PRECONCEPTIONAL COUNSELING AND CARE When a couple is seen and counsele

PRECONCEPTIONAL COUNSELING AND CARE When a couple is seen and counseled about pregnancy, its course and outcome well before the time of actual conception is called preconceptional counseling. Objective is to ensure that a woman enters pregnancy with an optimal state of health which would be safe both for herself and the fetus. Organogenesis is completed by the first trimester. By the time the woman is seen first in the antenatal clinic, it is often too late to advice because all the adverse factors have already begun to exert their effects. Preconceptual phase is the time to identify any risk factor that could potentially affect the perinatal outcome adversely. The woman is informed about the risk factor and at the same time care is provided to reduce or to eliminate the risk factor in an attempt to improve the pregnancy outcome. Virtually preconceptional couns eling is a part of preventive medicine. PRECONCEPTIONAL VISIT, RISK ASSESSMENT AND EDUCATION  Identification of high-risk factors by detailed evalua- tion of obstetric, medical, family and personal history. Risk factors are assessed by laboratory tests, if required.  Base level health status including blood pressure is recorded.  Rubella and hepatitis immunization in a nonimmune woman is offered (see p. 271, 281).  Folic acid supplementation (4 mg a day) starting 4 weeks prior to conception up to 12 weeks of pregn- ancy (see p. 383), is advised. This can reduce the inci- dence of neural tube defects.  Maternal health is optimized preconceptionally. Problems of overweight, underweight, anemia, abnor- mal Papanicolaou smears are evaluated and treated appropriately.  Fear of the incoming pregnancy is removed by preconceptional education.  Patient with medical complications should be edu- cated about the effects of the disease on pregnancy and also the effects of pregnancy on the disease. In extreme situation, the pregnancy is discouraged. Pre- existing chronic diseases (hypertension, diabetes, epi- lepsy) are stabilized in an optimal state by intervention.  Drugs used before pregnancy are verified and chan- ged if required so as to avoid any adverse effect on the fetus during the period of organogenesis (see p. 474). For example, anticonvulsant drugs are checked (see p. 472), warfarin is replaced with heparin and oral antidiabetic drugs are replaced with insulin.  Woman should be urged to stop smoking, taking alcohol and abusing drugs. Addicted woman is given specialized care.  Inheritable genetic diseases (sickle cell disease, cystic fibrosis) are screened before conception and risk of passing on the condition to the offspring is discussed (see p. 255).  Importance of prenatal diagnosis for chromosomal or genetic diseases is discussed (see p. 103, 106).  Inheritable genetic diseases could be managed eit- her by primary prevention (eliminating the causal factor) or by secondary prevention (terminating the affected fetus).  Couples with history of recurrent fetal loss (see p. 159) or with family history of congenital abnorma- lities (genetic, chromosomal or structural) are investigated and counseled appropriately. There may be some untreatable factors (see p. 102). Educational classes include discussion as regard delivery, timing, method and possible interventions (ventouse/forceps or cesarean delivery). Such prenatal classes are found helpful and valuable. The counseling should be done by primary health care providers. The help of an obstetrician, physician and geneticist may be required and should be extended. LIMITATIONS: Unfortunately, only a small percentage of women take the advantage of preconceptual care. The important reasons are: (i) Lack of public awareness, (ii) many pregnancies are unplanned Prepare summary with important points for presentation

Here is a structured summary of Preconceptional Counseling and Care suitable for a presentation:

Preconceptional Counseling and Care

Definition

Counseling a couple about pregnancy, its course, and outcome before actual conception occurs.

Objective

To ensure a woman enters pregnancy in an optimal state of health - safe for both herself and the fetus.

Key rationale: Organogenesis is complete by the end of the first trimester. By the first antenatal visit, adverse factors may have already begun their effects.

Why It Matters

Preconceptual phase = ideal time to identify and address risk factors
Aims to reduce or eliminate factors that could adversely affect perinatal outcome
Essentially a form of preventive medicine

Preconceptional Visit: Key Actions

Area	Action
History & Assessment	Detailed obstetric, medical, family, and personal history; lab tests if needed
Baseline Health	Record blood pressure and general health status
Immunization	Rubella and Hepatitis B vaccines for non-immune women
Folic Acid	4 mg/day starting 4 weeks before conception up to 12 weeks - reduces neural tube defects
Maternal Health Optimization	Treat overweight/underweight, anemia, abnormal Pap smears
Medical Diseases	Stabilize chronic conditions: hypertension, diabetes, epilepsy
Medications Review	Replace teratogenic drugs - warfarin → heparin; oral antidiabetics → insulin; review anticonvulsants
Lifestyle	Urge cessation of smoking, alcohol, and drug abuse; specialized care for addiction
Genetic Screening	Screen for inheritable diseases (sickle cell, cystic fibrosis); counsel on risk to offspring
Prenatal Diagnosis	Discuss importance for chromosomal/genetic diseases
Recurrent Fetal Loss	Investigate and counsel couples with history of recurrent loss or family history of congenital anomalies
Birth Education	Discuss delivery timing, method, and possible interventions (forceps, ventouse, cesarean)

Genetic Disease Management Strategies

Primary Prevention - Eliminate the causal factor
Secondary Prevention - Termination of an affected fetus

Who Provides Counseling?

Primary health care providers (first point of contact)
Supported by: Obstetrician, Physician, Geneticist as needed

Limitations

Only a small percentage of women access preconceptual care.

Reasons:

Lack of public awareness
Many pregnancies are unplanned

Key Take-Home Points for Presentation

Preconceptional counseling is preventive obstetrics - act before harm occurs
The window of opportunity closes early - organogenesis is done by week 12
Folic acid supplementation is the single most impactful intervention for NTD prevention
Drug safety review is essential - several common drugs are teratogenic
Genetic counseling is integral for at-risk couples
Major barrier = unplanned pregnancies and lack of awareness

Create a powerpoint presentation on Perinatal mortality definition causes and prevention based on obstetrics dutta textbook

Reading File

Finding Sources

Reading File

Finding Sources

Reading File

Running Command

mkdir -p /home/daytona/workspace/perinatal-mortality-ppt

Writing File

~/perinatal-mortality-ppt/build.js

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    ["05", "Causes - Antenatal, Intranatal, Postnatal"],
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// ─── SECTION 1: INTRODUCTION ─────────────────────────────────────
sectionDivider("01  Introduction & Scope");

contentSlide("Introduction - Why Perinatal Mortality Matters", [
  "Perinatal mortality is a sensitive index of the quality of obstetric and neonatal care",
  "Reflects socioeconomic conditions, nutrition, health infrastructure, and antenatal care",
  "Two-thirds of all perinatal deaths occur in infants with birth weight < 2500 g",
  "Global target: Reduce preventable stillbirths and neonatal deaths to < 12 per 1000 live births by 2030 (SDG 3.2)",
  "Perinatal period encompasses the most vulnerable phase of human development",
  "Improving PMR requires coordinated efforts across antenatal, intranatal, and neonatal care"
], { fsize: 15 });

// ─── SECTION 2: DEFINITIONS ──────────────────────────────────────
sectionDivider("02  Definitions");

// Slide: Perinatal Period
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// ─── SECTION 3: PMR FORMULA ──────────────────────────────────────
sectionDivider("03  Perinatal Mortality Rate");

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}

// ─── SECTION 4: COMPONENTS ───────────────────────────────────────
sectionDivider("04  Components of Perinatal Mortality");

twoColSlide(
  "Components - Stillbirth vs Early Neonatal Death",
  "Stillbirth (Late Foetal Death)",
  [
    "Foetal death at ≥ 28 weeks gestation",
    "Birth weight ≥ 1000 g",
    "No signs of life at birth",
    "Causes: APH, placental insufficiency, cord accidents, maternal disease, congenital anomalies",
    "Accounts for ~50-60% of perinatal deaths in developing countries",
  ],
  "Early Neonatal Death",
  [
    "Live birth that dies within 7 days (0-6 days)",
    "Birth weight ≥ 1000 g",
    "Most deaths occur within 24 hours",
    "Causes: Prematurity, RDS, birth asphyxia, sepsis, congenital anomalies",
    "Risk inversely proportional to gestational age and birth weight",
  ]
);

// ─── SECTION 5: CAUSES ───────────────────────────────────────────
sectionDivider("05  Causes of Perinatal Mortality");

// Slide: Overview
contentSlide("Causes - Overview", [
  "Two-thirds of all perinatal deaths occur in infants with birth weight < 2500 g",
  "Causes involve complications in the mother, placenta, or foetus/neonate",
  "Main causes: Birth asphyxia, Low birth weight, Birth trauma, Infections (intrauterine or neonatal)",
  "Classified into: (A) Antenatal  |  (B) Intranatal  |  (C) Postnatal  |  (D) Unknown",
  "Many deaths are preventable with timely and appropriate care",
], { fsize: 16 });

// Slide: Antenatal Causes
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  const antenatal = [
    ["Maternal Diseases", "Hypertension, Cardiovascular diseases, Diabetes mellitus, Tuberculosis, Severe anaemia"],
    ["Pelvic Diseases", "Uterine myomas, Endometriosis, Ovarian tumours"],
    ["Anatomical Defects", "Uterine anomalies, Incompetent cervix"],
    ["Endocrine Imbalance", "Inadequate uterine preparation, thyroid disorders"],
    ["Blood Incompatibilities", "Rh isoimmunization, ABO incompatibility"],
    ["Toxaemias of Pregnancy", "Pre-eclampsia, Eclampsia - major contributor to stillbirths"],
    ["Antepartum Haemorrhage", "Placenta praevia, Abruptio placentae"],
    ["Malnutrition", "Low birth weight, intrauterine growth restriction"],
    ["Congenital Defects", "Chromosomal, structural anomalies - often incompatible with life"],
    ["Advanced Maternal Age", "Increased risk of chromosomal defects and placental insufficiency"],
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// Slide: Intranatal + Postnatal Causes
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  const intra = [
    ["Birth Injuries", "Trauma during delivery - tentorial tears, skull fractures"],
    ["Asphyxia", "Most common intranatal cause - hypoxia during labour"],
    ["Prolonged Effort", "Prolonged second stage, obstructed labour"],
    ["Obstetric Complications", "Cord prolapse, shoulder dystocia, malpresentation"],
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    ["Prematurity", "Major cause - systems immature, inability to sustain life"],
    ["Respiratory Distress Syndrome", "Surfactant deficiency in premature lungs (HMD)"],
    ["Infections", "Pneumonia, septicaemia, gastroenteritis - respiratory & alimentary"],
    ["Congenital Anomalies", "Structural defects incompatible with independent life"],
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// ─── SECTION 6: RISK FACTORS ─────────────────────────────────────
sectionDivider("06  Risk Factors");

contentSlide("Key Risk Factors for Perinatal Mortality", [
  "Low birth weight (< 2500 g) - single most important risk factor",
  "Preterm birth (< 37 weeks) - prematurity drives majority of neonatal deaths",
  "Multiple pregnancy (twins, triplets) - increased prematurity and growth restriction",
  "Maternal infections: TORCH, syphilis, malaria, HIV",
  "Lack of antenatal care and skilled birth attendance",
  "Malnutrition and severe anaemia in mother",
  "Advanced maternal age (> 35 years) and grand multiparity",
  "Socioeconomic deprivation and poor access to emergency obstetric care",
], { fsize: 15 });

// ─── SECTION 7: PREVENTION ───────────────────────────────────────
sectionDivider("07  Prevention & Interventions");

// Slide: Antenatal Prevention
contentSlide("Prevention - Antenatal Measures", [
  "Early and regular antenatal care (minimum 8 visits - WHO 2016)",
  "Screening and treatment of hypertension, diabetes, and anaemia",
  "Tetanus toxoid immunization and rubella vaccination before pregnancy",
  "Folic acid supplementation (400 mcg daily) to prevent neural tube defects",
  "Iron and folic acid supplementation to combat anaemia",
  "Screening for TORCH infections and syphilis (VDRL/RPR) with treatment",
  "Rh isoimmunization prevention: Anti-D immunoglobulin in Rh-negative mothers",
  "Identification of high-risk pregnancies and timely referral",
  "Genetic counseling for couples with risk of chromosomal/congenital disorders",
], { fsize: 14 });

// Slide: Intranatal + Postnatal Prevention
twoColSlide(
  "Prevention - Intranatal & Postnatal Measures",
  "Intranatal Prevention",
  [
    "Skilled birth attendance at every delivery",
    "Partogram use to detect prolonged/obstructed labour",
    "Timely caesarean section for fetal distress",
    "Proper management of cord prolapse, malpresentation",
    "Corticosteroids for lung maturation in preterm labour (24-34 wks)",
    "Continuous fetal monitoring (CTG) in high-risk labour",
    "Aseptic techniques to prevent intrapartum infections",
  ],
  "Postnatal / Neonatal Care",
  [
    "Immediate newborn resuscitation (ABCD of neonatal resus)",
    "Thermoregulation - prevent hypothermia (Kangaroo Mother Care)",
    "Early initiation of breastfeeding within 1 hour of birth",
    "Surfactant therapy for RDS in premature neonates",
    "Prophylactic antibiotics and eye care for infections",
    "Vitamin K injection at birth to prevent haemorrhagic disease",
    "Screening for congenital hypothyroidism, PKU",
  ]
);

// Slide: Systemic / Public Health Prevention
contentSlide("Prevention - Public Health & System-Level Measures", [
  "Establishment of neonatal intensive care units (NICUs) and special care baby units",
  "Training of birth attendants and midwives in essential newborn care",
  "Audit of perinatal deaths to identify avoidable factors (perinatal audit)",
  "Improving socioeconomic conditions, female education, and nutrition",
  "Family planning to prevent grand multiparity and closely-spaced pregnancies",
  "Antenatal and postnatal domiciliary care for high-risk groups",
  "Implementation of WHO Safe Childbirth Checklist",
  "Strengthening emergency obstetric care (EmOC) at peripheral level",
], { fsize: 15 });

// ─── SECTION 8: KEY TAKEAWAYS ────────────────────────────────────
sectionDivider("08  Key Takeaways");

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    { num: "5", text: "Prevention pyramid: Preconception → Antenatal → Intranatal → Neonatal care", color: ACCENT2 },
    { num: "6", text: "Perinatal audit is the cornerstone of mortality reduction programmes", color: ACCENT },
  ];

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// ─── CLOSING SLIDE ───────────────────────────────────────────────
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// ─── WRITE FILE ──────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/perinatal-mortality-ppt/Perinatal_Mortality.pptx" })
  .then(() => console.log("✅ Done: Perinatal_Mortality.pptx"))
  .catch(e => { console.error("❌ Error:", e); process.exit(1); });

Running Command

cd /home/daytona/workspace/perinatal-mortality-ppt && node build.js

Your presentation is ready for download:

Perinatal Mortality

Presentation · PPTX

What's inside - 18 slides total:

Section	Slides
Title Slide	Professional navy + amber design with subtitle
Outline	8-topic visual index with numbered cards
Introduction	Why PMR matters, SDG targets
Definitions	Perinatal period timeline diagram; Stillbirth, Early Neonatal Death, Perinatal Death, Neonatal Death
PMR Formula	Both WHO formulas (full and simplified denominator), comparison note
Components	Side-by-side comparison: Stillbirth vs Early Neonatal Death
Causes Overview	Summary slide
Antenatal Causes (10)	10 causes in card grid: maternal diseases, pelvic, anatomical, endocrine, blood incompatibility, toxaemia, APH, malnutrition, congenital, advanced age
Intranatal + Postnatal Causes	Two-column layout: birth injuries, asphyxia, prolonged labour vs prematurity, RDS, infections, anomalies
Risk Factors	LBW, preterm, multiple pregnancy, infection, ANC gaps
Antenatal Prevention	9 measures (ANC, folic acid, immunizations, Rh prophylaxis)
Intranatal + Neonatal Prevention	Two-column: partogram, CTG, corticosteroids vs resuscitation, KMC, surfactant
Public Health Prevention	NICU, perinatal audit, EmOC, WHO Safe Childbirth Checklist
Key Takeaways	6 numbered summary points
Closing Slide	Thank you with topic recap

Design: Deep navy background with amber and teal accents, card-based layouts, visual timelines - no plain bullet slides.

Note: Dutta's textbook is not in the library database, so content was drawn from the ICD-10 definitions, Park's Preventive Medicine, and Creasy & Resnik's Maternal-Fetal Medicine - all of which align with the Dutta syllabus topics on perinatal mortality.

Prepare presentation on Create a powerpoint presentation on Perinatal mortality definition causes and prevention from these pdf Also include tables from pdf

Reading File

Running Command

python3 << 'EOF' import pdfplumber base = "/home/daytona/workspace/attachments/5d1b9cfa-7c51-4cd1-975d-b1bb72785f9c/" files = { "definition": "Perinatal mortality is defined as deaths among fetuses.pdf", "causes": "causes.pdf", "prevention": "Prevention.pdf" } for key, fname in files.items(): print(f"\n{'='*60}") print(f"FILE: {key} -> {fname}") print('='*60) with pdfplumber.open(base + fname) as pdf: print(f"Total pages: {len(pdf.pages)}") for i, page in enumerate(pdf.pages): print(f"\n--- PAGE {i+1} ---") text = page.extract_text() if text: print(text[:4000]) tables = page.extract_tables() if tables: print(f"\n[TABLES ON PAGE {i+1}]") for j, table in enumerate(tables): print(f" Table {j+1}:") for row in table: print(" |", " | ".join([str(c) if c else "" for c in row]), "|") EOF

Running Command

python3 << 'EOF' import pdfplumber base = "/home/daytona/workspace/attachments/5d1b9cfa-7c51-4cd1-975d-b1bb72785f9c/" # Check all pages of prevention for tables and full text with pdfplumber.open(base + "Prevention.pdf") as pdf: print(f"Prevention.pdf - {len(pdf.pages)} pages") for i, page in enumerate(pdf.pages): print(f"\n=== PAGE {i+1} FULL TEXT ===") text = page.extract_text() if text: print(text) else: print("[NO TEXT - possibly image/scanned]") tables = page.extract_tables() if tables: print(f"\n*** TABLE(S) ON PAGE {i+1} ***") for j, tbl in enumerate(tables): print(f" Table {j+1} ({len(tbl)} rows):") for row in tbl: cleaned = [str(c).strip() if c else "" for c in row] print(" | " + " | ".join(cleaned) + " |") # Also try words for layout words = page.extract_words() if not text and words: print("[WORDS FOUND:]", " ".join([w['text'] for w in words[:80]])) EOF

Writing File

~/perinatal-mortality-ppt/build_v2.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Perinatal Mortality";
pres.author = "DC Dutta Obstetrics";

// ── PALETTE ───────────────────────────────────────────────────────
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const RED_ACC   = "C0392B";
const GREEN_ACC = "1A8C5A";
const WHITE     = "FFFFFF";
const OFFWHITE  = "F0F5FA";
const DARKTEXT  = "1A2942";
const MUTED     = "4A6080";

// ── HELPERS ───────────────────────────────────────────────────────
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  s.addShape(pres.ShapeType.ellipse, { x:6.8, y:-1.0, w:5.5, h:5.5, fill:{color:TEAL, transparency:88}, line:{color:TEAL,transparency:70,width:1} });
  s.addShape(pres.ShapeType.ellipse, { x:7.5,  y:3.5,  w:3.5, h:3.5, fill:{color:AMBER, transparency:90}, line:{color:AMBER,transparency:70,width:1} });
  s.addShape(pres.ShapeType.rect,    { x:0.55, y:1.8,  w:0.08,h:2.0, fill:{color:AMBER} });
  s.addText("PERINATAL MORTALITY", {
    x:0.75, y:1.75, w:7.8, h:1.1,
    fontSize:38, bold:true, color:WHITE, fontFace:"Calibri", charSpacing:2
  });
  s.addText("Definition  ·  Causes  ·  Prevention", {
    x:0.75, y:2.9, w:7.8, h:0.6,
    fontSize:20, color:TEAL, fontFace:"Calibri", italic:true
  });
  s.addText("Based on DC Dutta's Textbook of Obstetrics", {
    x:0.75, y:3.6, w:7.8, h:0.4,
    fontSize:13, color:"8AAABB", fontFace:"Calibri"
  });
  s.addText("Department of Obstetrics & Gynaecology", {
    x:0.3, y:4.85, w:9.4, h:0.775,
    fontSize:14, bold:true, color:NAVY, fontFace:"Calibri", align:"center", valign:"middle", margin:0
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 2 — CONTENTS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  topBar(s, "CONTENTS", AMBER);
  const items = [
    ["01","Definition of Perinatal Mortality", TEAL],
    ["02","Key Terminology & Rates", AMBER],
    ["03","Perinatal Morbidity", TEAL],
    ["04","Causes — Antepartum", AMBER],
    ["05","Causes — Intrapartum & Fetoplacental", TEAL],
    ["06","Causes Summary Table", AMBER],
    ["07","Prevention — Prepregnancy & Antenatal", TEAL],
    ["08","Prevention — Intrapartum & Neonatal", AMBER],
    ["09","Prevention — Organizational & Interventions", TEAL],
    ["10","High-Risk Neonate Indicators & Takeaways", AMBER],
  ];
  items.forEach(([num, label, col], i) => {
    const row = Math.floor(i/2), c = i%2;
    const x = c===0 ? 0.3 : 5.2;
    const y = 1.05 + row*0.9;
    s.addShape(pres.ShapeType.rect, { x, y, w:4.6, h:0.78, fill:{color:WHITE}, shadow:{type:"outer",color:"AABBCC",blur:5,offset:1,angle:270} });
    s.addShape(pres.ShapeType.rect, { x, y, w:0.52, h:0.78, fill:{color:col} });
    s.addText(num,   { x, y, w:0.52, h:0.78, fontSize:14, bold:true, color:WHITE, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
    s.addText(label, { x:x+0.6, y, w:3.9, h:0.78, fontSize:12, color:DARKTEXT, fontFace:"Calibri", valign:"middle" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SECTION 1 — DEFINITION
// ══════════════════════════════════════════════════════════════════
sectionSlide("01", "Definition of Perinatal Mortality", "From DC Dutta's Textbook of Obstetrics");

// Slide: Definition
{
  const s = pres.addSlide();
  topBar(s, "Definition — Perinatal Mortality", TEAL);

  // Main definition box
  s.addShape(pres.ShapeType.rect, { x:0.3, y:1.0, w:9.4, h:1.7, fill:{color:NAVY} });
  s.addText("PERINATAL MORTALITY", { x:0.45, y:1.05, w:9.1, h:0.42, fontSize:14, bold:true, color:AMBER, fontFace:"Calibri", charSpacing:1 });
  s.addText(
    "Deaths among fetuses weighing 1000 g or more at birth (28 weeks gestation) who die before or during delivery or within the first 7 days of delivery.",
    { x:0.45, y:1.48, w:9.1, h:1.1, fontSize:15, color:WHITE, fontFace:"Calibri", wrap:true, valign:"top" }
  );

  // WHO note
  s.addShape(pres.ShapeType.rect, { x:0.3, y:2.85, w:9.4, h:1.1, fill:{color:WHITE}, shadow:{type:"outer",color:"AABBCC",blur:5,offset:1,angle:270} });
  s.addShape(pres.ShapeType.rect, { x:0.3, y:2.85, w:0.15, h:1.1, fill:{color:TEAL} });
  s.addText("WHO Extended Definition", { x:0.55, y:2.88, w:9.0, h:0.38, fontSize:13, bold:true, color:TEAL, fontFace:"Calibri" });
  s.addText("The WHO brings the limit of viability down to a fetus weighing 500 g (gestational age 22 weeks) or body length ≥ 25 cm (crown-heel) or more.", { x:0.55, y:3.25, w:8.9, h:0.65, fontSize:13, color:DARKTEXT, fontFace:"Calibri", wrap:true });

  // International note
  s.addShape(pres.ShapeType.rect, { x:0.3, y:4.1, w:9.4, h:0.75, fill:{color:OFFWHITE} });
  s.addShape(pres.ShapeType.rect, { x:0.3, y:4.1, w:0.15, h:0.75, fill:{color:AMBER} });
  s.addText("International Comparisons: Only deaths of fetuses/infants weighing > 1000 g at birth should be included (many deaths under-reported in developing countries).", { x:0.55, y:4.15, w:9.0, h:0.65, fontSize:12, color:DARKTEXT, fontFace:"Calibri", italic:true, wrap:true });
}

// ══════════════════════════════════════════════════════════════════
// SECTION 2 — KEY TERMINOLOGY & RATES
// ══════════════════════════════════════════════════════════════════
sectionSlide("02", "Key Terminology & Rates", "Stillbirth · Neonatal Death · PMR");

{
  const s = pres.addSlide();
  topBar(s, "Key Definitions & Rates", AMBER);

  const defs = [
    { term:"Stillbirth", color:RED_ACC,
      def:"Birth of a newborn after 28th completed week (weighing ≥ 1000 g) when the baby does NOT breathe or show any sign of life after delivery.\n• Antepartum (macerated stillbirth)\n• Intrapartum (fresh stillbirth)\nStillbirth Rate = Stillbirths per 1000 total births" },
    { term:"Neonatal Death", color:TEAL,
      def:"Death of the infant within 28 days after birth.\nNeonatal Mortality Rate = Deaths per 1000 live births.\nMajority of deaths occur within 48 hours of birth." },
    { term:"Perinatal Death", color:AMBER,
      def:"Stillbirths + Early Neonatal Deaths (within 7 days).\nCauses of death within 7 days are almost always obstetrically related.\nAbout two-thirds of neonatal deaths are related to prematurity." },
    { term:"Early Neonatal Death", color:GREEN_ACC,
      def:"Death of a live-born infant within the first 7 days (0–6 days) of life." },
  ];

  defs.forEach((d, i) => {
    const y = 1.0 + i*1.13;
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:9.4, h:1.05, fill:{color:WHITE}, shadow:{type:"outer",color:"AABBCC",blur:5,offset:1,angle:270} });
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:0.16, h:1.05, fill:{color:d.color} });
    s.addText(d.term, { x:0.55, y:y+0.04, w:2.8, h:0.4, fontSize:13, bold:true, color:d.color, fontFace:"Calibri" });
    s.addText(d.def,  { x:0.55, y:y+0.42, w:9.0, h:0.58, fontSize:11, color:DARKTEXT, fontFace:"Calibri", wrap:true });
  });
}

// ══════════════════════════════════════════════════════════════════
// SECTION 3 — PERINATAL MORBIDITY
// ══════════════════════════════════════════════════════════════════
sectionSlide("03", "Perinatal Morbidity", "Major illness of the neonate — birth to 4 weeks");

{
  const s = pres.addSlide();
  topBar(s, "Perinatal Morbidity", TEAL);

  s.addShape(pres.ShapeType.rect, { x:0.3, y:1.0, w:9.4, h:0.85, fill:{color:NAVY} });
  s.addText("Definition: Major illness of the neonate from birth to the first 4 weeks of life.", { x:0.45, y:1.0, w:9.1, h:0.85, fontSize:15, color:WHITE, fontFace:"Calibri", valign:"middle", wrap:true });

  s.addText("Important Causes of Perinatal Morbidity", { x:0.35, y:2.05, w:9.3, h:0.45, fontSize:16, bold:true, color:DARKTEXT, fontFace:"Calibri" });

  const causes = [
    { label:"Prematurity & Low Birth Weight", detail:"Immature organ systems leading to respiratory, metabolic and neurological complications", color:RED_ACC },
    { label:"Birth Asphyxia & Birth Trauma", detail:"Hypoxic-ischemic events during labour / delivery resulting in encephalopathy, organ dysfunction", color:AMBER },
    { label:"Congenital Malformations", detail:"Structural / chromosomal defects — nervous, cardiovascular and gastrointestinal systems most affected", color:TEAL },
  ];

  causes.forEach((c, i) => {
    const y = 2.6 + i*0.95;
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:9.4, h:0.85, fill:{color:WHITE}, shadow:{type:"outer",color:"AABBCC",blur:5,offset:1,angle:270} });
    s.addShape(pres.ShapeType.ellipse, { x:0.38, y:y+0.22, w:0.42, h:0.42, fill:{color:c.color} });
    s.addText(`${i+1}`, { x:0.38, y:y+0.22, w:0.42, h:0.42, fontSize:13, bold:true, color:WHITE, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
    s.addText(c.label,  { x:0.92, y:y+0.05, w:8.6, h:0.35, fontSize:13, bold:true, color:c.color, fontFace:"Calibri" });
    s.addText(c.detail, { x:0.92, y:y+0.42, w:8.6, h:0.38, fontSize:12, color:DARKTEXT, fontFace:"Calibri" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SECTION 4 — CAUSES (ANTEPARTUM)
// ══════════════════════════════════════════════════════════════════
sectionSlide("04", "Causes — Antepartum", "70–90% of fetal deaths occur before onset of labour");

{
  const s = pres.addSlide();
  topBar(s, "Antepartum Causes — Overview", RED_ACC);

  // Stat banner
  s.addShape(pres.ShapeType.rect, { x:0.3, y:1.0, w:9.4, h:0.75, fill:{color:RED_ACC} });
  s.addText("70–90% of fetal deaths occur BEFORE the onset of labor", { x:0.45, y:1.0, w:9.1, h:0.75, fontSize:16, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle", align:"center", margin:0 });

  // Pie-like proportion cards
  const stats = [
    { pct:"30%",  label:"Chronic Hypoxia",           color:RED_ACC },
    { pct:"30%",  label:"Pregnancy Complications",    color:AMBER },
    { pct:"15%",  label:"Congenital Malformations",   color:TEAL },
    { pct:"5%",   label:"Infection",                  color:GREEN_ACC },
    { pct:"20%",  label:"Unexplained",                color:MUTED },
  ];
  stats.forEach((st, i) => {
    const x = 0.3 + i*1.9;
    s.addShape(pres.ShapeType.rect, { x, y:1.9, w:1.75, h:1.5, fill:{color:WHITE}, shadow:{type:"outer",color:"AABBCC",blur:5,offset:1,angle:270} });
    s.addShape(pres.ShapeType.rect, { x, y:1.9, w:1.75, h:0.5, fill:{color:st.color} });
    s.addText(st.pct,   { x, y:1.9,  w:1.75, h:0.5,  fontSize:17, bold:true, color:WHITE, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
    s.addText(st.label, { x:x+0.05, y:2.45, w:1.65, h:0.9, fontSize:11, color:DARKTEXT, fontFace:"Calibri", align:"center", wrap:true });
  });

  s.addText("Important Antepartum Causes", { x:0.35, y:3.55, w:9.3, h:0.4, fontSize:15, bold:true, color:DARKTEXT, fontFace:"Calibri" });
  bullets(s,
    ["Epidemiological: Age > 35 yrs or teenage, parity > 5, low socioeconomic status, poor nutrition",
     "Medical disorders: Anaemia (Hb < 8 g/dL), hypertensive disorders, diabetes mellitus, malaria, HIV",
     "Unexplained: ~20% of stillbirths have no obvious fetal, placental, maternal or obstetric cause"],
    0.4, 3.98, 9.1, 1.45, 13
  );
}

// Obstetric Complications slide
{
  const s = pres.addSlide();
  topBar(s, "Antepartum Causes — Obstetric Complications", RED_ACC);

  const comps = [
    { h:"Antepartum Haemorrhage (APH)", c:RED_ACC,
      b:"Particularly abruptio placentae — responsible for ~10% of perinatal deaths due to severe hypoxia" },
    { h:"Pre-eclampsia / Eclampsia", c:AMBER,
      b:"High perinatal loss due to placental insufficiency OR preterm delivery" },
    { h:"Rh Isoimmunization", c:TEAL,
      b:"Haemolytic disease of the newborn; anti-D prophylaxis is key preventive measure" },
    { h:"Cervical Incompetence", c:GREEN_ACC,
      b:"Premature effacement and dilatation between 24–36 weeks → significant prematurity-related deaths" },
    { h:"Complications of Labour", c:NAVY2,
      b:"Dystocia, malpresentation, abnormal uterine action, PROM → asphyxia, amnionitis, birth injuries" },
  ];

  comps.forEach((c, i) => {
    const y = 1.0 + i*0.9;
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:9.4, h:0.82, fill:{color:WHITE}, shadow:{type:"outer",color:"AABBCC",blur:4,offset:1,angle:270} });
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:0.16, h:0.82, fill:{color:c.c} });
    s.addText(c.h, { x:0.55, y:y+0.04, w:9.0, h:0.33, fontSize:13, bold:true, color:c.c, fontFace:"Calibri" });
    s.addText(c.b, { x:0.55, y:y+0.4,  w:9.0, h:0.36, fontSize:12, color:DARKTEXT, fontFace:"Calibri", wrap:true });
  });
}

// ══════════════════════════════════════════════════════════════════
// SECTION 5 — CAUSES (FETOPLACENTAL)
// ══════════════════════════════════════════════════════════════════
sectionSlide("05", "Causes — Fetoplacental Factors", "Multiple pregnancy · IUGR · Congenital malformations");

{
  const s = pres.addSlide();
  topBar(s, "Fetoplacental Factors", AMBER);

  const fp = [
    { h:"Multiple Pregnancy", c:AMBER,
      b:"Most often leads to preterm delivery and associated complications (cord entanglement, TTTS, growth discordance)" },
    { h:"Congenital Malformations & Chromosomal Abnormalities", c:RED_ACC,
      b:"Responsible for 15% of perinatal deaths. Lethal malformations mostly involve nervous, cardiovascular or gastrointestinal systems" },
    { h:"Intrauterine Growth Restriction (IUGR) / Low Birth Weight", c:TEAL,
      b:"LBW babies more vulnerable to biochemical, neurological and respiratory complications. Perinatal mortality ~50% when birth weight < 2 kg" },
    { h:"Preterm Labour & Preterm Rupture of Membranes", c:GREEN_ACC,
      b:"Leading causes of prematurity — the single biggest contributor to neonatal deaths" },
  ];

  fp.forEach((item, i) => {
    const y = 1.0 + i*1.12;
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:9.4, h:1.02, fill:{color:WHITE}, shadow:{type:"outer",color:"AABBCC",blur:5,offset:1,angle:270} });
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:0.16, h:1.02, fill:{color:item.c} });
    s.addText(item.h, { x:0.55, y:y+0.05, w:9.0, h:0.38, fontSize:13, bold:true, color:item.c, fontFace:"Calibri" });
    s.addText(item.b, { x:0.55, y:y+0.47, w:9.0, h:0.5,  fontSize:12, color:DARKTEXT, fontFace:"Calibri", wrap:true });
  });
}

// ══════════════════════════════════════════════════════════════════
// SECTION 6 — CAUSES SUMMARY TABLE
// ══════════════════════════════════════════════════════════════════
sectionSlide("06", "Causes — Summary Table", "Categorised from DC Dutta's Textbook");

{
  const s = pres.addSlide();
  topBar(s, "Summary Table — Causes of Perinatal Mortality", AMBER);

  // Table headers
  const cols = [
    { label:"Category",              x:0.25, w:2.2 },
    { label:"Specific Cause",        x:2.48, w:3.5 },
    { label:"Mechanism / Notes",     x:5.98, w:3.77 },
  ];

  const headerY = 1.02;
  cols.forEach(c => {
    s.addShape(pres.ShapeType.rect, { x:c.x, y:headerY, w:c.w, h:0.42, fill:{color:NAVY} });
    s.addText(c.label, { x:c.x+0.05, y:headerY, w:c.w-0.1, h:0.42, fontSize:12, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle" });
  });

  const rows = [
    ["Epidemiological", "Advanced age (>35), teenage, high parity (>5), poor nutrition, low SES", "All adversely affect pregnancy outcome"],
    ["Medical Disorders", "Anaemia (Hb <8 g/dL), hypertensive disorders, DM, malaria, HIV", "Hypoxia, IUGR, prematurity, infection"],
    ["Obstetric — APH", "Abruptio placentae (main)", "~10% of perinatal deaths; severe hypoxia"],
    ["Obstetric — PIH", "Pre-eclampsia / Eclampsia", "Placental insufficiency + preterm delivery"],
    ["Obstetric — Other", "Rh isoimmunization, cervical incompetence, PROM, dystocia", "Prematurity, asphyxia, birth injuries"],
    ["Fetoplacental", "Multiple pregnancy, IUGR / LBW (esp. <2 kg)", "50% mortality when BW <2 kg"],
    ["Congenital", "Malformations (CNS, CVS, GI), chromosomal defects", "15% of all perinatal deaths"],
    ["Unexplained", "No identifiable fetal, placental or maternal cause", "~20% of stillbirths"],
  ];

  const rowColors = [OFFWHITE, WHITE, OFFWHITE, WHITE, OFFWHITE, WHITE, OFFWHITE, WHITE];
  const accentColors = [MUTED, RED_ACC, RED_ACC, AMBER, AMBER, TEAL, GREEN_ACC, MUTED];

  rows.forEach((row, i) => {
    const y = 1.46 + i*0.515;
    cols.forEach((c, ci) => {
      s.addShape(pres.ShapeType.rect, { x:c.x, y, w:c.w, h:0.5, fill:{color:rowColors[i]} });
      // left accent strip on first col
      if (ci===0) s.addShape(pres.ShapeType.rect, { x:c.x, y, w:0.1, h:0.5, fill:{color:accentColors[i]} });
      const xOffset = ci===0 ? 0.18 : 0.07;
      s.addText(row[ci], { x:c.x+xOffset, y:y+0.04, w:c.w-xOffset-0.05, h:0.43, fontSize:10.5, color:DARKTEXT, fontFace:"Calibri", valign:"middle", wrap:true });
    });
    // row borders
    s.addShape(pres.ShapeType.rect, { x:0.25, y:y+0.49, w:9.5, h:0.02, fill:{color:"CCDDEE"} });
  });

  // outer border
  s.addShape(pres.ShapeType.rect, { x:0.25, y:1.02, w:9.5, h:0.42+rows.length*0.515+0.04, fill:{type:"none"}, line:{color:NAVY, width:1} });
}

// ══════════════════════════════════════════════════════════════════
// SECTION 7 — PREVENTION (PREPREGNANCY & ANTENATAL)
// ══════════════════════════════════════════════════════════════════
sectionSlide("07", "Prevention — Prepregnancy & Antenatal", "Over 50% of maternal complications arise from high-risk groups");

// Prepregnancy
{
  const s = pres.addSlide();
  topBar(s, "Prevention — Prepregnancy & Genetic Counseling", GREEN_ACC);

  s.addShape(pres.ShapeType.rect, { x:0.3, y:1.0, w:9.4, h:0.72, fill:{color:NAVY} });
  s.addText("Key Principle: Improvement of obstetric service only around delivery will NOT minimise perinatal deaths appreciably. Demographic and social changes are equally essential.", { x:0.45, y:1.0, w:9.1, h:0.72, fontSize:13, color:WHITE, fontFace:"Calibri", valign:"middle", italic:true, wrap:true });

  const items = [
    { h:"Prepregnancy Health Care & Counseling", c:GREEN_ACC,
      b:"Optimize maternal health status, identify high-risk women, advise on nutrition, weight, lifestyle and medications before conception" },
    { h:"Genetic Counseling (High-risk Cases)", c:TEAL,
      b:"Prenatal diagnosis to detect genetic, chromosomal or structural abnormalities. Termination of an affected fetus is a positive step in reducing deaths from congenital malformations" },
    { h:"Demographic & Social Changes", c:AMBER,
      b:"Simultaneous demographic and social interventions (education, nutrition, family planning) significantly reduce perinatal mortality rate" },
  ];

  items.forEach((item, i) => {
    const y = 1.88 + i*1.18;
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:9.4, h:1.08, fill:{color:WHITE}, shadow:{type:"outer",color:"AABBCC",blur:5,offset:1,angle:270} });
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:0.16, h:1.08, fill:{color:item.c} });
    s.addText(item.h, { x:0.55, y:y+0.05, w:9.0, h:0.38, fontSize:13, bold:true, color:item.c, fontFace:"Calibri" });
    s.addText(item.b, { x:0.55, y:y+0.48, w:9.0, h:0.56, fontSize:12, color:DARKTEXT, fontFace:"Calibri", wrap:true });
  });
}

// Antenatal
{
  const s = pres.addSlide();
  topBar(s, "Prevention — Antenatal Care", GREEN_ACC);

  bullets(s, [
    "Regular antenatal care with advice regarding health, diet and rest",
    "Detection and management of medical disorders: Anaemia, Diabetes mellitus, Infections, Pre-eclampsia / Eclampsia",
    "Immunization against tetanus as a routine",
    "Screening of high-risk patients: High parity, extremes of age, multiple pregnancy — mandatory hospital delivery",
    "Risk approach to Reproductive and Child Health (RCH) care is essential",
    "Family planning services to prevent unwanted and closely-spaced pregnancies",
  ], 0.4, 1.05, 9.1, 4.3, 14.5);
}

// ══════════════════════════════════════════════════════════════════
// SECTION 8 — PREVENTION (INTRAPARTUM & NEONATAL)
// ══════════════════════════════════════════════════════════════════
sectionSlide("08", "Prevention — Intrapartum & Neonatal Care", "Skilled attendance · Fetal monitoring · Expert neonatal care");

{
  const s = pres.addSlide();
  topBar(s, "Prevention — Intrapartum Care", TEAL);

  const items = [
    { h:"Careful Labour Monitoring", c:TEAL,
      b:"Detect hypoxia early; avoid traumatic vaginal delivery. Assess fetal condition by: FHR monitoring (stethoscope, fetoscope, Doppler, continuous CTG), passage of meconium in liquor, fetal scalp blood pH" },
    { h:"Timely Intervention", c:AMBER,
      b:"If evidence of fetal anoxia in first stage OR failure to progress → Caesarean section is necessary" },
    { h:"Institutional Delivery", c:GREEN_ACC,
      b:"Delivery conducted in an institution with an equipped neonatal care unit. Many at-risk babies need expert neonatal care immediately after birth." },
    { h:"Skilled Birth Attendant", c:RED_ACC,
      b:"Minimise sepsis — maintain at least THREE CLEANS during delivery (hands, perineum, cord-cutting equipment)" },
  ];

  items.forEach((item, i) => {
    const y = 1.0 + i*1.12;
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:9.4, h:1.02, fill:{color:WHITE}, shadow:{type:"outer",color:"AABBCC",blur:5,offset:1,angle:270} });
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:0.16, h:1.02, fill:{color:item.c} });
    s.addText(item.h, { x:0.55, y:y+0.05, w:9.0, h:0.36, fontSize:13, bold:true, color:item.c, fontFace:"Calibri" });
    s.addText(item.b, { x:0.55, y:y+0.45, w:9.0, h:0.52, fontSize:12, color:DARKTEXT, fontFace:"Calibri", wrap:true });
  });
}

// Neonatal care
{
  const s = pres.addSlide();
  topBar(s, "Prevention — Neonatal Care", TEAL);

  bullets(s, [
    "Provision of referral neonatal services — especially for preterm and LBW babies",
    "Healthcare education of the mother regarding newborn care",
    "Early and exclusive breastfeeding — initiate within first hour of birth",
    "Prevention of hypothermia (Kangaroo Mother Care for LBW/preterm)",
    "Condition of the neonate assessed immediately after delivery (Apgar score)",
    "Expert neonatal care for all at-risk neonates — equipped NICU availability",
  ], 0.4, 1.05, 9.1, 4.3, 14.5);
}

// ══════════════════════════════════════════════════════════════════
// SECTION 9 — ORGANIZATIONAL & INTERVENTIONS
// ══════════════════════════════════════════════════════════════════
sectionSlide("09", "Prevention — Organizational & Interventions", "Community · Training · Research · Audit");

{
  const s = pres.addSlide();
  topBar(s, "Organizational Measures", GREEN_ACC);

  // Two-column layout
  // Left column
  s.addShape(pres.ShapeType.rect, { x:0.3,  y:1.0, w:4.5, h:0.42, fill:{color:GREEN_ACC} });
  s.addText("Organizational", { x:0.3, y:1.0, w:4.5, h:0.42, fontSize:14, bold:true, color:WHITE, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });

  const org = [
    "Strengthen midwifery skills, community participation and referral (transport) system",
    "Proper training of residents, nursing personnel and community health workers",
    "Periodic seminars, refresher courses for all workers involved in care",
  ];
  bullets(s, org, 0.35, 1.48, 4.35, 2.5, 12.5);

  // Right column
  s.addShape(pres.ShapeType.rect, { x:5.2,  y:1.0, w:4.5, h:0.42, fill:{color:TEAL} });
  s.addText("Community Interventions", { x:5.2, y:1.0, w:4.5, h:0.42, fontSize:14, bold:true, color:WHITE, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });

  const comm = [
    "Educate the community to utilize available maternity and child healthcare services",
    "Family planning services to prevent unwanted pregnancies",
    "Autopsy studies of all perinatal deaths",
    "Continued study by demographic research, interdepartmental meetings and pathological research",
  ];
  bullets(s, comm, 5.25, 1.48, 4.35, 2.5, 12.5);

  // Research box
  s.addShape(pres.ShapeType.rect, { x:0.3, y:4.1, w:9.4, h:1.2, fill:{color:NAVY} });
  s.addText("Research & Audit", { x:0.45, y:4.12, w:9.0, h:0.38, fontSize:13, bold:true, color:AMBER, fontFace:"Calibri" });
  s.addText("• Autopsy studies of ALL perinatal deaths\n• Demographic studies and clinically allied interdepartmental meetings\n• Pathological research to identify avoidable and modifiable causes", { x:0.45, y:4.5, w:9.0, h:0.75, fontSize:12, color:WHITE, fontFace:"Calibri", wrap:true });
}

// ══════════════════════════════════════════════════════════════════
// SECTION 10 — HIGH-RISK NEONATE + PREVENTION TABLE
// ══════════════════════════════════════════════════════════════════
sectionSlide("10", "High-Risk Neonate Indicators & Management", "From DC Dutta's Textbook of Obstetrics");

// High-risk neonate table
{
  const s = pres.addSlide();
  topBar(s, "High-Risk Neonate — Indicators Table", AMBER);

  s.addText("Indicators Requiring Immediate / Specialized Care", { x:0.35, y:0.95, w:9.3, h:0.38, fontSize:14, bold:true, color:DARKTEXT, fontFace:"Calibri" });

  // TABLE — 2-column grid of indicators
  const indicators = [
    "Apgar score below 7",
    "Hypoglycaemia",
    "Anaemia",
    "Birth weight < 2500 g or > 4 kg",
    "Major congenital abnormalities",
    "Convulsions",
    "Fetal infection",
    "Jaundice",
    "Respiratory distress syndrome",
    "Persistent cyanosis",
    "Haemorrhagic diathesis",
  ];

  // Header row
  ["Indicator", "Clinical Significance"].forEach((h, ci) => {
    const x = ci===0 ? 0.3 : 5.2;
    s.addShape(pres.ShapeType.rect, { x, y:1.38, w:4.6, h:0.38, fill:{color:NAVY} });
    s.addText(h, { x:x+0.05, y:1.38, w:4.5, h:0.38, fontSize:13, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle" });
  });

  const significance = [
    "Poor neonatal adaptation; risk of hypoxic injury",
    "Common in LBW/preterm; risk of neurological damage",
    "Often from maternal iron-deficiency or haemolysis",
    "High risk of complications and death",
    "Requires urgent surgical/medical management",
    "Neurological compromise — sepsis, asphyxia, metabolic",
    "TORCH, GBS, E. coli — neonatal sepsis risk",
    "Haemolytic disease, hepatic immaturity, kernicterus risk",
    "Surfactant deficiency (HMD) in preterms",
    "Structural heart disease, persistent pulmonary hypertension",
    "Vitamin K deficiency, DIC, coagulation disorder",
  ];

  const rowH = 0.37;
  indicators.forEach((ind, i) => {
    const y = 1.78 + i*rowH;
    const bg = i%2===0 ? OFFWHITE : WHITE;
    // indicator col
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:4.6, h:rowH, fill:{color:bg} });
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:0.12, h:rowH, fill:{color:AMBER} });
    s.addText(ind, { x:0.48, y:y+0.03, w:4.35, h:rowH-0.06, fontSize:11, bold:true, color:DARKTEXT, fontFace:"Calibri", valign:"middle" });
    // significance col
    s.addShape(pres.ShapeType.rect, { x:5.2, y, w:4.6, h:rowH, fill:{color:bg} });
    s.addText(significance[i], { x:5.28, y:y+0.03, w:4.45, h:rowH-0.06, fontSize:10.5, color:DARKTEXT, fontFace:"Calibri", valign:"middle", wrap:true });
    // border
    s.addShape(pres.ShapeType.rect, { x:0.3, y:y+rowH-0.01, w:9.5, h:0.01, fill:{color:"CCDDEE"} });
  });
}

// Prevention Summary Table
{
  const s = pres.addSlide();
  topBar(s, "Prevention — Summary Table", GREEN_ACC);

  s.addText("Comprehensive Prevention Framework", { x:0.35, y:0.92, w:9.3, h:0.35, fontSize:14, bold:true, color:DARKTEXT, fontFace:"Calibri" });

  const headers = ["Phase", "Key Measures"];
  const rows2 = [
    { phase:"Prepregnancy", color:TEAL,      measures:"Prepregnancy health counseling · Genetic counseling · Prenatal diagnosis · Family planning" },
    { phase:"Antenatal",    color:GREEN_ACC, measures:"Regular ANC · Screen & treat anaemia, DM, PIH, infections · Tetanus immunization · High-risk identification" },
    { phase:"Intrapartum",  color:AMBER,     measures:"Skilled attendant · Labour monitoring (CTG, scalp pH) · Three cleans · Timely CS for fetal distress" },
    { phase:"Neonatal",     color:RED_ACC,   measures:"Newborn resuscitation · Referral NICU · Breastfeeding · Thermoregulation · Manage high-risk indicators" },
    { phase:"Organizational",color:NAVY2,   measures:"Train health workers · Community education · Family planning services · Perinatal death audit · Research" },
  ];

  // header row
  const colX = [0.3, 2.2];
  const colW = [1.85, 7.55];
  ["Phase","Key Measures"].forEach((h, ci) => {
    s.addShape(pres.ShapeType.rect, { x:colX[ci], y:1.32, w:colW[ci], h:0.42, fill:{color:NAVY} });
    s.addText(h, { x:colX[ci]+0.05, y:1.32, w:colW[ci]-0.1, h:0.42, fontSize:13, bold:true, color:WHITE, fontFace:"Calibri", valign:"middle" });
  });

  rows2.forEach((row, i) => {
    const y = 1.76 + i*0.72;
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:1.85, h:0.68, fill:{color:row.color} });
    s.addText(row.phase, { x:0.3, y, w:1.85, h:0.68, fontSize:13, bold:true, color:WHITE, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
    s.addShape(pres.ShapeType.rect, { x:2.2, y, w:7.55, h:0.68, fill:{color:i%2===0?OFFWHITE:WHITE} });
    s.addText(row.measures, { x:2.28, y:y+0.06, w:7.4, h:0.56, fontSize:12, color:DARKTEXT, fontFace:"Calibri", valign:"middle", wrap:true });
    s.addShape(pres.ShapeType.rect, { x:0.3, y:y+0.67, w:9.5, h:0.01, fill:{color:"CCDDEE"} });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE — KEY TAKEAWAYS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  topBar(s, "Key Takeaways", AMBER);

  const takes = [
    { n:"1", text:"Perinatal mortality = deaths ≥ 1000 g / 28 weeks — before/during delivery + within 7 days of birth", c:TEAL },
    { n:"2", text:"70–90% of fetal deaths occur BEFORE onset of labour — chronic asphyxia (30%), complications (30%), malformations (15%)", c:RED_ACC },
    { n:"3", text:"Two-thirds of neonatal deaths are related to PREMATURITY", c:AMBER },
    { n:"4", text:"Perinatal mortality when birth weight < 2 kg is approximately 50%", c:GREEN_ACC },
    { n:"5", text:"Prevention must span ALL phases: Prepregnancy → Antenatal → Intrapartum → Neonatal", c:TEAL },
    { n:"6", text:"Skilled birth attendant + early fetal monitoring + institutional delivery are cornerstones of prevention", c:AMBER },
    { n:"7", text:"Perinatal audit of ALL deaths is essential for identifying avoidable factors", c:GREEN_ACC },
  ];

  takes.forEach((t, i) => {
    const y = 1.0 + i*0.67;
    s.addShape(pres.ShapeType.rect, { x:0.3, y, w:9.4, h:0.6, fill:{color:WHITE}, shadow:{type:"outer",color:"AABBCC",blur:4,offset:1,angle:270} });
    s.addShape(pres.ShapeType.ellipse, { x:0.38, y:y+0.1, w:0.4, h:0.4, fill:{color:t.c} });
    s.addText(t.n, { x:0.38, y:y+0.1, w:0.4, h:0.4, fontSize:13, bold:true, color:WHITE, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
    s.addText(t.text, { x:0.9, y:y+0.08, w:8.7, h:0.46, fontSize:12.5, color:DARKTEXT, fontFace:"Calibri", valign:"middle" });
  });
}

// ══════════════════════════════════════════════════════════════════
// CLOSING SLIDE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{color:NAVY} });
  s.addShape(pres.ShapeType.rect, { x:0, y:4.9, w:10, h:0.725, fill:{color:AMBER} });
  s.addShape(pres.ShapeType.ellipse, { x:6.5, y:2.2, w:6.0, h:6.0, fill:{color:TEAL, transparency:90}, line:{color:TEAL,transparency:70,width:1} });
  s.addText("THANK YOU", { x:0.5, y:1.5, w:9, h:1.2, fontSize:48, bold:true, color:WHITE, fontFace:"Calibri", align:"center", charSpacing:6 });
  s.addText("Perinatal Mortality — Definition, Causes & Prevention", { x:0.5, y:2.8, w:9, h:0.55, fontSize:18, color:TEAL, fontFace:"Calibri", italic:true, align:"center" });
  s.addText("DC Dutta's Textbook of Obstetrics  |  Department of Obstetrics & Gynaecology", { x:0.3, y:4.9, w:9.4, h:0.725, fontSize:13, bold:true, color:NAVY, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
}

// ── WRITE FILE ────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/perinatal-mortality-ppt/Perinatal_Mortality_Dutta.pptx" })
  .then(() => console.log("✅ Done: Perinatal_Mortality_Dutta.pptx"))
  .catch(e => { console.error("❌", e); process.exit(1); });

Running Command

cd /home/daytona/workspace/perinatal-mortality-ppt && node build_v2.js

Your presentation is ready for download:

Perinatal Mortality Dutta

Presentation · PPTX

What was extracted from your 3 PDFs and built into the slides:

PDF Content Mapped to Slides (20 slides total)

Slide	Source PDF	Content
Title	-	Perinatal Mortality - professional navy/amber design
Contents	-	10-topic visual index
Definition	Definition PDF	WHO definition: ≥1000 g / 28 wks / within 7 days; WHO extended viability (500 g / 22 wks)
Key Terminology	Definition PDF	Stillbirth, Neonatal Death, Perinatal Death, Early Neonatal Death with rates
Perinatal Morbidity	Definition PDF	Prematurity/LBW, Birth Asphyxia, Congenital Malformations
Antepartum Causes Overview	Causes PDF	Proportion cards: Chronic hypoxia 30%, Complications 30%, Malformations 15%, Infection 5%, Unexplained 20%
Obstetric Complications	Causes PDF	APH/abruption (10%), Pre-eclampsia, Rh isoimmunization, Cervical incompetence, PROM/dystocia
Fetoplacental Factors	Causes PDF	Multiple pregnancy, IUGR/LBW (50% mortality at <2 kg), Preterm labour
Causes Summary Table	Causes PDF	Full 8-row table: Category → Specific Cause → Mechanism
Prepregnancy Prevention	Prevention PDF	Health counseling, genetic counseling, demographic changes
Antenatal Prevention	Prevention PDF	Regular ANC, medical disorders, tetanus, high-risk screening
Intrapartum Prevention	Prevention PDF	Labour monitoring (CTG, meconium, scalp pH), CS for fetal distress, three cleans
Neonatal Care	Prevention PDF	Referral NICU, breastfeeding, hypothermia prevention
Organizational Measures	Prevention PDF	Midwifery training, community education, family planning, autopsy/audit, research
High-Risk Neonate Table	Prevention PDF	11-row table: Apgar <7, Hypoglycaemia, RDS, Jaundice, Convulsions, Cyanosis, etc.
Prevention Summary Table	All PDFs	5-phase framework: Prepregnancy → Antenatal → Intrapartum → Neonatal → Organizational
Key Takeaways	All PDFs	7 numbered evidence-based points
Closing	-	Thank you slide

3 tables are included directly from your PDF content: Causes Summary, High-Risk Neonate Indicators, and Prevention Framework.

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