mkdir -p /home/daytona/workspace/prolonged-labour && ls /home/daytona/workspace/…

~/prolonged-labour/build.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Prolonged Labour";
pres.author = "Medical Education";

// ─── COLOUR PALETTE ───────────────────────────────────────────────────────────
const C = {
  navy:   "0B2545",   // dominant dark
  teal:   "1A6B72",   // supporting mid-tone
  mint:   "D4EDE7",   // light fill
  gold:   "E8A020",   // sharp accent
  white:  "FFFFFF",
  light:  "F0F6F8",
  text:   "1C2B3A",
  sub:    "4A6580",
  danger: "C0392B",
  warn:   "E67E22",
  safe:   "1E8449",
};

// ─── HELPERS ──────────────────────────────────────────────────────────────────
function addSlide() { return pres.addSlide(); }

function titleBar(slide, title, subtitle) {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 4.6, w: 10, h: 1.025, fill: { color: C.teal } });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 2.3, w: 0.12, h: 1.5, fill: { color: C.gold } });
  slide.addText(title, {
    x: 0.5, y: 1.5, w: 9, h: 1.5,
    fontSize: 40, bold: true, color: C.white, align: "center",
    fontFace: "Calibri", valign: "middle"
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.5, y: 3.2, w: 9, h: 0.6,
      fontSize: 18, color: "B0D4DC", align: "center", fontFace: "Calibri"
    });
  }
  slide.addText("Prolonged Labour — Medical Students Guide", {
    x: 0.3, y: 4.7, w: 9.4, h: 0.5,
    fontSize: 12, color: C.white, align: "center", fontFace: "Calibri"
  });
}

function sectionHeader(slide, num, title, subtitle) {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.teal } });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: C.gold } });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 4.5, w: 10, h: 1.125, fill: { color: C.navy } });
  slide.addText(num, {
    x: 0.4, y: 0.6, w: 2, h: 1.2,
    fontSize: 72, bold: true, color: C.gold, fontFace: "Calibri", align: "left"
  });
  slide.addText(title, {
    x: 0.4, y: 1.8, w: 9.2, h: 1.4,
    fontSize: 32, bold: true, color: C.white, fontFace: "Calibri", align: "left"
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.4, y: 3.3, w: 9.2, h: 0.8,
      fontSize: 16, color: "D0EAF0", fontFace: "Calibri", align: "left"
    });
  }
}

function contentSlide(slide, heading, bullets, { twoCol = false, col1 = [], col2 = [] } = {}) {
  // Header bar
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.72, fill: { color: C.navy } });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0.72, w: 10, h: 0.04, fill: { color: C.gold } });
  slide.addText(heading, {
    x: 0.3, y: 0, w: 9.4, h: 0.72,
    fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });
  if (!twoCol) {
    const items = bullets.map((b, i) => ({
      text: b.text || b,
      options: {
        bullet: { type: "bullet", characterCode: "25B8", color: C.gold },
        color: b.sub ? C.sub : C.text,
        fontSize: b.sub ? 14 : 16,
        bold: b.bold || false,
        indentLevel: b.sub ? 1 : 0,
        breakLine: true,
        paraSpaceBefore: b.sub ? 0 : 4,
      }
    }));
    slide.addText(items, {
      x: 0.4, y: 0.9, w: 9.2, h: 4.5,
      fontFace: "Calibri", valign: "top"
    });
  } else {
    const makeItems = arr => arr.map(b => ({
      text: b.text || b,
      options: {
        bullet: { type: "bullet", characterCode: "25B8", color: C.gold },
        color: b.sub ? C.sub : C.text,
        fontSize: b.sub ? 13 : 15,
        bold: b.bold || false,
        indentLevel: b.sub ? 1 : 0,
        breakLine: true,
        paraSpaceBefore: b.sub ? 0 : 3,
      }
    }));
    slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0.76, w: 4.85, h: 4.85, fill: { color: C.light } });
    slide.addShape(pres.shapes.RECTANGLE, { x: 5.15, y: 0.76, w: 4.85, h: 4.85, fill: { color: C.mint } });
    slide.addText(makeItems(col1), { x: 0.3, y: 0.9, w: 4.55, h: 4.5, fontFace: "Calibri", valign: "top" });
    slide.addText(makeItems(col2), { x: 5.3, y: 0.9, w: 4.55, h: 4.5, fontFace: "Calibri", valign: "top" });
  }
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.45, w: 10, h: 0.175, fill: { color: C.navy } });
}

function boxSlide(slide, heading, boxes) {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.72, fill: { color: C.navy } });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0.72, w: 10, h: 0.04, fill: { color: C.gold } });
  slide.addText(heading, {
    x: 0.3, y: 0, w: 9.4, h: 0.72,
    fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });
  // up to 4 boxes per row, 2 rows max
  const cols = Math.min(boxes.length, 4);
  const boxW = (9.6 / cols) - 0.15;
  boxes.forEach((box, i) => {
    const row = Math.floor(i / 4);
    const col = i % 4;
    const bx = 0.2 + col * (boxW + 0.15);
    const by = 0.95 + row * 2.15;
    slide.addShape(pres.shapes.ROUNDED_RECTANGLE, {
      x: bx, y: by, w: boxW, h: 1.95,
      fill: { color: box.color || C.navy }, rectRadius: 0.1,
      shadow: { type: "outer", color: "000000", blur: 6, offset: 3, angle: 135, opacity: 0.2 }
    });
    if (box.icon) {
      slide.addText(box.icon, { x: bx, y: by + 0.1, w: boxW, h: 0.5, fontSize: 20, align: "center", fontFace: "Segoe UI Emoji" });
    }
    slide.addText(box.title, {
      x: bx + 0.1, y: by + 0.55, w: boxW - 0.2, h: 0.45,
      fontSize: 13, bold: true, color: C.white, align: "center", fontFace: "Calibri"
    });
    slide.addText(box.body, {
      x: bx + 0.1, y: by + 0.95, w: boxW - 0.2, h: 0.9,
      fontSize: 11.5, color: "D8E8EF", align: "center", fontFace: "Calibri", valign: "top"
    });
  });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.45, w: 10, h: 0.175, fill: { color: C.navy } });
}

function definitionSlide(slide, heading, defTitle, defText, keyPoints) {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.72, fill: { color: C.navy } });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0.72, w: 10, h: 0.04, fill: { color: C.gold } });
  slide.addText(heading, {
    x: 0.3, y: 0, w: 9.4, h: 0.72,
    fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });
  // Definition box
  slide.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x: 0.3, y: 0.85, w: 9.4, h: 1.6,
    fill: { color: C.teal }, rectRadius: 0.1,
  });
  slide.addShape(pres.shapes.RECTANGLE, {
    x: 0.3, y: 0.85, w: 0.1, h: 1.6,
    fill: { color: C.gold }
  });
  slide.addText(defTitle, {
    x: 0.6, y: 0.88, w: 9, h: 0.45,
    fontSize: 14, bold: true, color: C.gold, fontFace: "Calibri"
  });
  slide.addText(defText, {
    x: 0.6, y: 1.3, w: 8.9, h: 1.1,
    fontSize: 14.5, color: C.white, fontFace: "Calibri", valign: "top"
  });
  // Key points below
  const items = keyPoints.map(k => ({
    text: k.text || k,
    options: {
      bullet: { type: "bullet", characterCode: "25CF", color: C.gold },
      color: k.sub ? C.sub : C.text,
      fontSize: k.sub ? 13 : 15,
      bold: k.bold || false,
      indentLevel: k.sub ? 1 : 0,
      breakLine: true,
      paraSpaceBefore: 4,
    }
  }));
  slide.addText(items, {
    x: 0.4, y: 2.6, w: 9.2, h: 2.7,
    fontFace: "Calibri", valign: "top"
  });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.45, w: 10, h: 0.175, fill: { color: C.navy } });
}

function tableSlide(slide, heading, headers, rows, colWidths) {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.72, fill: { color: C.navy } });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0.72, w: 10, h: 0.04, fill: { color: C.gold } });
  slide.addText(heading, {
    x: 0.3, y: 0, w: 9.4, h: 0.72,
    fontSize: 20, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });
  const tableData = [
    headers.map(h => ({ text: h, options: { bold: true, color: C.white, fill: C.teal, fontSize: 13, align: "center" } })),
    ...rows.map((row, ri) => row.map(cell => ({
      text: cell,
      options: { color: C.text, fill: ri % 2 === 0 ? C.light : C.white, fontSize: 12, align: "center" }
    })))
  ];
  slide.addTable(tableData, {
    x: 0.25, y: 0.9, w: 9.5,
    colW: colWidths,
    border: { type: "solid", color: "C0D0DB", pt: 0.5 },
    fontFace: "Calibri"
  });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.45, w: 10, h: 0.175, fill: { color: C.navy } });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE SLIDE
// ═══════════════════════════════════════════════════════════════════════════════
let s = addSlide();
titleBar(s, "PROLONGED LABOUR", "A Comprehensive Guide for Medical Students");
s.addText("Topics Covered: Definition · Aetiology · Diagnosis · Monitoring · Management · Complications", {
  x: 0.5, y: 4.75, w: 9, h: 0.5,
  fontSize: 12, color: "CCE8EF", align: "center", fontFace: "Calibri"
});

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — OUTLINE
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
contentSlide(s, "Lecture Outline", [
  { text: "1. Normal Labour — Recap", bold: true },
  { text: "Stages, mechanisms, cervicogram", sub: true },
  { text: "2. Definition & Classification of Prolonged Labour", bold: true },
  { text: "Latent & active phase abnormalities", sub: true },
  { text: "3. Aetiology — The 3 Ps", bold: true },
  { text: "Powers, Passenger, Passage", sub: true },
  { text: "4. Diagnosis & Monitoring — Partograph", bold: true },
  { text: "Alert & action lines", sub: true },
  { text: "5. Complications — Maternal & Fetal", bold: true },
  { text: "6. Management — Active Interventions", bold: true },
  { text: "7. Obstructed Labour — Special Consideration", bold: true },
  { text: "8. Clinical Scenarios & MCQs", bold: true },
]);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — SECTION: NORMAL LABOUR
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
sectionHeader(s, "01", "Normal Labour — Recap", "Understanding baseline before recognising abnormality");

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — DEFINITION OF NORMAL LABOUR
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
definitionSlide(s,
  "Normal Labour — Definition",
  "WHO Definition",
  "Labour is defined as regular, painful uterine contractions leading to progressive effacement and dilatation of the cervix, ending in delivery of the baby, placenta and membranes.",
  [
    { text: "Onset: ≥37 completed weeks gestation (term labour)", bold: false },
    { text: "Spontaneous onset with vertex (occiput) presentation", bold: false },
    { text: "Duration: up to 18 hours in primigravida; up to 12 hours in multigravida", bold: false },
    { text: "Completed without major maternal or fetal complications", bold: false },
    { text: "Three recognised stages: 1st, 2nd and 3rd stage of labour", bold: false },
  ]
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — STAGES OF LABOUR TABLE
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
tableSlide(s,
  "Stages of Labour — Duration & Landmarks",
  ["Stage", "Definition / Events", "Primigravida", "Multigravida"],
  [
    ["1st Stage\nLatent Phase", "Onset of labour → 3 cm dilatation\nEffacement, early dilatation", "Up to 20 hours", "Up to 14 hours"],
    ["1st Stage\nActive Phase", "3 cm → Full dilatation (10 cm)\nRate: ≥1 cm/hour expected", "Up to 12 hours\n(avg 8 h)", "Up to 6 hours\n(avg 5 h)"],
    ["2nd Stage", "Full dilatation → Delivery of baby\nPassive + active pushing", "Up to 2 hours\n(3 h with epidural)", "Up to 1 hour\n(2 h with epidural)"],
    ["3rd Stage", "Delivery of baby → Delivery of placenta", "5–30 minutes", "5–30 minutes"],
  ],
  [1.8, 3.5, 2.1, 2.1]
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — SECTION: PROLONGED LABOUR
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
sectionHeader(s, "02", "Definition & Classification", "Prolonged Labour — When does normal become abnormal?");

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — DEFINITION OF PROLONGED LABOUR
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
definitionSlide(s,
  "Prolonged Labour — Definition",
  "Clinical Definition (WHO / FIGO)",
  "Prolonged labour is defined as labour lasting more than 18 hours in primigravida or more than 12 hours in multigravida from onset of regular uterine contractions to delivery.",
  [
    { text: "Also called 'dystocia' (Greek: dys = difficult; tokos = birth)", bold: false },
    { text: "Occurs in ~8% of all deliveries globally (major cause of maternal & perinatal mortality)", bold: false },
    { text: "Prolonged LATENT phase: >20 hrs (primip) / >14 hrs (multip)", bold: true },
    { text: "Prolonged ACTIVE phase: cervical dilatation <1 cm/hr for >2 hrs", bold: false },
    { text: "Prolonged 2nd stage: >2 hrs (primip) / >1 hr (multip) without epidural", bold: false },
    { text: "Arrest of descent: no descent in >1 hour during pushing", bold: false },
  ]
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — CLASSIFICATION TABLE
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
tableSlide(s,
  "Classification of Labour Abnormalities",
  ["Type", "Definition", "Primigravida", "Multigravida"],
  [
    ["Prolonged Latent Phase", "Irregular, infrequent contractions; no progressive dilatation beyond 3 cm", ">20 hours", ">14 hours"],
    ["Protracted Active Phase", "Active phase progresses but too slowly; <1 cm/hr", "Any duration", "Any duration"],
    ["Active Phase Arrest", "No cervical change for ≥2 hours in active labour", "≥2 hours", "≥2 hours"],
    ["Protracted Descent", "Descent <1 cm/hr in 2nd stage", "Common cause: OP position", "Common cause: OP position"],
    ["Arrest of Descent", "No descent for ≥1 hour in 2nd stage", "Absolute: CPD", "Absolute: CPD"],
    ["Prolonged 2nd Stage", "Total 2nd stage exceeds limits", ">2 hrs (3 w/epidural)", ">1 hr (2 w/epidural)"],
  ],
  [2.4, 3.4, 1.9, 1.8]
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — SECTION: AETIOLOGY
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
sectionHeader(s, "03", "Aetiology — The 3 Ps", "Powers · Passenger · Passage");

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — POWERS
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
boxSlide(s, "Aetiology — Powers (Uterine Dysfunction)", [
  { icon: "🔴", title: "Hypotonic Uterine Dysfunction", color: C.danger,
    body: "Infrequent, weak contractions (<3 in 10 min, <25 mmHg). Most common in prolonged active phase. Responds to oxytocin." },
  { icon: "🟠", title: "Hypertonic Dysfunction", color: C.warn,
    body: "Irregular, frequent, painful but ineffective contractions. Usually in latent phase. Risk of fetal distress. Manage with sedation / tocolysis." },
  { icon: "🟡", title: "Incoordinate Uterine Action", color: "7D6608",
    body: "Asynchronous contraction of fundus, body and LUS. Colicky pain. Treat with epidural analgesia to normalise coordination." },
  { icon: "🟢", title: "Cervical Factors", color: C.teal,
    body: "Rigid cervix (primigravida, older age), scarring from surgery/LLETZ. Cervix fails to efface and dilate despite adequate contractions." },
]);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — PASSENGER
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
contentSlide(s, "Aetiology — Passenger (Fetal Factors)", [], {
  twoCol: true,
  col1: [
    { text: "Macrosomia (>4 kg)", bold: true },
    { text: "EFW >90th percentile increases dystocia risk 3-fold", sub: true },
    { text: "Malpresentations", bold: true },
    { text: "Brow (mentum posterior) — always obstructs", sub: true },
    { text: "Face presentation (50% vaginal delivery)", sub: true },
    { text: "Shoulder dystocia — emergency", sub: true },
    { text: "Malpositions", bold: true },
    { text: "Occiput Posterior (OP) — most common; prolonged 2nd stage", sub: true },
    { text: "Occiput Transverse (OT) — deep transverse arrest", sub: true },
    { text: "Compound presentation", bold: false },
    { text: "Asynclitism — lateral deviation of fetal head", bold: false },
  ],
  col2: [
    { text: "Fetal Anomalies", bold: true },
    { text: "Hydrocephalus — head too large to engage", sub: true },
    { text: "Fetal hydrops", sub: true },
    { text: "Conjoint twins", sub: true },
    { text: "Multiple Pregnancy", bold: true },
    { text: "Second twin after delivery of first twin", sub: true },
    { text: "Entanglement in monochorionic twins", sub: true },
    { text: "Cord Prolapse", bold: true },
    { text: "Can impede descent if baby compresses cord", sub: true },
    { text: "Short umbilical cord", bold: false },
    { text: "Nuchal cord — can impede descent", sub: true },
  ]
});

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — PASSAGE
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
contentSlide(s, "Aetiology — Passage (Pelvic Factors)", [], {
  twoCol: true,
  col1: [
    { text: "Bony Pelvis — CPD (Cephalopelvic Disproportion)", bold: true },
    { text: "Android / platypelloid pelvis — contracted inlet", sub: true },
    { text: "Absolute CPD: fetus physically cannot pass", sub: true },
    { text: "Relative CPD: moulding may allow vaginal delivery", sub: true },
    { text: "Pelvic Contracted Inlet", bold: true },
    { text: "Diagonal conjugate <11.5 cm", sub: true },
    { text: "AP diameter <10 cm — engagement fails", sub: true },
    { text: "Pelvic Outlet Contraction", bold: true },
    { text: "Interischial diameter <8 cm", sub: true },
    { text: "Rachitic / osteomalacic pelvis", sub: true },
  ],
  col2: [
    { text: "Soft Tissue Obstruction", bold: true },
    { text: "Cervical fibroid — rare but serious", sub: true },
    { text: "Ovarian cyst in pouch of Douglas", sub: true },
    { text: "Full rectum or bladder impeding descent", sub: true },
    { text: "Previous caesarean scar band", sub: true },
    { text: "Congenital vaginal septum / stenosis", sub: true },
    { text: "Perineal Factors", bold: true },
    { text: "Rigid perineum (elderly primigravida)", sub: true },
    { text: "Previous perineal repair / FGM", sub: true },
    { text: "Uterine Factors", bold: true },
    { text: "Lower uterine fibroid — blocks descent", sub: true },
    { text: "Uterine rupture — loss of contractions", sub: true },
  ]
});

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — SECTION: DIAGNOSIS & MONITORING
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
sectionHeader(s, "04", "Diagnosis & Monitoring", "History · Examination · Partograph");

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — CLINICAL ASSESSMENT
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
contentSlide(s, "Clinical Assessment of Labour", [], {
  twoCol: true,
  col1: [
    { text: "History", bold: true },
    { text: "Onset & duration of contractions", sub: true },
    { text: "Parity and obstetric history", sub: true },
    { text: "Previous CS or pelvic surgery", sub: true },
    { text: "EDD & fetal movements", sub: true },
    { text: "Rupture of membranes (time, colour of liquor)", sub: true },
    { text: "Abdominal Examination", bold: true },
    { text: "Fundal height, lie, presentation, engagement", sub: true },
    { text: "Contraction frequency, duration, strength (palpate)", sub: true },
    { text: "Fetal heart rate auscultation (normal: 110-160 bpm)", sub: true },
    { text: "5th of head palpable per abdomen = not engaged", sub: true },
  ],
  col2: [
    { text: "Vaginal Examination (VE)", bold: true },
    { text: "Cervical dilatation (cm) and effacement (%)", sub: true },
    { text: "Station of presenting part (-3 to +3)", sub: true },
    { text: "Position (OA, OP, OT) and moulding grade", sub: true },
    { text: "Membranes: intact / ruptured / bulging", sub: true },
    { text: "Caput succedaneum grade (0-3+)", sub: true },
    { text: "Investigations", bold: true },
    { text: "CTG / electronic fetal monitoring", sub: true },
    { text: "Liquor colour (clear vs meconium stained)", sub: true },
    { text: "USS — estimated fetal weight, BPP", sub: true },
    { text: "Maternal vitals: pulse, BP, temperature, urine output", sub: true },
  ]
});

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 — PARTOGRAPH
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
definitionSlide(s,
  "The Partograph — WHO Monitoring Tool",
  "Definition",
  "A pre-printed form on which labour observations are recorded. Provides a pictorial overview of labour progress, vital signs, fetal condition and medications given.",
  [
    { text: "Components recorded: cervical dilatation, fetal descent, contractions, FHR, membranes, moulding, oxytocin, drugs, maternal vitals, urine", bold: false },
    { text: "ALERT LINE: crosses 3 cm dilatation point; has slope of 1 cm/hour. Labour should stay LEFT of or ON this line.", bold: true },
    { text: "ACTION LINE: 4 hours to the RIGHT of the alert line. Reaching or crossing → immediate obstetric review", bold: true },
    { text: "Introduced by Philpott (Zimbabwe, 1972); adopted by WHO 1988 — reduces prolonged labour and CS rates significantly", bold: false },
    { text: "Modified WHO partograph (2000) — recording begins in active phase (≥4 cm) omitting latent phase section", bold: false },
  ]
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 — MOULDING & CAPUT GRADING TABLE
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
tableSlide(s,
  "Moulding & Caput Grading — Signs of Obstructed Labour",
  ["Grade", "Moulding (Sutures / Bones)", "Caput Succedaneum", "Clinical Significance"],
  [
    ["0", "Bones normally separated; sutures felt easily", "Absent", "Normal"],
    ["1+", "Bones just touching", "Just palpable", "Early CPD — monitor closely"],
    ["2+", "Bones overlapping but reducible on pressure", "Definite (+)", "Significant CPD — reassess progress"],
    ["3+", "Bones overlapping and NOT reducible", "Large (++)", "OBSTRUCTED LABOUR — deliver immediately"],
  ],
  [0.7, 3.2, 2.3, 3.3]
);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 17 — SECTION: COMPLICATIONS
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
sectionHeader(s, "05", "Complications", "Maternal & Fetal — Know them to prevent them");

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 18 — MATERNAL COMPLICATIONS
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
boxSlide(s, "Maternal Complications of Prolonged Labour", [
  { icon: "🩸", title: "Haemorrhage (PPH)", color: C.danger,
    body: "Uterine atony from prolonged labour is #1 cause of PPH. Blood loss ≥500 mL (vaginal) / ≥1000 mL (CS)." },
  { icon: "🦠", title: "Sepsis / Chorioamnionitis", color: "8E44AD",
    body: "Ascending infection after ROM. Fever, uterine tenderness, foul liquor. Can progress to septic shock." },
  { icon: "💔", title: "Uterine Rupture", color: C.danger,
    body: "Life-threatening. Signs: bandl ring, loss of contractions, sudden relief of pain, fetal parts palpable outside uterus." },
  { icon: "🔱", title: "Vesicovaginal Fistula", color: "117A65",
    body: "Pressure necrosis of bladder base. VVF / RVF. Major cause of morbidity in developing world. Lifelong incontinence if untreated." },
  { icon: "💤", title: "Exhaustion & Dehydration", color: "6E2F7A",
    body: "Prolonged labour → maternal ketosis, metabolic acidosis, hyponatraemia. IV fluids and nutrition essential." },
  { icon: "⚠️", title: "Psychological Trauma", color: C.teal,
    body: "PTSD, postnatal depression, bonding difficulties. Birth trauma review and debrief essential after prolonged/assisted delivery." },
  { icon: "🔪", title: "Operative Delivery", color: "1F618D",
    body: "Increased rates of: instrumental delivery (forceps/ventouse), caesarean section, episiotomy, 3rd/4th degree tears." },
  { icon: "💀", title: "Maternal Mortality", color: "2C3E50",
    body: "Leading cause in low-income countries. Triad: haemorrhage + infection + obstructed labour → PREVENT with partograph use." },
]);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 19 — FETAL COMPLICATIONS
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
boxSlide(s, "Fetal & Neonatal Complications", [
  { icon: "🧠", title: "Birth Asphyxia", color: C.danger,
    body: "Hypoxic-ischaemic encephalopathy (HIE). APGAR <7 at 5 min. Cord pH <7.0. Long-term: cerebral palsy, seizures." },
  { icon: "💉", title: "Meconium Aspiration", color: C.warn,
    body: "Fetal hypoxia → passage of meconium → aspiration → MAS. MSAF with FHR abnormalities = urgent delivery." },
  { icon: "📊", title: "Fetal Distress on CTG", color: "1F618D",
    body: "Late decelerations, prolonged decelerations, loss of variability, sinusoidal pattern — urgent intervention." },
  { icon: "🩺", title: "Intrauterine Infection", color: "8E44AD",
    body: "Fetal sepsis, pneumonia from infected liquor. Associated with premature ROM and prolonged labour." },
  { icon: "☠️", title: "Stillbirth / Neonatal Death", color: "2C3E50",
    body: "Obstructed labour is a leading preventable cause of stillbirth in sub-Saharan Africa and South Asia." },
  { icon: "🏥", title: "Neonatal ICU Admission", color: "117A65",
    body: "Prolonged labour → increased NICU admission for birth asphyxia, respiratory distress, sepsis, trauma." },
  { icon: "🦴", title: "Birth Trauma", color: C.teal,
    body: "Forceps → facial nerve palsy, skull fracture. Ventouse → cephalhaematoma, subgaleal haematoma. Shoulder dystocia → brachial plexus injury." },
  { icon: "⚡", title: "Hypoxic Brain Injury", color: "C0392B",
    body: "Watershed infarction, periventricular leukomalacia. MRI at 24-48 hrs of life. Therapeutic hypothermia within 6 hrs if HIE grade ≥2." },
]);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 20 — SECTION: MANAGEMENT
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
sectionHeader(s, "06", "Management", "Conservative · Medical · Surgical — Step-by-Step Approach");

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 21 — MANAGEMENT OF PROLONGED LATENT PHASE
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
contentSlide(s, "Management — Prolonged Latent Phase", [], {
  twoCol: true,
  col1: [
    { text: "Initial Assessment", bold: true },
    { text: "Confirm true labour vs false labour (Braxton Hicks)", sub: true },
    { text: "Exclude malpresentation, CPD, PROM", sub: true },
    { text: "CTG — ensure fetal well-being", sub: true },
    { text: "Conservative Management (First-line)", bold: true },
    { text: "Reassurance, ambulation, hydration", sub: true },
    { text: "Sedation: Morphine 10-15 mg SC/IM (therapeutic rest)", sub: true },
    { text: "30-40% will wake in active labour; 10% will cease contracting (false labour)", sub: true },
    { text: "Membrane sweep (if cervix accessible)", sub: true },
  ],
  col2: [
    { text: "Active Management (if conservative fails)", bold: true },
    { text: "Amniotomy (ARM) — rupture of membranes if cervix is favourable (Bishop score ≥6)", sub: true },
    { text: "Oxytocin augmentation: start at 1-2 mIU/min, increase every 30-40 min to max 20-40 mIU/min", sub: true },
    { text: "Target: 3-5 contractions per 10 minutes, each lasting 40-60 seconds", sub: true },
    { text: "Epidural analgesia reduces hypertonic dysfunction", sub: true },
    { text: "If fails after 8 hrs of oxytocin augmentation → Caesarean section", bold: true },
    { text: "Bishop Score ≥8 = favourable cervix for induction", sub: true },
  ]
});

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 22 — MANAGEMENT OF PROLONGED ACTIVE PHASE
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
contentSlide(s, "Management — Prolonged Active Phase", [], {
  twoCol: true,
  col1: [
    { text: "Step 1: Exclude CPD and Malpresentation", bold: true },
    { text: "3/5 or more of head palpable per abdomen = CPD until proven otherwise", sub: true },
    { text: "Moulding grade 3+ → Caesarean section immediately", sub: true },
    { text: "Step 2: Amniotomy (if membranes intact)", bold: true },
    { text: "AROM: accelerates active labour by 1-2 hrs on average", sub: true },
    { text: "Assess liquor — clear vs MSAF", sub: true },
    { text: "Step 3: Oxytocin Augmentation", bold: true },
    { text: "Only if NO obstruction (no CPD, normal lie/presentation)", sub: true },
    { text: "Start 1-2 mIU/min IV; titrate every 30 min to adequate contractions", sub: true },
    { text: "Continuous CTG monitoring mandatory during oxytocin", sub: true },
  ],
  col2: [
    { text: "Step 4: Adequate Analgesia", bold: true },
    { text: "Epidural — gold standard, improves contraction coordination", sub: true },
    { text: "Systemic opioids (morphine, pethidine) — second line", sub: true },
    { text: "Step 5: Reassess after 2 hours", bold: true },
    { text: "VE every 2 hours to assess progress on partograph", sub: true },
    { text: "Alert line crossed → increased monitoring", sub: true },
    { text: "Action line crossed → immediate obstetric decision", sub: true },
    { text: "Delivery if no progress → Instrumental or CS", sub: true },
    { text: "Maternal Supportive Care", bold: true },
    { text: "IV fluids (Hartmann's / Normal Saline)", sub: true },
    { text: "Empty bladder regularly (catheterise if needed)", sub: true },
    { text: "Temperature, BP, pulse hourly; urine output ≥30 mL/hr", sub: true },
  ]
});

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 23 — BISHOP SCORE TABLE
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
tableSlide(s,
  "Bishop Score — Cervical Favourability for Induction / Augmentation",
  ["Parameter", "Score 0", "Score 1", "Score 2", "Score 3"],
  [
    ["Dilatation (cm)", "Closed", "1-2", "3-4", "≥5"],
    ["Effacement (%)", "0-30%", "31-50%", "51-80%", ">80%"],
    ["Station", "-3", "-2", "-1 / 0", "+1 / +2"],
    ["Consistency", "Firm", "Medium", "Soft", "—"],
    ["Position", "Posterior", "Mid", "Anterior", "—"],
  ],
  [2.2, 1.85, 1.85, 1.85, 1.75]
);
s.addShape(pres.shapes.RECTANGLE, { x: 0.25, y: 5.05, w: 9.5, h: 0.38,
  fill: { color: C.teal }, line: { color: C.teal } });
s.addText("Score ≤5 = Unfavourable (ripen with PGE2 / misoprostol) | Score 6-7 = Borderline | Score ≥8 = Favourable → proceed with ARM + oxytocin", {
  x: 0.3, y: 5.08, w: 9.4, h: 0.32, fontSize: 11.5, color: C.white, fontFace: "Calibri", align: "center"
});

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 24 — MANAGEMENT OF PROLONGED 2ND STAGE
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
contentSlide(s, "Management — Prolonged 2nd Stage", [], {
  twoCol: true,
  col1: [
    { text: "Prerequisites Before Intervention", bold: true },
    { text: "Full dilatation confirmed", sub: true },
    { text: "Head at or below ischial spines (station 0 or +)", sub: true },
    { text: "Known position of head (OA/OP/OT)", sub: true },
    { text: "No evidence of CPD / moulding 3+", sub: true },
    { text: "Informed consent and experienced operator", sub: true },
    { text: "Instrumental Delivery Options", bold: true },
    { text: "Ventouse (vacuum extraction): preferred, less maternal trauma", sub: true },
    { text: "Low-cavity forceps: when head at +2 or below in OA", sub: true },
    { text: "Kjelland forceps: for OT/OP rotation (specialist skill)", sub: true },
  ],
  col2: [
    { text: "Conditions for Instrumental Delivery (RSVP)", bold: true },
    { text: "R — Ruptured membranes", sub: true },
    { text: "S — Station at or below spines", sub: true },
    { text: "V — Vertex presentation", sub: true },
    { text: "P — Pelvis adequate / no CPD", sub: true },
    { text: "Caesarean Section", bold: true },
    { text: "Head in mid-pelvis or above → CS", sub: true },
    { text: "Failed instrumental attempt → CS", sub: true },
    { text: "Uterine action: push-pull technique (reverse breech extraction)", sub: true },
    { text: "Oxytocin Augmentation", bold: true },
    { text: "Continue oxytocin in 2nd stage if hypotonic", sub: true },
    { text: "Directed pushing with each contraction", sub: true },
    { text: "Upright / lateral positions may aid descent", sub: true },
  ]
});

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 25 — SECTION: OBSTRUCTED LABOUR
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
sectionHeader(s, "07", "Obstructed Labour", "A Surgical Emergency — Distinguish from Prolonged Labour");

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 26 — OBSTRUCTED LABOUR
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
contentSlide(s, "Obstructed Labour — Definition, Signs & Management", [], {
  twoCol: true,
  col1: [
    { text: "Definition", bold: true },
    { text: "Complete mechanical obstruction to descent of the fetus despite strong uterine contractions. Delivery cannot occur without intervention.", sub: false },
    { text: "Key Diagnostic Signs", bold: true },
    { text: "Bandl's ring (pathological retraction ring): visible transverse groove between upper and lower uterine segment on abdominal inspection", sub: true },
    { text: "Tense lower uterine segment", sub: true },
    { text: "Moulding grade 3+ with severe caput", sub: true },
    { text: "Maternal exhaustion, dehydration, tachycardia, fever", sub: true },
    { text: "Fetal distress or absent FHR (stillbirth)", sub: true },
    { text: "Impending or actual uterine rupture", sub: true },
  ],
  col2: [
    { text: "Immediate Management", bold: true },
    { text: "IV access × 2, fluid resuscitation (1 L Hartmann's STAT)", sub: true },
    { text: "Broad-spectrum IV antibiotics (cefuroxime + metronidazole)", sub: true },
    { text: "Bladder catheterisation (hourly urine output)", sub: true },
    { text: "Crossmatch 4 units blood", sub: true },
    { text: "Caesarean section — URGENT", bold: true },
    { text: "NEVER attempt vaginal delivery in obstructed labour with CPD or moulding 3+", sub: true },
    { text: "If uterus ruptured: emergency laparotomy ± repair ± hysterectomy", sub: true },
    { text: "Postoperative care: antibiotics × 5-7 days, VVF surveillance, breastfeeding support", sub: true },
    { text: "Prevention: USE THE PARTOGRAPH!", bold: true },
  ]
});

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 27 — CLINICAL SCENARIOS
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
contentSlide(s, "Clinical Scenarios — Test Your Knowledge", [
  { text: "Scenario 1", bold: true },
  { text: "A 24-yr-old primigravida at 39 weeks, in labour for 22 hours, cervix 4 cm dilated for the last 4 hours, 3/5 of head palpable per abdomen, moulding 2+, FHR 152 bpm. What is the management?", sub: true },
  { text: "→ Answer: Prolonged active phase with suspected CPD. DO NOT augment. Caesarean section.", sub: true },
  { text: "Scenario 2", bold: true },
  { text: "A 30-yr-old para 1, 40 weeks, active labour, cervix 6 cm → 7 cm over 2 hours, membranes intact, OA position, no caput, head at station -1. CTG normal.", sub: true },
  { text: "→ Answer: Protracted active phase. Perform ARM (AROM) and reassess in 2 hours. Start partograph.", sub: true },
  { text: "Scenario 3", bold: true },
  { text: "Term primigravida, full dilatation for 3 hours, head at station +1, OA position, strong contractions, actively pushing. Fetal HR shows late decelerations.", sub: true },
  { text: "→ Answer: Prolonged 2nd stage + fetal distress. Ventouse / forceps delivery if criteria met. Prepare for CS if instrumental fails.", sub: true },
]);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 28 — MCQs
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
contentSlide(s, "Self-Assessment MCQs", [
  { text: "Q1. What is the maximum acceptable duration of active phase labour in a primigravida?", bold: true },
  { text: "A) 6 hrs  B) 8 hrs  C) 12 hrs  D) 18 hrs  →  Answer: C) 12 hours", sub: true },
  { text: "Q2. The ACTION LINE on the WHO partograph is drawn how far to the right of the alert line?", bold: true },
  { text: "A) 2 hours  B) 3 hours  C) 4 hours  D) 6 hours  →  Answer: C) 4 hours", sub: true },
  { text: "Q3. Which finding is MOST consistent with obstructed labour?", bold: true },
  { text: "A) Moulding 1+  B) Bishop score 8  C) Bandl's retraction ring + moulding 3+  D) OA position  →  Answer: C", sub: true },
  { text: "Q4. Which drug is used for therapeutic rest in prolonged latent phase?", bold: true },
  { text: "A) Oxytocin  B) Misoprostol  C) Morphine sulphate  D) Salbutamol  →  Answer: C) Morphine", sub: true },
  { text: "Q5. A primigravida has cervix at 6 cm for 3 hours despite oxytocin, head 4/5 palpable per abdomen, moulding 3+. Next step?", bold: true },
  { text: "A) Increase oxytocin  B) Forceps delivery  C) Caesarean section  D) Continue monitoring  →  Answer: C) CS", sub: true },
]);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 29 — PREVENTION & WHO SAFE CHILDBIRTH CHECKLIST
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
boxSlide(s, "Prevention of Prolonged Labour — Key Strategies", [
  { icon: "📋", title: "Partograph Use", color: C.teal,
    body: "Mandatory intrapartum monitoring. WHO estimates partograph use alone reduces obstructed labour rates by 30-50% in LMICs." },
  { icon: "🏥", title: "Skilled Birth Attendance", color: C.navy,
    body: "Every delivery attended by a trained midwife or doctor. Reduces failure to recognise prolonged labour." },
  { icon: "🔬", title: "Antenatal Pelvimetry", color: "1F618D",
    body: "Clinical pelvimetry + USS EFW at 36 weeks in high-risk cases. Plan elective CS for absolute CPD before onset of labour." },
  { icon: "💊", title: "Active Management of Labour", color: C.warn,
    body: "O'Driscoll protocol: ARM + oxytocin if <1 cm/hr in active labour. Reduces CS rate and duration. Requires continuous support." },
  { icon: "🤝", title: "Continuous Labour Support", color: C.safe,
    body: "Doula / midwife support → 25% reduction in CS, 15% reduction in prolonged labour. Cochrane meta-analysis evidence." },
  { icon: "🌍", title: "Health System Strengthening", color: C.teal,
    body: "EmONC (Emergency Obstetric and Newborn Care) availability within 2 hours for all women. Referral pathways must be clear." },
  { icon: "📱", title: "Antenatal Education", color: "7D6608",
    body: "Recognising true labour, when to seek care, importance of skilled attendance. Reduces delayed presentation." },
  { icon: "🩺", title: "Intrapartum CTG + FBS", color: "8E44AD",
    body: "High-risk labours: continuous EFM. If pathological CTG: fetal blood sampling pH/lactate to guide intervention timing." },
]);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 30 — SUMMARY
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
contentSlide(s, "Summary — Key Take-Home Points", [
  { text: "Definition: Labour >18 hrs (primip) / >12 hrs (multip) from onset of regular contractions to delivery", bold: true },
  { text: "Causes follow the 3 Ps: Powers (uterine dysfunction), Passenger (malpresentation/CPD), Passage (pelvic/soft tissue obstruction)", bold: false },
  { text: "Monitoring: Partograph is the single most important tool — plot every VE, note alert/action lines", bold: true },
  { text: "Cervical progress must be ≥1 cm/hr in active phase; if slower → investigate cause before augmenting", bold: false },
  { text: "Never augment with oxytocin if CPD or obstruction is suspected (moulding 3+, head 3/5 above brim)", bold: true },
  { text: "Moulding 3+ = obstructed labour = Caesarean section (emergency)", bold: false },
  { text: "Maternal complications: PPH, sepsis, VVF, uterine rupture, maternal death", bold: false },
  { text: "Fetal complications: birth asphyxia, HIE, meconium aspiration, stillbirth, birth trauma", bold: false },
  { text: "Prevention: partograph + skilled birth attendance + active management of labour", bold: true },
]);

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 31 — REFERENCES
// ═══════════════════════════════════════════════════════════════════════════════
s = addSlide();
contentSlide(s, "References & Further Reading", [
  { text: "WHO (2014). WHO recommendations for augmentation of labour. World Health Organization, Geneva.", bold: false },
  { text: "Creasy & Resnik's Maternal-Fetal Medicine: Principles and Practice, 8th ed. Elsevier, 2022.", bold: false },
  { text: "Berek & Novak's Gynecology, 16th ed. Lippincott Williams & Wilkins, 2020.", bold: false },
  { text: "Williams Obstetrics, 26th ed. McGraw-Hill, 2022. Chapters 22-24.", bold: false },
  { text: "RCOG Green-top Guideline No. 26: Operative vaginal delivery (2011, updated 2020).", bold: false },
  { text: "Philpott RH, Castle WM (1972). Cervicographs in the management of labour in primigravidae. J Obstet Gynaecol Br Commonw. 79(7): 592-598.", bold: false },
  { text: "O'Driscoll K, Meagher D (1993). Active Management of Labour, 3rd ed. Mosby.", bold: false },
  { text: "Hofmeyr GJ et al. (2017). Preventing obstructed labour. Best Pract Res Clin Obstet Gynaecol. 45:59-70.", bold: false },
  { text: "Abalos E et al. (2018). Duration of spontaneous labour in 'low-risk' women with 'normal' perinatal outcomes. BJOG. 125(13):1680-1688.", bold: false },
  { text: "Park's Textbook of Preventive and Social Medicine. Chapter on Maternal and Child Health.", bold: false },
]);

// ═══════════════════════════════════════════════════════════════════════════════
// SAVE
// ═══════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/prolonged-labour/Prolonged_Labour.pptx" })
  .then(() => console.log("SUCCESS: /home/daytona/workspace/prolonged-labour/Prolonged_Labour.pptx"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

cd /home/daytona/workspace/prolonged-labour && node build.js 2>&1

ls -lh /home/daytona/workspace/prolonged-labour/Prolonged_Labour.pptx