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pres.layout = "LAYOUT_16x9";
pres.title = "Common Obstetric Procedures";
pres.author = "Orris Medical Education";

// ─── THEME ───────────────────────────────────────────────────────────────────
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// ─── HELPERS ─────────────────────────────────────────────────────────────────
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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 - TITLE
// ═══════════════════════════════════════════════════════════════════════════════
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    { text: "Episiotomy  |  Vacuum Extraction  |  Low Forceps", options: { breakLine: true } },
    { text: "Caesarean Section  |  Assisted Breech Delivery", options: { breakLine: true } },
    { text: "External Cephalic Version  |  Cervical Cerclage", options: { breakLine: false } },
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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 - OVERVIEW / TABLE OF CONTENTS
// ═══════════════════════════════════════════════════════════════════════════════
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  const procedures = [
    { num: "01", name: "EPISIOTOMY", desc: "Perineal incision to enlarge introitus" },
    { num: "02", name: "VACUUM EXTRACTION", desc: "Suction-assisted instrumental delivery" },
    { num: "03", name: "LOW FORCEPS", desc: "Instrumental delivery at +2 station or below" },
    { num: "04", name: "CAESAREAN SECTION", desc: "Surgical abdominal delivery" },
    { num: "05", name: "ASSISTED BREECH", desc: "Vaginal delivery of breech presentation" },
    { num: "06", name: "EXT. CEPHALIC VERSION", desc: "External turning of non-cephalic fetus" },
    { num: "07", name: "CERVICAL CERCLAGE", desc: "Suture reinforcement of incompetent cervix" },
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// ═══════════════════════════════════════════════════════════════════════════════
// ─── 01. EPISIOTOMY ──────────────────────────────────────────────────────────
// ═══════════════════════════════════════════════════════════════════════════════
addSectionTitle("01. EPISIOTOMY", "Surgical incision of the perineum to enlarge the vaginal introitus at delivery");

addContentSlide("EPISIOTOMY — Definition & Types", [
  "A surgical incision in the perineum to enlarge the introitus at delivery",
  "One of the most common obstetric procedures performed",
  "",
  "MIDLINE (MEDIAN) — most common in the USA",
  "  • Incision from posterior vagina directly toward anus (~half perineum length)",
  "  • Easier to repair, less blood loss, less pain",
  "  • Higher risk of extension to 3rd/4th degree tear",
  "",
  "MEDIOLATERAL — diagonal incision toward either side",
  "  • Reduces risk of extension into rectum",
  "  • More blood loss, more pain, more difficult to repair",
  "  • Preferred in UK and Europe",
]);

addTwoColSlide(
  "EPISIOTOMY — Indications & Contraindications",
  "INDICATIONS (Selective Use)",
  [
    "Imminent severe perineal laceration",
    "Instrumental delivery (forceps / vacuum)",
    "Shoulder dystocia",
    "Breech delivery (often required)",
    "Prolonged second stage with fetal compromise",
    "Rigid perineum preventing descent",
    "Preterm delivery to reduce head compression",
  ],
  "NOT INDICATED (Evidence-Based)",
  [
    "Routine episiotomy is NOT supported by evidence",
    "Does NOT prevent pelvic floor relaxation",
    "Does NOT prevent urinary or fecal incontinence",
    "Does NOT reduce 2nd stage of labor",
    "Does NOT protect against neonatal intracranial haemorrhage",
    "Associated with 3rd/4th degree tears in primigravidae",
  ],
  TEAL, ACCENT
);

addThreeBoxSlide("EPISIOTOMY — Technique & Complications",
  {
    title: "TECHNIQUE",
    bullets: [
      "Perform when head crowns 3–4 cm",
      "Local infiltration with lidocaine (if no epidural)",
      "Two fingers in vagina to protect fetal head",
      "Incise with scissors or scalpel at peak of contraction",
      "Midline: straight toward anus",
      "Mediolateral: 45° angle to midline",
      "Average incision: 5–6 cm into vagina",
      "Repair in layers after delivery of placenta",
    ]
  },
  {
    title: "PERINEAL TEAR DEGREES",
    bullets: [
      "1st: Superficial skin/mucosa only",
      "2nd: Involves deeper vaginal & perineal tissues",
      "3rd: Involves anal sphincter",
      "3a: <50% external sphincter",
      "3b: >50% external sphincter",
      "3c: Both external & internal sphincter",
      "4th: Extends into rectal mucosa",
    ]
  },
  {
    title: "COMPLICATIONS",
    bullets: [
      "Extension to 3rd/4th degree tear",
      "Haemorrhage / haematoma",
      "Infection / wound breakdown",
      "Dyspareunia (painful intercourse)",
      "Fistula formation (rare)",
      "Urinary/fecal incontinence",
      "Failure to heal",
      "Perineal pain (acute & chronic)",
    ]
  }
);

// ═══════════════════════════════════════════════════════════════════════════════
// ─── 02. VACUUM EXTRACTION ───────────────────────────────────────────────────
// ═══════════════════════════════════════════════════════════════════════════════
addSectionTitle("02. VACUUM EXTRACTION", "Ventouse — suction cup applied to fetal scalp for assisted vaginal delivery");

addTwoColSlide(
  "VACUUM EXTRACTION — Indications & Contraindications",
  "INDICATIONS",
  [
    "Arrest of labor in 2nd stage",
    "Fetal distress (non-reassuring CTG) in 2nd stage",
    "Maternal indication to shorten 2nd stage:",
    "  - Cardiovascular disease",
    "  - Cerebrovascular disease",
    "  - Maternal exhaustion",
    "Elective low-pelvic delivery",
    "Same indications as forceps delivery",
  ],
  "CONTRAINDICATIONS",
  [
    "Cephalopelvic disproportion (CPD)",
    "Face or brow presentation",
    "Breech presentation",
    "Unengaged fetal head",
    "Prematurity (<34 weeks — soft skull)",
    "Incompletely dilated cervix",
    "Fetal coagulation disorder",
    "Active scalp/skin infection",
    "Previous fetal scalp sampling in same labour",
  ],
  TEAL, ACCENT
);

addContentSlide("VACUUM EXTRACTION — Technique", [
  "PRE-REQUISITES: vertex presentation, fully dilated cervix, engaged head, ruptured membranes, no CPD",
  "",
  "1. Position patient in lithotomy; empty bladder",
  "2. Select appropriate cup (soft silicone preferred in USA; rigid metal for OP positions)",
  "3. Apply cup to 'flexion point' (3 cm anterior to posterior fontanelle, along sagittal suture)",
  "4. Ensure no maternal tissue is caught under rim",
  "5. Create negative pressure: build to 0.6–0.8 kg/cm² (or 500–600 mmHg)",
  "6. Check for no tissue under cup",
  "7. Apply traction during contraction, in axis of birth canal — perpendicular then upward",
  "8. Maternal pushing efforts essential throughout",
  "9. Allow chignon (artificial caput) to form — confirms correct placement",
  "10. If cup detaches ('pops off') >2 times — ABANDON and proceed to caesarean",
]);

addThreeBoxSlide("VACUUM EXTRACTION — Complications & Forceps vs Vacuum",
  {
    title: "MATERNAL COMPLICATIONS",
    bullets: [
      "Cervical / vaginal lacerations (less than forceps)",
      "Perineal trauma",
      "Urinary retention",
      "Postpartum haemorrhage",
      "Genital tract infection",
    ]
  },
  {
    title: "NEONATAL COMPLICATIONS",
    bullets: [
      "Cephalhaematoma (common, benign)",
      "Chignon (temporary — resolves)",
      "Subgaleal haemorrhage (4%) — SERIOUS",
      "Intracranial haemorrhage (2.5%)",
      "Retinal haemorrhages (mostly benign)",
      "Scalp lacerations / abrasions",
      "Jaundice (from haematoma)",
    ]
  },
  {
    title: "VACUUM vs FORCEPS",
    bullets: [
      "Vacuum: less maternal pelvic trauma",
      "Vacuum: higher pop-off / failure rate",
      "Vacuum: more cephalhaematoma & retinal haemorrhage",
      "Forceps: less neonatal injury in meta-analyses",
      "Forceps: higher maternal pelvic floor trauma",
      "Sequential use of both = 7.4× ICH risk — AVOID",
      "Vacuum: easier to learn & apply",
      "Vacuum: less anaesthesia required",
    ]
  }
);

// ═══════════════════════════════════════════════════════════════════════════════
// ─── 03. LOW FORCEPS ─────────────────────────────────────────────────────────
// ═══════════════════════════════════════════════════════════════════════════════
addSectionTitle("03. LOW FORCEPS DELIVERY", "Instrumental delivery when the leading fetal skull edge is at +2 cm station or below");

addContentSlide("FORCEPS CLASSIFICATION (ACOG 1988)", [
  "OUTLET FORCEPS:",
  "  • Scalp visible at introitus without separating labia",
  "  • Fetal skull has reached pelvic floor",
  "  • Sagittal suture in AP diameter or ROA/LOA/ROP/LOP",
  "  • Rotation does not exceed 45°",
  "",
  "LOW FORCEPS:",
  "  • Leading point of fetal skull at +2 cm or lower, NOT on pelvic floor",
  "  • Rotation ≤45° (LOA/ROA → OA, or LOP/ROP → OP)",
  "  • Or rotation >45°",
  "",
  "MID-FORCEPS:",
  "  • Station above +2 cm but head engaged — rarely used; reserve for emergency",
  "",
  "HIGH FORCEPS: ABANDONED — no place in modern obstetrics",
]);

addTwoColSlide(
  "LOW FORCEPS — Indications & Prerequisites",
  "INDICATIONS",
  [
    "Prolonged 2nd stage of labour",
    "Fetal distress in 2nd stage",
    "Maternal exhaustion",
    "Medical condition requiring shortened 2nd stage:",
    "  - Cardiac / respiratory disease",
    "  - Severe hypertension / pre-eclampsia",
    "  - Neurological contraindication to pushing",
    "Elective shortening of 2nd stage",
  ],
  "PREREQUISITES (ALL must be met)",
  [
    "Vertex presentation",
    "Fully dilated cervix (10 cm)",
    "Ruptured membranes",
    "Fetal head at +2 station or below",
    "No cephalopelvic disproportion",
    "Known fetal position confirmed",
    "Adequate maternal analgesia / anaesthesia",
    "Willingness to abandon for caesarean if needed",
    "Empty bladder (catheterise if necessary)",
  ],
  TEAL, "2E86C1"
);

addContentSlide("LOW FORCEPS — Technique (Simpson / DeLee Forceps)", [
  "1. Confirm prerequisites: position, station, no CPD",
  "2. Patient in lithotomy; empty bladder",
  "3. Adequate anaesthesia (pudendal block, epidural, or local)",
  "4. LEFT BLADE applied first: operator's right hand inserted between head & left vaginal wall; left blade rotated into position (12 o'clock → counterclockwise)",
  "5. RIGHT BLADE applied: operator's left hand guides right blade into place",
  "6. LOCK handles — should come together easily",
  "7. CONFIRM placement: sagittal suture equidistant between blades, perpendicular to shanks; posterior fontanelle 1 fingerbreadth above shank",
  "8. ROTATE fetal head if needed (during uterine relaxation before contraction)",
  "9. APPLY TRACTION with contraction + maternal pushing — direction guided by pelvis",
  "   • Initial traction DOWNWARD (toward floor) until head clears symphysis",
  "   • Then traction UPWARD as head delivers in extension",
  "10. Remove forceps before crowning if possible; episiotomy only if needed",
  "11. Inspect vagina & cervix for lacerations",
]);

addThreeBoxSlide("LOW FORCEPS — Complications",
  {
    title: "MATERNAL COMPLICATIONS",
    bullets: [
      "Perineal lacerations (3rd/4th degree)",
      "Vaginal & cervical tears",
      "Bladder / urethral injury",
      "Postpartum haemorrhage",
      "Puerperal infection",
      "Urinary incontinence",
      "Pelvic floor dysfunction",
      "Symphysis pubis damage (rare)",
    ]
  },
  {
    title: "FETAL COMPLICATIONS",
    bullets: [
      "Facial / scalp bruising / abrasions",
      "Facial nerve palsy (transient)",
      "Cephalhaematoma",
      "Skull fracture (rare)",
      "Intracranial haemorrhage",
      "Brachial plexus injury",
      "Hyperbilirubinaemia",
      "Failed forceps → emergency LSCS",
    ]
  },
  {
    title: "KEY POINTS",
    bullets: [
      "Low > mid > high in terms of safety",
      "Serious morbidity increases if vertex above +2 cm",
      "No significant difference in neonatal ICH vs vacuum vs CS in large studies",
      "Sequential vacuum + forceps: 7.4× ICH risk — AVOID",
      "Failed operative delivery → CS carries highest morbidity",
      "Abandon and proceed to CS if not progressing",
    ]
  }
);

// ═══════════════════════════════════════════════════════════════════════════════
// ─── 04. CAESAREAN SECTION ───────────────────────────────────────────────────
// ═══════════════════════════════════════════════════════════════════════════════
addSectionTitle("04. CAESAREAN SECTION", "Surgical delivery of the fetus through abdominal and uterine incisions");

addTwoColSlide(
  "CAESAREAN SECTION — Indications",
  "ABSOLUTE INDICATIONS",
  [
    "Complete placenta praevia",
    "Cord prolapse (with live fetus)",
    "Transverse lie at term",
    "Obstructed labour with CPD",
    "Previous classical uterine incision",
    "Active genital herpes at onset of labour",
    "Placenta accreta / increta / percreta",
    "Failed trial of labour (fetal distress)",
    "Brow presentation (usually)",
  ],
  "RELATIVE INDICATIONS (Common)",
  [
    "Failure to progress / dystocia",
    "Non-reassuring fetal status (fetal distress)",
    "Malpresentation (breech, face)",
    "Repeat caesarean section",
    "Severe pre-eclampsia / eclampsia",
    "Fetal macrosomia with CPD",
    "Previous uterine surgery / myomectomy",
    "Maternal request (after counselling)",
    "Multiple pregnancy (in certain configurations)",
  ],
  TEAL, "2E86C1"
);

addContentSlide("CAESAREAN SECTION — Technique (Lower Segment)", [
  "1. Anaesthesia: spinal (preferred) or epidural; GA for extreme emergency",
  "2. Foley catheter; supine with left lateral tilt (wedge under right hip) — prevents aortocaval compression",
  "3. SKIN INCISION: Pfannenstiel (transverse, 2–3 cm above symphysis pubis) — most common; midline vertical for emergency/rapid access",
  "4. Layers divided: skin → subcutaneous fat → rectus sheath (transverse) → rectus muscles separated → peritoneum",
  "5. UTERINE INCISION: Low transverse (Kerr incision) — standard; avoids bowel, better healing, allows VBAC",
  "6. Vesico-uterine peritoneum reflected down; bladder protected",
  "7. DELIVERY OF FETUS: surgeon's hand under presenting part; assistant applies fundal pressure; head delivered with extension",
  "8. Syntocinon (oxytocin) IV bolus given after delivery of fetus",
  "9. PLACENTA delivered; uterine cavity inspected",
  "10. UTERINE CLOSURE: 2 layers (or 1 layer for thin LUS); continuous absorbable suture",
  "11. Peritoneum closure optional; rectus sheath closure; skin closure",
]);

addThreeBoxSlide("CAESAREAN SECTION — Complications",
  {
    title: "INTRAOPERATIVE",
    bullets: [
      "Haemorrhage (uterine atony, placenta accreta)",
      "Injury to bladder (most common)",
      "Injury to ureter",
      "Bowel injury",
      "Uterine artery injury",
      "Extension of uterine incision",
      "Fetal laceration",
      "Anaesthetic complications",
    ]
  },
  {
    title: "POSTOPERATIVE",
    bullets: [
      "Wound infection / dehiscence",
      "Endometritis",
      "Urinary tract infection",
      "DVT / pulmonary embolism",
      "Paralytic ileus",
      "Bladder dysfunction",
      "Postpartum haemorrhage",
      "Peritonitis (rare)",
    ]
  },
  {
    title: "FUTURE PREGNANCY",
    bullets: [
      "Uterine scar rupture (0.5% in TOLAC)",
      "Placenta praevia / accreta risk ↑",
      "Adhesion formation",
      "Bowel obstruction from adhesions",
      "Increased risk with each repeat CS",
      "Ectopic pregnancy risk ↑",
      "Scar ectopic (rare but dangerous)",
    ]
  }
);

// ═══════════════════════════════════════════════════════════════════════════════
// ─── 05. ASSISTED BREECH DELIVERY ────────────────────────────────────────────
// ═══════════════════════════════════════════════════════════════════════════════
addSectionTitle("05. ASSISTED BREECH DELIVERY", "Vaginal delivery of fetus presenting by the buttocks or feet");

addTwoColSlide(
  "BREECH DELIVERY — Types & Indications",
  "TYPES OF BREECH",
  [
    "Frank breech (65%): hips flexed, knees extended",
    "Complete breech (25%): hips & knees flexed",
    "Footling / incomplete (10%): one or both feet present",
    "",
    "INCIDENCE: 3–4% of term deliveries",
    "",
    "VAGINAL DELIVERY CONSIDERED WHEN:",
    "  • Experienced operator available",
    "  • Frank or complete breech at term",
    "  • Estimated fetal weight 1500–4000 g",
    "  • Normal pelvis (clinical/X-ray pelvimetry)",
    "  • No hyperextended fetal head",
  ],
  "PREREQUISITES",
  [
    "Experienced obstetrician present",
    "Anaesthetist available",
    "Neonatologist / paediatric team on standby",
    "Operating theatre immediately available",
    "Informed consent obtained",
    "Labour progressing normally",
    "No cord prolapse",
    "Epidural anaesthesia available",
    "Fetal monitoring (continuous CTG)",
  ],
  TEAL, "2E86C1"
);

addContentSlide("ASSISTED BREECH DELIVERY — Technique", [
  "GOLDEN RULE: 'Hands off the breech' until needed — avoid premature traction",
  "",
  "1. Episiotomy may be needed — not routine",
  "2. Allow spontaneous delivery to umbilicus; DO NOT pull",
  "3. POSTERIOR HIP delivers first from 6 o'clock position, then anterior hip",
  "4. LEGS: splint medial thighs with fingers parallel to femur, press laterally to sweep legs",
  "5. Wrap fetal body in warm towel for grip",
  "6. ARMS (when scapulae appear under symphysis):",
  "   Lovset's manoeuvre: rotate 180° to deliver posterior arm — sweep anteriorly",
  "7. HEAD delivery (most dangerous step):",
  "   Mauriceau-Smellie-Veit (MSV): body on operator's forearm; fingers over maxilla for flexion; traction downward then upward",
  "   Burns-Marshall: allow body to hang by gravity then swing upward",
  "   Forceps to after-coming head (Piper's forceps): most controlled",
  "8. SUPRAPUBIC PRESSURE by assistant during head delivery",
]);

addThreeBoxSlide("ASSISTED BREECH — Complications & Management",
  {
    title: "COMPLICATIONS",
    bullets: [
      "Head entrapment (most feared)",
      "Cord prolapse",
      "Nuchal arm entrapment",
      "Birth asphyxia / hypoxia",
      "Brachial plexus injury (Erb's palsy)",
      "Cervical spine injury",
      "Spinal cord damage",
      "Intracranial haemorrhage",
      "Maternal perineal trauma",
    ]
  },
  {
    title: "HEAD ENTRAPMENT MANAGEMENT",
    bullets: [
      "Maintain head flexion throughout",
      "Apply gentle suprapubic pressure",
      "MSV manoeuvre — first line",
      "Piper's forceps — safest for after-coming head",
      "Duhrssen's cervical incisions (1, 5, 7 o'clock) — last resort",
      "General anaesthesia for uterine relaxation",
      "NEVER apply traction to fetal neck",
    ]
  },
  {
    title: "WHEN TO PERFORM CS",
    bullets: [
      "Footling breech (cord prolapse risk ↑)",
      "Estimated weight >4000 g",
      "Previous CS (relative)",
      "Failed ECV",
      "Labour dystocia",
      "Non-reassuring fetal status",
      "Hyperextended head (risk of spinal injury)",
      "Absence of experienced operator",
    ]
  }
);

// ═══════════════════════════════════════════════════════════════════════════════
// ─── 06. EXTERNAL CEPHALIC VERSION ───────────────────────────────────────────
// ═══════════════════════════════════════════════════════════════════════════════
addSectionTitle("06. EXTERNAL CEPHALIC VERSION (ECV)", "External manual turning of a non-cephalic fetus to cephalic presentation");

addTwoColSlide(
  "ECV — Indications, Contraindications & Success Factors",
  "INDICATIONS & TIMING",
  [
    "Breech or transverse lie at ≥36 weeks",
    "Singleton pregnancy",
    "Suitable for vaginal delivery after successful version",
    "",
    "FACTORS → SUCCESS:",
    "  • Multiparity (most consistent)",
    "  • Normal amniotic fluid (AFI ↑ = success ↑)",
    "  • Transverse lie (success ~90%)",
    "  • Unengaged presenting part",
  ],
  "CONTRAINDICATIONS",
  [
    "Placenta praevia",
    "Abruption placenta / antepartum haemorrhage",
    "Ruptured membranes",
    "Severe pre-eclampsia / hypertension",
    "Multiple pregnancy",
    "Uterine anomaly / fibroids",
    "Previous uterine scar (relative)",
    "Oligohydramnios",
    "Non-reassuring CTG",
    "Fetal compromise or IUGR",
  ],
  TEAL, ACCENT
);

addContentSlide("ECV — Technique", [
  "REQUIREMENTS: CTG monitoring, ultrasound, IV access, theatre stand-by",
  "Rh-negative mothers: Anti-D immunoglobulin after procedure",
  "",
  "TOCOLYSIS: Terbutaline (0.25 mg SC) or salbutamol 5 min before — uterine relaxation",
  "",
  "1. Confirm fetal presentation and placental site on ultrasound",
  "2. Assess fetal heart rate (CTG — minimum 20 min reactive trace)",
  "3. Empty maternal bladder",
  "4. Position: supine with slight Trendelenburg (15°) and lateral tilt",
  "5. Apply ultrasound gel; maintain US probe in one hand (or assistant monitors throughout)",
  "6. FORWARD ROLL preferred: displace breech upward / laterally from pelvis, then push head down",
  "7. If unsuccessful: BACKWARD ROLL — opposite direction",
  "8. Continuous CTG monitoring throughout and for 30 min after",
  "9. Do NOT persist if fetal heart rate decelerates — STOP immediately",
  "10. Success rate: ~50–60% overall; 90% if none of 3 adverse factors present",
  "11. Spontaneous reversion rate after ECV: ~5%",
]);

// ═══════════════════════════════════════════════════════════════════════════════
// ─── 07. CERVICAL CERCLAGE ────────────────────────────────────────────────────
// ═══════════════════════════════════════════════════════════════════════════════
addSectionTitle("07. CERVICAL CERCLAGE", "Suture reinforcement of an incompetent cervix to prevent preterm delivery");

addContentSlide("CERVICAL CERCLAGE — Background & Types of Cerclage", [
  "CERVICAL INSUFFICIENCY: painless cervical dilation and shortening in 2nd trimester without contractions, leading to pregnancy loss",
  "",
  "THREE TYPES BASED ON INDICATION (ACOG / CREASY & RESNIK):",
  "",
  "1. HISTORY-INDICATED CERCLAGE (HIC):",
  "   • Based on obstetric history alone; placed at 11–14 weeks",
  "   • Indications: ≥3 prior 2nd trimester losses, prior exam-indicated cerclage",
  "",
  "2. ULTRASOUND-INDICATED CERCLAGE (UIC):",
  "   • Prior preterm birth (16–36+6 weeks) + current CL <25 mm before 24 weeks",
  "   • Offered before 24 weeks",
  "",
  "3. PHYSICAL EXAMINATION-INDICATED (RESCUE) CERCLAGE:",
  "   • Painless cervical dilation <24 weeks without contractions, PPROM, or chorioamnionitis",
  "   • Highest risk procedure; may require membrane replacement",
]);

addTwoColSlide(
  "CERVICAL CERCLAGE — Technique & Contraindications",
  "SURGICAL TECHNIQUE (McDonald / Shirodkar)",
  [
    "McDONALD (most common):",
    "  • Purse-string suture around cervix at cervicovaginal junction",
    "  • No bladder dissection needed",
    "  • Removed at 36–37 weeks",
    "",
    "SHIRODKAR:",
    "  • Bladder reflected anteriorly, rectum posteriorly",
    "  • Suture placed higher on cervix",
    "  • More complex; used in failure of McDonald",
    "",
    "TRANSABDOMINAL CERCLAGE (TAC):",
    "  • Via laparotomy or laparoscopy",
    "  • For anatomical or prior vaginal failure",
    "  • Delivery must be by caesarean",
  ],
  "CONTRAINDICATIONS & COMPLICATIONS",
  [
    "CONTRAINDICATIONS:",
    "  • Active chorioamnionitis",
    "  • PPROM",
    "  • Active vaginal bleeding",
    "  • Uterine contractions",
    "  • Fetal anomaly incompatible with life",
    "",
    "COMPLICATIONS:",
    "  • Rupture of membranes (PPROM)",
    "  • Chorioamnionitis / infection",
    "  • Cervical laceration",
    "  • Suture displacement / failure",
    "  • Preterm labour",
    "  • Bladder injury (rare)",
    "  • Cervical stenosis after removal",
  ],
  TEAL, ACCENT
);

// ═══════════════════════════════════════════════════════════════════════════════
// FINAL SLIDE — SUMMARY TABLE
// ═══════════════════════════════════════════════════════════════════════════════
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  slide.addText("SUMMARY — KEY POINTS FOR EACH PROCEDURE", {
    x: 0.3, y: 0.1, w: 9.4, h: 0.82, fontFace: TITLE_FONT, fontSize: 24, bold: true, color: WHITE, valign: "middle",
  });

  const rows = [
    ["Procedure", "Primary Indication", "Key Prerequisite", "Main Complication"],
    ["Episiotomy", "Instrumental delivery / imminent severe tear", "Crowning head (3–4 cm visible)", "Extension to 3rd/4th degree tear"],
    ["Vacuum Extraction", "2nd stage arrest / fetal distress", "Fully dilated, engaged vertex", "Subgaleal / intracranial haemorrhage"],
    ["Low Forceps", "2nd stage arrest at +2 station or below", "Vertex at +2 cm, known position", "Perineal / vaginal lacerations"],
    ["Caesarean Section", "CPD / fetal distress / malpresentation", "Anaesthesia, empty bladder, consent", "Haemorrhage, adhesions, scar rupture"],
    ["Breech Delivery", "Breech presentation, experienced operator", "Frank/complete breech, normal pelvis", "Head entrapment, birth asphyxia"],
    ["Ext. Cephalic Version", "Breech/transverse at ≥36 weeks", "CTG, US, IV access, theatre stand-by", "Cord prolapse, emergency CS"],
    ["Cervical Cerclage", "Cervical insufficiency / short cervix", "No infection, no active labour", "PPROM, chorioamnionitis"],
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        align: "center", valign: "middle",
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// ═══════════════════════════════════════════════════════════════════════════════
// CLOSING SLIDE
// ═══════════════════════════════════════════════════════════════════════════════
{
  const slide = pres.addSlide();
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  slide.addText("COMMON OBSTETRIC PROCEDURES", {
    x: 0.5, y: 1.2, w: 9, h: 1.0, fontFace: TITLE_FONT, fontSize: 34, bold: true, color: WHITE, align: "center",
  });
  slide.addText("Episiotomy  •  Vacuum Extraction  •  Low Forceps\nCaesarean Section  •  Assisted Breech Delivery\nExternal Cephalic Version  •  Cervical Cerclage", {
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  slide.addText("Sources: Creasy & Resnik's Maternal-Fetal Medicine | Textbook of Family Medicine 9e\nRoberts and Hedges' Clinical Procedures in Emergency Medicine | Pfenninger & Fowler's Procedures for Primary Care", {
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}

// WRITE FILE
pres.writeFile({ fileName: "/home/daytona/workspace/obstetric-procedures/Obstetric_Procedures.pptx" })
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