number of living children"],
]
gtpal_table = Table(
    [[Paragraph(f"<b>{r[0]}</b>", ParagraphStyle("gt", fontName="Helvetica-Bold",
               fontSize=8, textColor=TEAL, leading=11)),
      Paragraph(r[1], item_style)] for r in gtpal_data],
    colWidths=[col_w1, col_w2],
)
gtpal_table.setStyle(TableStyle([
    ("ROWBACKGROUNDS", (0,0), (-1,-1), [TEAL_LIGHT, WHITE]),
    ("BACKGROUND",    (0,0), (0,-1), TEAL_LIGHT),
    ("TOPPADDING",    (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#CCCCCC")),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(gtpal_table)
story.append(Spacer(1, 2*mm))

preg_label = Paragraph("<b>For each previous pregnancy record:</b>", item_style)
story.append(preg_label)
story.append(Spacer(1, 1*mm))

preg_items_left = [
    checkbox("Year and gestation at delivery"),
    checkbox("Mode: SVD / instrumental / CS"),
    bullet("If CS — indication, lower segment vs classical"),
    checkbox("Complications in pregnancy"),
    bullet("Pre-eclampsia, GDM, APH, placenta praevia"),
]
preg_items_right = [
    checkbox("Complications in labour/delivery"),
    bullet("PPH, perineal tears, shoulder dystocia"),
    checkbox("Baby — weight, sex, Apgar, NICU admission"),
    checkbox("Postnatal complications"),
    checkbox("Miscarriage / TOP / ectopic — gestation, Rh status"),
]
story.append(two_col(preg_items_left, preg_items_right))
story.append(Spacer(1, 3*mm))

# ── ROW 4: Gynae + Sexual History ────────────────────────────────────────────
gyn_items = [
    checkbox("Cervical smear — date, result, colposcopy?"),
    checkbox("Contraception — current and past methods"),
    checkbox("STI history"),
    checkbox("Subfertility — duration TTC, investigations"),
    checkbox("Previous PID or pelvic surgery"),
    checkbox("HRT / hormonal medications"),
]
sex_items = [
    checkbox("Sexually active?"),
    checkbox("Gender of partner(s)"),
    checkbox("Dyspareunia — superficial or deep?"),
    checkbox("Postcoital bleeding"),
    checkbox("Safer sex / STI screening needs"),
    note_box("Ask in private; use non-judgmental language",
             bg=AMBER_LIGHT, text_color=AMBER),
]
story.append(two_col(gyn_items, sex_items,
                     left_header="6. GYNAECOLOGICAL HISTORY",
                     right_header="7. SEXUAL HISTORY",
                     left_bg=TEAL_LIGHT, right_bg=AMBER_LIGHT,
                     left_border=TEAL, right_border=AMBER))
story.append(Spacer(1, 3*mm))

# ── ROW 5: PMH + Drugs ───────────────────────────────────────────────────────
pmh_items = [
    checkbox("Medical conditions"),
    bullet("Diabetes, hypertension, thyroid, autoimmune"),
    bullet("Coagulopathies (VWD, thrombophilia)"),
    checkbox("Surgical history — esp. pelvic/abdominal"),
    checkbox("Previous anaesthetic problems"),
    checkbox("VTE / DVT / PE history"),
]
drug_items = [
    checkbox("Current medications — including OTC & herbal"),
    checkbox("Hormonal meds: OCP, HRT, progestogens"),
    checkbox("Anticoagulants, antiepileptics"),
    checkbox("Folic acid / iron supplementation"),
    checkbox("Drug allergies + nature of reaction"),
    checkbox("Recreational drugs (non-judgemental)"),
]
story.append(two_col(pmh_items, drug_items,
                     left_header="8. PAST MEDICAL HISTORY",
                     right_header="9. DRUG HISTORY & ALLERGIES",
                     left_bg=GREY_LIGHT, right_bg=GREY_LIGHT,
                     left_border=GREY_MID, right_border=GREY_MID))
story.append(Spacer(1, 3*mm))

# ── ROW 6: Family + Social ───────────────────────────────────────────────────
fam_items = [
    checkbox("Gynaecological cancers (ovarian, endometrial, breast)"),
    bullet("BRCA1/2 mutations — offer referral"),
    checkbox("Pre-eclampsia, VTE in first-degree relatives"),
    checkbox("Coagulopathies — VWD"),
    checkbox("DM, HTN, congenital anomalies"),
    checkbox("Haemoglobinopathies (sickle cell, thalassaemia)"),
]
soc_items = [
    checkbox("Occupation & impact on symptoms"),
    checkbox("Smoking — pack-years"),
    checkbox("Alcohol — units/week"),
    checkbox("Recreational drug use"),
    checkbox("Relationship status & social support"),
    checkbox("Domestic violence screen — ask privately"),
    checkbox("Country of origin — FGM, haemoglobinopathy risk"),
]
story.append(two_col(fam_items, soc_items,
                     left_header="10. FAMILY HISTORY",
                     right_header="11. SOCIAL HISTORY",
                     left_bg=TEAL_LIGHT, right_bg=TEAL_LIGHT,
                     left_border=TEAL, right_border=TEAL))
story.append(Spacer(1, 3*mm))

# ── Review of Systems ─────────────────────────────────────────────────────────
story.append(section_header("12. Targeted Review of Systems"))
story.append(Spacer(1, 1.5*mm))

ros_data = [
    ["Urinary",   "Frequency, urgency, stress/urge incontinence, dysuria, haematuria, nocturia"],
    ["Bowel",     "Constipation, rectal bleeding, tenesmus, change in bowel habit (endo / prolapse)"],
    ["Thyroid",   "Weight change, heat/cold intolerance, palpitations (thyroid → AUB)"],
    ["Skin/Hair", "Acne, hirsutism, weight gain, striae (PCOS / Cushing's)"],
    ["Breast",    "Lumps, nipple discharge, galactorrhoea (hyperprolactinaemia → amenorrhoea)"],
    ["VTE",       "Leg swelling, calf tenderness, breathlessness (esp. in pregnancy / OCP)"],
]
ros_table = Table(
    [[Paragraph(f"<b>{r[0]}</b>", ParagraphStyle("rs", fontName="Helvetica-Bold",
               fontSize=8, textColor=PINK, leading=11)),
      Paragraph(r[1], item_style)] for r in ros_data],
    colWidths=[24*mm, usable_w - 24*mm],
)
ros_table.setStyle(TableStyle([
    ("ROWBACKGROUNDS", (0,0), (-1,-1), [PINK_LIGHT, WHITE]),
    ("TOPPADDING",    (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#CCCCCC")),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(ros_table)
story.append(Spacer(1, 3*mm))

# ── Antenatal Additions ───────────────────────────────────────────────────────
story.append(section_header("13. Antenatal-Specific Additions  (if applicable)", bg=colors.HexColor("#2E6B4F")))
story.append(Spacer(1, 1.5*mm))

ante_left = [
    checkbox("Gestational age — LMP + dating scan EDD"),
    bullet("Naegele's rule: LMP + 9 months + 7 days"),
    checkbox("Symptoms: morning sickness, heartburn, breast changes"),
    checkbox("Fetal movements — onset ~18–20 wks; any reduction?"),
    checkbox("Bleeding, pain, leaking fluid"),
    checkbox("Booking bloods completed?"),
    bullet("Blood group, antibody screen, FBC, rubella, VDRL"),
    bullet("HIV, HBsAg, haemoglobinopathy screen"),
]
ante_right = [
    checkbox("Antenatal scans"),
    bullet("Dating scan (11–14 wks), anomaly scan (18–22 wks)"),
    bullet("Growth scans if indicated"),
    checkbox("Pre-eclampsia risk factors"),
    bullet("1st preg, BMI >35, age >40, multiple pregnancy, HTN"),
    checkbox("GDM screening — OGTT at 24–28 wks if indicated"),
    checkbox("VTE risk assessment — prophylaxis considered?"),
    checkbox("Vaccinations — flu, whooping cough, COVID"),
]
GREEN      = colors.HexColor("#2E6B4F")
GREEN_LIGHT= colors.HexColor("#EBF5EF")
story.append(two_col(ante_left, ante_right,
                     left_bg=GREEN_LIGHT, right_bg=GREEN_LIGHT,
                     left_border=GREEN, right_border=GREEN))
story.append(Spacer(1, 3*mm))

# ── Closing ───────────────────────────────────────────────────────────────────
story.append(section_header("14. Closing the History"))
story.append(Spacer(1, 1.5*mm))

close_items = [
    checkbox("ICE — Ideas: \"What do you think is causing this?\""),
    checkbox("ICE — Concerns: \"Is there anything you are particularly worried about?\""),
    checkbox("ICE — Expectations: \"What were you hoping we could do for you today?\""),
    checkbox("Summarise back to patient and invite corrections"),
    checkbox("Safeguarding — domestic violence (ask privately), FGM, child protection concerns"),
    checkbox("\"Is there anything else you would like to tell me?\""),
]
close_table = Table([[c] for c in close_items], colWidths=[usable_w])
close_table.setStyle(TableStyle([
    ("ROWBACKGROUNDS", (0,0), (-1,-1), [TEAL_LIGHT, WHITE]),
    ("TOPPADDING",    (0,0), (-1,-1), 2),
    ("BOTTOMPADDING", (0,0), (-1,-1), 2),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("RIGHTPADDING",  (0,0), (-1,-1), 8),
    ("GRID",          (0,0), (-1,-1), 0.3, colors.HexColor("#CCCCCC")),
]))
story.append(close_table)
story.append(Spacer(1, 4*mm))

# ── Footer ────────────────────────────────────────────────────────────────────
story.append(HRFlowable(width=usable_w, thickness=0.5, color=TEAL))
footer = Paragraph(
    "Berek &amp; Novak's Gynecology (9th ed.) · Rosen's Emergency Medicine · For educational use only",
    ParagraphStyle("footer", fontName="Helvetica", fontSize=6.5,
                   textColor=GREY_MID, leading=9, alignment=TA_CENTER, spaceBefore=2)
)
story.append(footer)

# ── Build ─────────────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF saved to {OUTPUT}")

Running Command

python3 /home/daytona/workspace/obs-gynae-checklist/generate_checklist.py 2>&1

Running Command

ls -lh /home/daytona/workspace/obs-gynae-checklist/

Your checklist PDF is ready:

ObsGynae History Checklist

PDF Document · PDF

What's included in the PDF (single A4 page, print-ready):

Section	Contents
1-2	Patient Details + Presenting Complaint
3	SOCRATES table for HPC
4	Menstrual History with PALM-COEIN reminder
5	Obstetric History (GTPAL) + per-pregnancy checklist
6-7	Gynaecological + Sexual History
8-9	PMH + Drug History & Allergies
10-11	Family History + Social History
12	Targeted Review of Systems (6 systems)
13	Antenatal-specific additions
14	Closing the History (ICE + safeguarding)

The layout uses colour-coded sections (teal for obstetric, pink for gynaecological), tick boxes throughout, and clinical memory aids (PALM-COEIN, GTPAL, Naegele's rule) built in. Fits cleanly on a single A4 sheet for use during OSCEs or clinical attachments.

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