"Smoking"[MeSH Terms] AND "Pregnancy"[MeSH Terms]

CDC smoking pregnancy risks quitting pregnancy 2025

maternal cigarette smoking pregnancy placenta fetus mechanism diagram

placental insufficiency fetal growth restriction diagram smoking pregnancy

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D C Dutta's Textbook of Obstetrics 9th edition smoking pregnancy publisher

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mkdir -p "/tmp/workspace/smoking-pregnancy-ppt/src" "/tmp/workspace/smoking-pregnancy-ppt/output" && python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/smoking-pregnancy-ppt/src/create_ppt.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.chart.data import CategoryChartData from pptx.enum.chart import XL_CHART_TYPE, XL_LABEL_POSITION from pptx.enum.dml import MSO_THEME_COLOR from pptx.oxml.xmlchemy import OxmlElement OUT='/tmp/workspace/smoking-pregnancy-ppt/output/Smoking_in_Pregnancy_SDL.pptx' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # palette NAVY=RGBColor(21,44,61); TEAL=RGBColor(26,123,121); MINT=RGBColor(221,242,237); CORAL=RGBColor(208,91,75); GOLD=RGBColor(231,177,74); INK=RGBColor(35,51,58); GREY=RGBColor(92,109,114); PALE=RGBColor(247,250,249); WHITE=RGBColor(255,255,255); RED=RGBColor(180,64,55) def bg(slide, dark=False): r=slide.background.fill; r.solid(); r.fore_color.rgb=NAVY if dark else PALE # signature vertical accent sh=slide.shapes.add_shape(MSO_SHAPE.RECTANGLE,0,0,Inches(.16),Inches(7.5)); sh.fill.solid(); sh.fill.fore_color.rgb=TEAL; sh.line.fill.background() def set_text(shape,text,size=20,color=INK,bold=False,align=PP_ALIGN.LEFT,font='Aptos',margin=.05): tf=shape.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(margin); tf.margin_top=tf.margin_bottom=Inches(margin); tf.vertical_anchor=MSO_ANCHOR.MIDDLE p=tf.paragraphs[0]; p.alignment=align r=p.add_run(); r.text=text; r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return tf def tb(slide,x,y,w,h,text,size=20,color=INK,bold=False,align=PP_ALIGN.LEFT): s=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); set_text(s,text,size,color,bold,align); return s def rect(slide,x,y,w,h,fill,rad=True,line=None): s=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if rad else MSO_SHAPE.RECTANGLE, Inches(x),Inches(y),Inches(w),Inches(h)); s.fill.solid();s.fill.fore_color.rgb=fill if line: s.line.color.rgb=line else:s.line.fill.background() s.shadow.inherit=False;return s def title(slide,t,sub=None,num=None,dark=False): col=WHITE if dark else NAVY tb(slide,.62,.36,11.5,.52,t,28,col,True) if sub: tb(slide,.64,.92,11.5,.3,sub,11,RGBColor(205,224,220) if dark else GREY) if num: tb(slide,12.3,.36,.5,.3,str(num).zfill(2),11,RGBColor(205,224,220) if dark else TEAL,True,PP_ALIGN.RIGHT) def footer(slide,source='Sources: D.C. Dutta’s Textbook of Obstetrics, 9th ed.; Fishman’s Pulmonary Diseases & Disorders; CDC'): tb(slide,.65,7.12,11.9,.2,source,7,RGBColor(104,121,124)) def notes(slide,txt): tf=slide.notes_slide.notes_text_frame tf.text=txt def bullet_list(slide,x,y,w,items,accent=TEAL,size=17): for i,item in enumerate(items): cy=y+i*.62 c=slide.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(cy+.11),Inches(.18),Inches(.18));c.fill.solid();c.fill.fore_color.rgb=accent;c.line.fill.background() tb(slide,x+.32,cy,w-.32,.43,item,size,INK) def add_icon_circle(slide,x,y,letter,fill=TEAL): s=slide.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(y),Inches(.62),Inches(.62));s.fill.solid();s.fill.fore_color.rgb=fill;s.line.fill.background();set_text(s,letter,19,WHITE,True,PP_ALIGN.CENTER) # 1 s=prs.slides.add_slide(blank); bg(s,True) tb(s,.8,.75,8.6,.5,'SELF-DIRECTED LEARNING',12,RGBColor(184,226,220),True) tb(s,.78,1.35,7.8,1.35,'Smoking\nin Pregnancy',38,WHITE,True) tb(s,.82,3.05,7.5,.55,'Mechanisms, consequences and cessation support',20,RGBColor(220,237,234)) # simple maternal-placental-fetal illustration rect(s,9.0,1.1,3.25,4.9,RGBColor(32,66,79),True) # uterus and fetus stylised u=s.shapes.add_shape(MSO_SHAPE.ARC,Inches(9.52),Inches(1.72),Inches(2.2),Inches(2.1));u.line.color.rgb=RGBColor(140,213,199);u.line.width=Pt(5);u.fill.background() plac=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(10.47),Inches(2.05),Inches(.72),Inches(.48));plac.fill.solid();plac.fill.fore_color.rgb=CORAL;plac.line.fill.background() f=s.shapes.add_shape(MSO_SHAPE.ARC,Inches(10.2),Inches(2.55),Inches(1.1),Inches(1.25));f.line.color.rgb=WHITE;f.line.width=Pt(4);f.fill.background() tb(s,9.45,4.45,2.25,.8,'Every cigarette\nmatters',22,WHITE,True,PP_ALIGN.CENTER) tb(s,.82,6.55,8,.3,'Presented by: ____________________ | Department: ____________________',12,RGBColor(184,226,220)) notes(s,'Open by stating that smoking is a modifiable exposure. This SDL explains how tobacco smoke affects placental function and fetal development, and how to provide supportive cessation care. Avoid stigma: nicotine dependence is a treatable condition.') #2 learning objectives s=prs.slides.add_slide(blank);bg(s);title(s,'Learning objectives','By the end, learners should be able to:',2) objs=[('01','Explain','key smoke constituents and placental-fetal effects'),('02','Recognise','maternal, fetal, neonatal and long-term outcomes'),('03','Screen','for active and secondhand exposure without stigma'),('04','Support','cessation with behavioural care and follow-up')] for i,(n,a,b) in enumerate(objs): x=.8+(i%2)*6.15;y=1.65+(i//2)*2.25;rect(s,x,y,5.5,1.6,WHITE);add_icon_circle(s,x+.35,y+.35,n,TEAL if i<2 else CORAL);tb(s,x+1.18,y+.29,3.8,.34,a,20,NAVY,True);tb(s,x+1.18,y+.77,3.8,.45,b,13,GREY) footer(s);notes(s,'Keep the session focused on four domains: biology, clinical consequences, compassionate assessment, and action. Tell the audience this is not about blaming patients; it is about preventing avoidable harm.') #3 exposure s=prs.slides.add_slide(blank);bg(s);title(s,'What is the exposure?','Tobacco smoke reaches the fetoplacental unit through maternal circulation.',3) # pathway for x,label,sub,col in [(1,'Cigarette / tobacco','combustion products',CORAL),(4.25,'Maternal blood','nicotine + CO',GOLD),(7.5,'Placenta','vascular exchange',TEAL),(10.75,'Fetus','oxygen & growth',NAVY)]: rect(s,x,2.05,1.58,1.58,col);tb(s,x+.12,2.32,1.34,.38,label,15,WHITE,True,PP_ALIGN.CENTER);tb(s,x+.12,2.83,1.34,.34,sub,10,WHITE,False,PP_ALIGN.CENTER) if x<10: ln=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x+1.62),Inches(2.84),Inches(x+2.15),Inches(2.84));ln.line.color.rgb=GREY;ln.line.width=Pt(2) # two lanes rect(s,.85,4.45,5.8,1.35,MINT);tb(s,1.12,4.64,1.1,.25,'ACTIVE',13,TEAL,True);tb(s,2.25,4.62,4.0,.55,'Smoked, smokeless tobacco, and nicotine-containing products',16,INK) rect(s,6.9,4.45,5.45,1.35,RGBColor(253,240,235));tb(s,7.18,4.64,1.25,.25,'PASSIVE',13,CORAL,True);tb(s,8.62,4.62,3.3,.55,'Secondhand smoke exposure also matters',16,INK) footer(s);notes(s,'Name the main components: nicotine causes vasoconstrictive and developmental effects, while carbon monoxide reduces oxygen carriage. Ask about all tobacco and nicotine products, including e-cigarettes. Do not describe vaping as safe in pregnancy.') #4 mechanism s=prs.slides.add_slide(blank);bg(s);title(s,'Why smoking harms the fetus','A placental oxygen-delivery problem, with direct developmental toxicity.',4) # diagram rect(s,.82,1.55,2.0,1.55,RGBColor(253,240,235));tb(s,1.05,1.78,1.52,.34,'Smoke exposure',21,CORAL,True,PP_ALIGN.CENTER);tb(s,1.05,2.25,1.52,.38,'Nicotine, carbon monoxide, oxidants',11,GREY,False,PP_ALIGN.CENTER) for y,lab,detail,col in [(1.35,'Nicotine','vasoconstriction / platelet activation',CORAL),(3.05,'Carbon monoxide','carboxyhaemoglobin competes with oxyhaemoglobin',GOLD),(4.75,'Placental change','↓ capillary volume; ↑ villous membrane thickness',TEAL)]: rect(s,4.0,y,4.35,1.18,WHITE);add_icon_circle(s,4.28,y+.28,'↓' if y!=3.05 else 'CO',col);tb(s,5.05,y+.2,3.0,.26,lab,16,NAVY,True);tb(s,5.05,y+.54,2.95,.35,detail,11,GREY) ln=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(2.85),Inches(2.35),Inches(3.85),Inches(y+.6));ln.line.color.rgb=GREY;ln.line.width=Pt(1.5) rect(s,9.25,2.36,2.7,2.15,NAVY);tb(s,9.55,2.7,2.1,.3,'Net effect',19,WHITE,True,PP_ALIGN.CENTER);tb(s,9.52,3.24,2.15,.65,'Reduced oxygen and nutrient delivery',17,RGBColor(210,240,233),True,PP_ALIGN.CENTER) footer(s,'Mechanism: Fishman’s Pulmonary Diseases & Disorders, 6th ed., “Smoking During Pregnancy”; Dutta, 9th ed.') notes(s,'Walk from maternal exposure to the placental interface. Carbon monoxide forms carboxyhaemoglobin and is cleared slowly from fetal circulation. In smokers, placental capillary volume is reduced and villous membranes are thicker. These changes help explain fetal growth restriction and preterm birth.') #5 outcomes maternal s=prs.slides.add_slide(blank);bg(s);title(s,'Clinical consequences across pregnancy','Smoking is associated with complications before, during and after birth.',5) cols=[('Early pregnancy',['Reduced fertility / delayed conception','First-trimester pregnancy loss'],GOLD),('Antepartum',['Placental abnormalities','Fetal growth restriction','Preterm prelabour rupture of membranes'],CORAL),('Postpartum',['Reduced milk volume','Shorter breastfeeding duration','High relapse risk'],TEAL)] for i,(h,items,col) in enumerate(cols): x=.76+i*4.18;rect(s,x,1.65,3.7,4.45,WHITE);rect(s,x,1.65,3.7,.68,col);tb(s,x+.18,1.83,3.3,.26,h,16,WHITE,True,PP_ALIGN.CENTER);bullet_list(s,x+.35,2.65,3.05,items,col,16) footer(s,'Sources: Dutta, 9th ed.; Fishman’s Pulmonary Diseases & Disorders, 6th ed.') notes(s,'Use the word “associated” because many outcomes are based on observational evidence. The risk profile includes placental problems, pregnancy loss, membrane rupture, growth restriction, and postpartum breastfeeding effects. Consider coexisting mental health conditions and social stressors.') #6 fetal neonatal effects s=prs.slides.add_slide(blank);bg(s);title(s,'Fetal and neonatal outcomes','The pattern spans growth, timing of birth, and infant health.',6) # central fetus rect(s,.8,1.55,3.1,4.75,NAVY);tb(s,1.2,1.92,2.3,.35,'Fetus / newborn',22,WHITE,True,PP_ALIGN.CENTER) for yy,tt in [(2.7,'Fetal growth restriction'),(3.5,'Preterm birth'),(4.3,'Low birth weight'),(5.1,'SIDS and respiratory illness')]: tb(s,1.18,yy,2.35,.3,tt,14,RGBColor(212,239,234),False,PP_ALIGN.CENTER) items=[('Before birth','Pregnancy loss; growth restriction; preterm birth',CORAL),('At birth','Low birth weight and neonatal morbidity',GOLD),('Later childhood','Wheeze, asthma and adverse cognitive / behavioural outcomes',TEAL)] for i,(h,d,c) in enumerate(items): y=1.55+i*1.58;rect(s,4.65,y,7.45,1.15,WHITE);add_icon_circle(s,4.98,y+.26,str(i+1),c);tb(s,5.85,y+.18,5.8,.25,h,16,NAVY,True);tb(s,5.85,y+.51,5.8,.38,d,13,GREY) footer(s,'Sources: Dutta, 9th ed.; Fishman’s Pulmonary Diseases & Disorders, 6th ed.; CDC, 2025.') notes(s,'Emphasise that fetal growth restriction and preterm birth are the headline obstetric outcomes. Infant effects include low birth weight and sudden infant death syndrome. Child exposure to secondhand smoke is also associated with respiratory and ear infections, asthma and SIDS.') #7 chart s=prs.slides.add_slide(blank);bg(s);title(s,'The benefit of stopping begins now','The earlier cessation occurs, the better. But quitting at any time can help.',7) # timeline line=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(1.2),Inches(3.25),Inches(12),Inches(3.25));line.line.color.rgb=TEAL;line.line.width=Pt(4) points=[(1.25,'Before conception','Best opportunity'),(4.7,'Early pregnancy','Greatest prevention potential'),(8.0,'Later pregnancy','Meaningful benefit remains'),(11.3,'Postpartum','Prevent relapse')] for x,h,d in points: c=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(2.96),Inches(.56),Inches(.56));c.fill.solid();c.fill.fore_color.rgb=CORAL if x<8 else TEAL;c.line.fill.background();tb(s,x-.57,1.9,1.75,.6,h,14,NAVY,True,PP_ALIGN.CENTER);tb(s,x-.7,3.7,2.0,.48,d,12,GREY,False,PP_ALIGN.CENTER) rect(s,2.1,5.35,9.1,.62,MINT);tb(s,2.35,5.52,8.6,.23,'Key message: Never use a late booking as a reason to withhold cessation support.',15,TEAL,True,PP_ALIGN.CENTER) footer(s,'Sources: CDC “Smoking, Pregnancy, and Babies” (accessed 2026); Fishman’s, 6th ed.') notes(s,'Say this plainly: the best time to stop is before conception and the next best time is as early as possible, yet cessation at any point in pregnancy is beneficial. Maintain support beyond delivery because relapse is common.') #8 approach s=prs.slides.add_slide(blank);bg(s);title(s,'A practical cessation conversation','Use a non-judgemental, repeatable approach at every contact.',8) steps=[('ASK','“Do you currently use any tobacco or nicotine products?”',TEAL),('ADVISE','Give clear, personalised advice to stop.',CORAL),('ASSESS','Readiness, dependence, home exposure, mental health and safety.',GOLD),('ASSIST','Behavioural support, quit plan, triggers, referral.',TEAL),('ARRANGE','Review progress and plan postpartum follow-up.',CORAL)] for i,(a,b,c) in enumerate(steps): x=.65+i*2.5;rect(s,x,1.8,2.1,3.65,WHITE);rect(s,x,1.8,2.1,.62,c);tb(s,x+.12,1.99,1.86,.25,a,15,WHITE,True,PP_ALIGN.CENTER);tb(s,x+.2,2.78,1.7,1.55,b,14,INK,False,PP_ALIGN.CENTER);tb(s,x+.72,4.52,.65,.35,str(i+1),18,c,True,PP_ALIGN.CENTER) footer(s,'Adapted from standard tobacco-dependence care; see Dutta, 9th ed.; CDC, 2025.') notes(s,'Use open questions, normalise difficulty, and ask permission before giving advice. Address secondhand smoke, partner smoking, housing, stress, and mental health. The care plan must be individualised. Behavioural counselling is first line in pregnancy.') #9 treatment safety s=prs.slides.add_slide(blank);bg(s);title(s,'Treatment principles in pregnancy','Offer support, not shame. Tailor treatment to dependence and risk.',9) # three-tier for i,(h,d,c) in enumerate([('1. Behavioural support','First-line: counselling, quitline, problem-solving, household support',TEAL),('2. Nicotine replacement','Consider only after clinician-led discussion of risks and benefits when behavioural care alone is insufficient',GOLD),('3. Follow-up','Confirm abstinence, prevent relapse, and continue care after birth',CORAL)]): y=1.45+i*1.55;rect(s,1.05,y,11.1,1.12,WHITE);rect(s,1.05,y,.85,1.12,c);tb(s,1.22,y+.32,.5,.3,str(i+1),20,WHITE,True,PP_ALIGN.CENTER);tb(s,2.2,y+.19,3.0,.28,h,17,NAVY,True);tb(s,5.15,y+.17,6.25,.52,d,13,GREY) rect(s,1.05,6.18,11.1,.45,RGBColor(253,240,235));tb(s,1.28,6.29,10.6,.18,'E-cigarettes are not considered safe in pregnancy. Avoid framing them as a safe alternative.',12,RED,True,PP_ALIGN.CENTER) footer(s,'Sources: CDC, 2025; ACOG Committee Opinion No. 807 (2020, reaffirmed); Dutta, 9th ed.') notes(s,'Do not give a one-size-fits-all medication prescription in a presentation. Explain that behavioural interventions are the preferred first step. If pharmacotherapy is considered, the clinician must balance continued smoking risk against treatment risk and use current local protocols. E-cigarettes are not safe in pregnancy.') #10 case s=prs.slides.add_slide(blank);bg(s);title(s,'Apply it: a brief case','Turn facts into a person-centred plan.',10) rect(s,.8,1.45,4.0,4.9,NAVY);tb(s,1.18,1.8,3.2,.35,'Case vignette',22,WHITE,True);tb(s,1.18,2.48,3.15,2.2,'A 24-year-old at 14 weeks smokes daily. Her partner smokes at home. She says, “I want to stop, but I get anxious.”',18,RGBColor(217,239,234),False) qs=[('What should you ask?','Pattern of use, prior quit attempts, triggers, secondhand exposure, anxiety and safety.'),('What should you say?','A clear, supportive message: stopping now helps both parent and baby; help is available.'),('What is the plan?','Set a quit goal, offer counselling and referral, involve household support, and arrange follow-up.')] for i,(q,a) in enumerate(qs): y=1.45+i*1.6;rect(s,5.25,y,6.9,1.25,WHITE);add_icon_circle(s,5.55,y+.32,'?',TEAL if i!=1 else CORAL);tb(s,6.4,y+.17,5.15,.25,q,15,NAVY,True);tb(s,6.4,y+.51,5.3,.48,a,12,GREY) footer(s);notes(s,'Invite the audience to respond before revealing each suggested action. The point is not to interrogate the patient. It is to identify dependence, environmental smoke, anxiety and barriers, then offer a concrete and compassionate plan.') #11 take-home s=prs.slides.add_slide(blank);bg(s,True);title(s,'Take-home messages',None,11,True) for i,(n,t) in enumerate([('01','Smoking impairs placental oxygen and nutrient delivery.'),('02','It is associated with pregnancy loss, growth restriction and preterm birth.'),('03','Ask about active and secondhand exposure at every contact.'),('04','Cessation support is beneficial at any stage, including postpartum.')]): y=1.42+i*1.15;add_icon_circle(s,.95,y,n,TEAL if i%2==0 else CORAL);tb(s,1.8,y+.07,9.5,.38,t,20,WHITE,True) tb(s,.96,6.42,11.3,.26,'The most useful intervention is a respectful conversation followed by practical support.',15,RGBColor(190,226,219),False) notes(s,'Close by restating the four messages. Ask for questions. If this is assessed as SDL, mention that your learning gap was to connect basic placental physiology with an actionable cessation approach.') #12 refs s=prs.slides.add_slide(blank);bg(s);title(s,'References and further reading','Core texts and current clinical resources used in this presentation.',12) refs=[ 'Dutta DC. D.C. Dutta’s Textbook of Obstetrics. 9th ed. Konar H, ed. Jaypee Brothers Medical Publishers; 2018.', 'Fishman AP, et al. Fishman’s Pulmonary Diseases and Disorders. 6th ed. McGraw Hill; chapter “Smoking During Pregnancy”.', 'American College of Obstetricians and Gynecologists. Tobacco and Nicotine Cessation During Pregnancy. Committee Opinion No. 807. Obstet Gynecol. 2020;135:e221-e229.', 'Centers for Disease Control and Prevention. Smoking, Pregnancy, and Babies. Updated web resource. Accessed October 2026.', 'Freijah II, Jones KA, Coleman T. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2026; PMID: 42011820.' ] for i,r in enumerate(refs): rect(s,.8,1.38+i*1.0,11.8,.72,WHITE);tb(s,1.05,1.55+i*1.0,11.2,.32,r,12,INK) rect(s,.8,6.55,11.8,.35,MINT);tb(s,1.05,6.64,11.2,.15,'Slide-specific notes are included in the Notes pane for presenter use.',10,TEAL,True) notes(s,'These references underpin the presentation. D.C. Dutta is listed as the core obstetric text. Use the edition available in your institution if it differs, and update local cessation referral numbers before presenting.') prs.save(OUT) print(OUT) ''') PY python "/tmp/workspace/smoking-pregnancy-ppt/src/create_ppt.py"

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/smoking-pregnancy-ppt/output/Smoking_in_Pregnancy_SDL.pptx') prs=Presentation(str(p)) print('exists', p.exists(), 'bytes', p.stat().st_size, 'slides', len(prs.slides)) for i, slide in enumerate(prs.slides, 1): texts=[sh.text.strip().replace('\n',' / ') for sh in slide.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()] note=slide.notes_slide.notes_text_frame.text.strip() print(f'{i:02d} title={texts[0][:70] if texts else "<none>"} | notes={len(note)} chars | shapes={len(slide.shapes)}') assert note and 'Click to add notes' not in note assert len(prs.slides)==12 PY python - <<'PY' from zipfile import ZipFile p='/tmp/workspace/smoking-pregnancy-ppt/output/Smoking_in_Pregnancy_SDL.pptx' with ZipFile(p) as z: notes=[n for n in z.namelist() if n.startswith('ppt/notesSlides/notesSlide') and n.endswith('.xml')] media=[n for n in z.namelist() if n.startswith('ppt/media/')] print('Notes XML slides:',len(notes),'Embedded media:',len(media)) PY

ACOG Tobacco and Nicotine Cessation During Pregnancy Committee Opinion 807 smoking pregnancy cessation behavioral interventions nicotine replacement

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Choose the main emphasis for the revised PowerPoint.

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python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/smoking-pregnancy-ppt/src/create_redesigned.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.dml import MSO_LINE_DASH_STYLE OUT='/tmp/workspace/smoking-pregnancy-ppt/output/Smoking_in_Pregnancy_SDL_Redesigned.pptx' prs=Presentation();prs.slide_width=Inches(13.333);prs.slide_height=Inches(7.5); blank=prs.slide_layouts[6] # warm clinical palette INK=RGBColor(33,48,64); DEEP=RGBColor(27,51,70); TEAL=RGBColor(17,133,128); SKY=RGBColor(92,177,198); MINT=RGBColor(217,241,235); CREAM=RGBColor(251,247,239); WHITE=RGBColor(255,255,255); CORAL=RGBColor(213,100,83); ROSE=RGBColor(249,231,226); GOLD=RGBColor(228,172,68); SLATE=RGBColor(87,103,115); PALE=RGBColor(242,247,246); RED=RGBColor(181,66,55) def shape(slide,typ,x,y,w,h,fill, line=None): s=slide.shapes.add_shape(typ,Inches(x),Inches(y),Inches(w),Inches(h));s.fill.solid();s.fill.fore_color.rgb=fill if line: s.line.color.rgb=line else:s.line.fill.background() s.shadow.inherit=False; return s def text(slide,x,y,w,h,val,sz=18,col=INK,bold=False,align=PP_ALIGN.LEFT,font='Aptos Display'): s=slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h));tf=s.text_frame;tf.clear();tf.word_wrap=True;tf.margin_left=tf.margin_right=Inches(.03);tf.margin_top=tf.margin_bottom=Inches(.02);tf.vertical_anchor=MSO_ANCHOR.MIDDLE p=tf.paragraphs[0];p.alignment=align;r=p.add_run();r.text=val;r.font.name=font;r.font.size=Pt(sz);r.font.bold=bold;r.font.color.rgb=col;return s def bg(slide, kind='light'): if kind=='dark': base=DEEP elif kind=='cream': base=CREAM else: base=PALE slide.background.fill.solid();slide.background.fill.fore_color.rgb=base # contemporary layered arcs / panels if kind=='dark': shape(slide,MSO_SHAPE.OVAL,10.9,-1.7,4.0,4.0,RGBColor(42,79,95));shape(slide,MSO_SHAPE.OVAL,11.85,-.8,2.3,2.3,TEAL) else: shape(slide,MSO_SHAPE.OVAL,10.8,-1.9,4.25,4.25,MINT);shape(slide,MSO_SHAPE.OVAL,11.55,-1.18,2.72,2.72,RGBColor(196,229,223)) shape(slide,MSO_SHAPE.RECTANGLE,0,0,.14,7.5,TEAL) def header(slide,title,section,no,kind='light'): col=WHITE if kind=='dark' else DEEP; sub=RGBColor(193,227,221) if kind=='dark' else TEAL text(slide,.62,.28,9.8,.28,section.upper(),10,sub,True) text(slide,.62,.61,10.9,.62,title,29,col,True) text(slide,12.05,.35,.55,.3,f'{no:02}',11,sub,True,PP_ALIGN.RIGHT) def foot(slide,ref='D.C. Dutta’s Textbook of Obstetrics, 9th ed. | Source mapping [1]-[17] supplied by presenter'): text(slide,.65,7.12,11.8,.18,ref,7,SLATE) def notes(slide,n): slide.notes_slide.notes_text_frame.text=n def card(slide,x,y,w,h,fill=WHITE): return shape(slide,MSO_SHAPE.ROUNDED_RECTANGLE,x,y,w,h,fill) def circle(slide,x,y,d,fill,label='',sz=16): s=shape(slide,MSO_SHAPE.OVAL,x,y,d,d,fill);text(slide,x,y,d,d,label,sz,WHITE,True,PP_ALIGN.CENTER);return s def bullet(slide,x,y,w,items,color=TEAL,sz=17, gap=.62): for i,it in enumerate(items): circle(slide,x,y+i*gap+.12,.16,color) text(slide,x+.3,y+i*gap,w-.3,.42,it,sz,INK) def arrow(slide,x1,y1,x2,y2,color=TEAL,width=2): l=slide.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x1),Inches(y1),Inches(x2),Inches(y2));l.line.color.rgb=color;l.line.width=Pt(width);l.line.end_arrowhead='triangle';return l def tag(slide,x,y,w,label,c): s=shape(slide,MSO_SHAPE.ROUNDED_RECTANGLE,x,y,w,.32,c);text(slide,x,y,w,.32,label,9,WHITE,True,PP_ALIGN.CENTER);return s #1 title s=prs.slides.add_slide(blank);bg(s,'dark') text(s,.82,.75,5.2,.35,'OBSTETRICS • SELF-DIRECTED LEARNING',12,RGBColor(171,222,212),True) text(s,.78,1.42,6.9,1.28,'Smoking\nin Pregnancy',43,WHITE,True) text(s,.83,3.15,6.7,.5,'From exposure to prevention',23,RGBColor(213,237,232)) # placental diagram visual card(s,8.7,1.1,3.55,4.95,RGBColor(39,74,89));tag(s,9.05,1.42,2.85,'PLACENTA • FETUS',CORAL) shape(s,MSO_SHAPE.ARC,9.18,2.08,2.55,2.6,RGBColor(39,74,89),RGBColor(153,222,208)).line.width=Pt(6) circle(s,10.05,2.34,.75,CORAL,'O₂',15); circle(s,10.15,3.36,.62,SKY,'CO',13) text(s,9.28,4.75,2.45,.55,'Every exposure\nmatters.',22,WHITE,True,PP_ALIGN.CENTER) text(s,.83,6.55,7.5,.25,'Name: _______________________ Roll no: __________',12,RGBColor(188,224,218)) notes(s,'Opening: Smoking in pregnancy is a modifiable exposure. This SDL covers screening, pathophysiology, complications and a practical cessation pathway. Use respectful language throughout: nicotine dependence is treatable, and every quit attempt matters.') #2 roadmap s=prs.slides.add_slide(blank);bg(s);header(s,'Today’s route','Learning map',2) items=[('01','Identify','active, passive and paternal exposure',TEAL),('02','Explain','nicotine, CO and placental dysfunction',CORAL),('03','Recognise','maternal, placental, fetal and neonatal outcomes',GOLD),('04','Act','screen, counsel, assist and follow-up',SKY)] for i,(n,h,d,c) in enumerate(items): x=.8+(i%2)*6.05;y=1.55+(i//2)*2.3;card(s,x,y,5.5,1.72);circle(s,x+.34,y+.38,.62,c,n,15);text(s,x+1.18,y+.31,3.8,.32,h,21,DEEP,True);text(s,x+1.18,y+.83,3.7,.35,d,15,SLATE) foot(s);notes(s,'Introduce the four-part structure. The deck is deliberately exam-oriented: mechanisms, complications, history and management are separated so the learner can reproduce a concise viva answer.') #3 Definition/screen s=prs.slides.add_slide(blank);bg(s,'cream');header(s,'Start at booking: ask, document, support','Screening & preconception',3) card(s,.8,1.5,4.0,4.85,WHITE);tag(s,1.05,1.77,1.7,'DEFINITION',TEAL);text(s,1.08,2.28,3.35,.92,'Tobacco use during pregnancy exposes the mother and fetus to nicotine, carbon monoxide and toxic combustion products.',21,DEEP,True) text(s,1.1,3.65,3.1,.27,'EXPOSURE CAN BE',11,TEAL,True);bullet(s,1.1,4.05,3.15,['Active smoking','Secondhand / passive smoke','Smokeless tobacco or nicotine products'],CORAL,16) card(s,5.12,1.5,7.05,4.85,WHITE);tag(s,5.45,1.77,1.55,'BOOKING VISIT',CORAL);text(s,5.45,2.28,5.85,.38,'Ask every pregnant woman, in a non-judgemental way:',21,DEEP,True) bullet(s,5.48,2.95,5.8,['Type: cigarette, bidi, hookah, smokeless tobacco, vaping','Quantity, duration and time to first cigarette','Previous quit attempts, withdrawal and triggers','Partner/family/workplace smoking; alcohol and drug use'],TEAL,16,.62) text(s,5.48,5.65,5.9,.28,'Preconception message: stop smoking before conception whenever possible.',15,CORAL,True) foot(s,'Source material: Antenatal history [1]; preconception counselling [2]; hygiene advice [3].');notes(s,'State that smoking and alcohol habits are part of personal history at the first antenatal check-up. Preconception counselling should urge cessation before conception, and specialised care should be offered for addiction. Ask privately and without blame.') #4 mechanism central s=prs.slides.add_slide(blank);bg(s);header(s,'The core mechanism','Nicotine + carbon monoxide → placental dysfunction',4) # lhs exposure card(s,.78,2.04,2.2,2.45,ROSE);text(s,1.05,2.34,1.65,.35,'SMOKING',22,CORAL,True,PP_ALIGN.CENTER);text(s,1.08,2.97,1.6,.55,'Nicotine\nCarbon monoxide\nOxidants',17,INK,False,PP_ALIGN.CENTER) arrow(s,3.1,3.25,4.05,3.25,CORAL,3) # boxes for y,h,d,c in [(1.42,'NICOTINE','Vasoconstriction ↓ uteroplacental blood flow',CORAL),(3.03,'CARBON MONOXIDE','Carboxyhaemoglobin ↓ oxygen transfer',GOLD),(4.64,'PLACENTAL CHANGE','↓ capillary volume; thicker villous membrane',TEAL)]: card(s,4.22,y,4.65,1.18,WHITE);circle(s,4.48,y+.28,.54,c,'↓' if h!='CARBON MONOXIDE' else 'CO',15);text(s,5.22,y+.18,3.25,.24,h,15,DEEP,True);text(s,5.22,y+.54,3.25,.32,d,13,SLATE) arrow(s,8.98,3.25,9.75,3.25,TEAL,3) card(s,9.88,2.04,2.22,2.45,DEEP);text(s,10.14,2.38,1.7,.28,'FINAL COMMON',12,RGBColor(191,232,223),True,PP_ALIGN.CENTER);text(s,10.13,2.78,1.75,.7,'Fetal hypoxia\n+ impaired growth',21,WHITE,True,PP_ALIGN.CENTER) text(s,2.0,5.95,9.6,.35,'Viva line: “Nicotine reduces uteroplacental perfusion; carbon monoxide reduces fetal oxygen delivery.”',16,TEAL,True,PP_ALIGN.CENTER) foot(s,'Source material: carboxyhaemoglobin and reduced placental oxygen transfer [4]; Fishman’s, “Smoking During Pregnancy”.');notes(s,'This is the key explanatory slide. Nicotine causes vasoconstriction and carbon monoxide forms carboxyhaemoglobin, reducing oxygen delivery. The supplied source material links this directly to reduced placental transfer. Keep this sequence intact in a viva answer.') #5 early loss s=prs.slides.add_slide(blank);bg(s,'cream');header(s,'Early pregnancy: impaired oxygen transfer','Miscarriage & early fetal effects',5) card(s,.85,1.55,3.45,4.9,DEEP);text(s,1.27,1.95,2.65,.28,'KEY ASSOCIATION',12,RGBColor(180,225,216),True,PP_ALIGN.CENTER);text(s,1.23,2.45,2.75,.96,'Smoking increases the incidence of spontaneous abortion / miscarriage.',27,WHITE,True,PP_ALIGN.CENTER);text(s,1.25,4.3,2.7,.65,'Mechanistic link: carboxyhaemoglobin → reduced placental oxygen transfer.',17,RGBColor(208,238,232),False,PP_ALIGN.CENTER) # simple oxygen balance for x,h,d,c in [(5.05,'Maternal smoke','CO enters blood',CORAL),(7.9,'Carboxyhaemoglobin','less O₂ carried',GOLD),(10.75,'Early fetus','hypoxic environment',TEAL)]: card(s,x,2.38,1.95,1.75,WHITE);circle(s,x+.7,2.62,.55,c,'CO' if x==5.05 else 'O₂',15);text(s,x+.16,3.32,1.63,.22,h,14,DEEP,True,PP_ALIGN.CENTER);text(s,x+.16,3.65,1.63,.25,d,12,SLATE,False,PP_ALIGN.CENTER) if x<10:arrow(s,x+1.98,3.25,x+2.66,3.25,TEAL) text(s,5.1,5.25,6.9,.37,'Clinical principle: support cessation immediately, without waiting for a later visit.',19,CORAL,True,PP_ALIGN.CENTER) foot(s,'Source material: miscarriage and decreased placental oxygen transfer [3,4].');notes(s,'Smoking is associated with a higher incidence of spontaneous abortion. Explain that carbon monoxide produces carboxyhaemoglobin and reduces oxygen transfer across the placenta. This is association and biologic plausibility, not a reason to blame the patient.') #6 placenta pathology s=prs.slides.add_slide(blank);bg(s);header(s,'Placental pathology','Why antepartum haemorrhage risk rises',6) for i,(h,sub,mech,c,ref) in enumerate([('Placenta previa','Recognised risk factor','Hypoxaemia may drive compensatory placental hypertrophy and lower-segment encroachment.',CORAL,'[5]'),('Placental abruption','Recognised risk factor','Vasospasm of uteroplacental vessels predisposes to premature separation.',GOLD,'[6]')]): x=.85+i*6.1;card(s,x,1.58,5.55,4.9,WHITE);tag(s,x+.35,1.9,1.1,ref,c);text(s,x+.38,2.44,4.55,.4,h,25,DEEP,True);text(s,x+.4,3.03,4.55,.25,sub,14,c,True) # placental schematic shape(s,MSO_SHAPE.ARC,x+.57,3.67,1.65,1.2,PALE,c).line.width=Pt(4);circle(s,x+1.08,3.78,.52,c,'P',13) text(s,x+2.38,3.68,2.65,1.2,mech,15,INK,False) text(s,.95,6.76,11.2,.22,'Also associated with PPROM and bleeding-related pregnancy complications.',14,SLATE,True,PP_ALIGN.CENTER) foot(s,'Source material: placenta previa [5], abruptio placentae [6]; Harrison’s 22e (2025), “Pregnancy”.');notes(s,'Smoking is a recognised high-risk factor for placenta previa and a predisposing factor for abruption. The supplied Dutta material attributes previa to hypoxaemia and compensatory placental hypertrophy, and abruption to vasospasm. Mention PPROM as an associated complication.') #7 fetal well-being s=prs.slides.add_slide(blank);bg(s,'cream');header(s,'Fetal well-being: what changes in utero?','Fetal physiology',7) card(s,.8,1.52,3.25,4.95,DEEP);text(s,1.12,1.96,2.62,.22,'CHRONIC MATERNAL SMOKING',11,RGBColor(184,228,219),True,PP_ALIGN.CENTER);text(s,1.16,2.52,2.53,1.1,'Can reduce maternal perception of active fetal movements.',25,WHITE,True,PP_ALIGN.CENTER);text(s,1.15,4.68,2.5,.6,'Reduced fetal breathing movements are also described with smoking and hypoxia.',16,RGBColor(208,236,231),False,PP_ALIGN.CENTER) # fetal breathing visual card(s,4.55,1.52,7.6,4.95,WHITE);text(s,4.95,1.97,6.7,.33,'Fetal breathing movements (FBM)',23,DEEP,True) # stylised wave line for i in range(9): x=5.05+i*.7; h=.35 if i%2==0 else .7 l=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x),Inches(4.25-h),Inches(x+.35),Inches(4.25));l.line.color.rgb=TEAL;l.line.width=Pt(3) l2=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x+.35),Inches(4.25),Inches(x+.7),Inches(4.25-h));l2.line.color.rgb=TEAL;l2.line.width=Pt(3) text(s,5.0,5.1,6.55,.48,'Smoking / hypoxia → reduced frequency of FBM',22,CORAL,True,PP_ALIGN.CENTER) foot(s,'Source material: fetal breathing movements [7]; movement perception [8].');notes(s,'This slide is a high-yield but less commonly mentioned consequence. Maternal smoking and hypoxia directly reduce fetal breathing movements. Chronic smoking may also reduce maternal perception of active fetal movements. Advise women to seek assessment for reduced movements as per local protocol.') #8 FGR s=prs.slides.add_slide(blank);bg(s);header(s,'Growth restriction: the hallmark fetal consequence','FGR / IUGR & low birth weight',8) # left scale graphic card(s,.82,1.5,3.0,5.0,DEEP);text(s,1.1,1.92,2.45,.25,'HEAVY SMOKING',12,RGBColor(180,226,218),True,PP_ALIGN.CENTER);circle(s,1.84,2.55,.9,CORAL,'↓',32);text(s,1.05,3.78,2.5,.78,'Smaller babies\nLow birth weight',26,WHITE,True,PP_ALIGN.CENTER);text(s,1.1,5.35,2.4,.4,'Due to impaired oxygen and substrate delivery.',15,RGBColor(211,238,232),False,PP_ALIGN.CENTER) steps=[('Maternal toxin','smoke exposure',CORAL),('Placental dysfunction','↓ perfusion',GOLD),('Fetal growth restriction','asymmetrical or symmetrical',TEAL)] for i,(h,d,c) in enumerate(steps): x=4.45+i*2.5;card(s,x,2.35,2.08,2.1,WHITE);circle(s,x+.72,2.63,.55,c,str(i+1),15);text(s,x+.16,3.43,1.74,.28,h,16,DEEP,True,PP_ALIGN.CENTER);text(s,x+.16,3.81,1.74,.32,d,12,SLATE,False,PP_ALIGN.CENTER) if i<2:arrow(s,x+2.12,3.42,x+2.43,3.42,c) text(s,4.55,5.65,7.1,.35,'Management principle: smoking cessation is a general measure for prevention and management of FGR.',16,TEAL,True,PP_ALIGN.CENTER) foot(s,'Source material: LBW / IUGR [3,9-11]; Fishman’s, “Smoking During Pregnancy”.');notes(s,'Heavy smokers consistently deliver smaller, low-birth-weight babies. Smoking is a maternal toxin that impairs substrate and oxygen delivery, producing asymmetric or symmetric IUGR. Avoidance and cessation are important general measures in FGR prevention and management.') #9 preterm VTE s=prs.slides.add_slide(blank);bg(s);header(s,'Beyond growth: timing of birth and thrombosis','Preterm labour & maternal vascular risk',9) for i,(n,h,items,c) in enumerate([('A','Preterm pathway',['Preterm labour','PPROM','Prematurity-related neonatal morbidity'],CORAL),('B','Vascular pathway',['Acquired risk for DVT','Pulmonary embolism risk','Important in pregnancy and puerperium'],TEAL)]): x=.85+i*6.1;card(s,x,1.58,5.55,4.92,WHITE);circle(s,x+.42,1.92,.62,c,n,17);text(s,x+1.3,1.98,3.7,.3,h,24,DEEP,True);bullet(s,x+.48,2.9,4.4,items,c,19,.75) text(s,.9,6.75,11.1,.23,'Clinical reasoning: smoking adds risk, so assess the patient’s complete obstetric and thrombotic profile.',14,SLATE,True,PP_ALIGN.CENTER) foot(s,'Source material: preterm labour [12]; VTE [13].');notes(s,'Smoking is a documented high-risk historical factor for preterm labour. It is also an acquired VTE risk factor in pregnancy and puerperium. Do not isolate one factor: incorporate smoking within a complete VTE and preterm-birth risk assessment.') #10 newborn/later outcomes s=prs.slides.add_slide(blank);bg(s,'cream');header(s,'The effects do not stop at birth','Neonatal & childhood outcomes',10) for i,(h,d,c) in enumerate([('At birth','Prematurity\nLow birth weight\nHigher perinatal morbidity and mortality',CORAL),('After birth','Respiratory problems\nSIDS risk rises with ongoing tobacco smoke exposure',GOLD),('Later childhood','Wheeze / asthma\nAdverse cognitive and behavioural outcomes',TEAL)]): x=.74+i*4.1;card(s,x,1.65,3.63,4.45,WHITE);circle(s,x+1.42,2.1,.72,c,str(i+1),20);text(s,x+.3,3.14,3.0,.32,h,21,DEEP,True,PP_ALIGN.CENTER);text(s,x+.36,3.85,2.9,1.25,d,18,INK,False,PP_ALIGN.CENTER) text(s,.85,6.5,11.5,.3,'Protect the infant after birth: keep home and car completely smoke-free.',18,CORAL,True,PP_ALIGN.CENTER) foot(s,'Source material [3]; Fishman’s, “Smoking During Pregnancy”; CDC, Smoking, Pregnancy, and Babies.');notes(s,'Link antenatal exposure with postnatal protection. Neonatal complications include prematurity, low birth weight and respiratory problems. Continued household exposure increases SIDS and respiratory risks. Smoking cessation should remain an active postpartum goal.') #11 passive paternal s=prs.slides.add_slide(blank);bg(s);header(s,'Smoking is a household exposure','Passive smoke & paternal effects',11) card(s,.8,1.55,5.6,4.95,DEEP);tag(s,1.1,1.88,1.45,'PASSIVE SMOKE',CORAL);text(s,1.12,2.42,4.9,.48,'A pregnant woman does not need to smoke herself to be exposed.',25,WHITE,True);bullet(s,1.15,3.42,4.75,['Partner or family members','Workplace / social environments','Home and car exposure after birth'],RGBColor(174,223,214),18,.72) card(s,6.75,1.55,5.45,4.95,WHITE);tag(s,7.05,1.88,1.5,'PATERNAL SMOKING',TEAL);text(s,7.08,2.45,4.7,.55,'Smoking may alter sperm morphology or semen composition.',22,DEEP,True);text(s,7.1,3.48,4.6,.9,'Associated progeny risks: abortion, congenital malformations, low birth weight and perinatal loss.',18,INK) text(s,7.1,5.35,4.55,.3,'Counsel the partner too.',18,CORAL,True,PP_ALIGN.CENTER) foot(s,'Source material: passive smoke section; paternal effects [14].');notes(s,'Ask about exposure at home, work and social settings. Involve the partner where appropriate, because a smoke-free home helps both maternal cessation and infant health. The supplied source material also identifies paternal smoking as associated with sperm changes and adverse progeny outcomes.') #12 contraindications s=prs.slides.add_slide(blank);bg(s);header(s,'Related pharmacology & contraception pearls','Exam considerations',12) for i,(h,d,c,ref) in enumerate([('Mifepristone','Avoid for medical abortion in heavy smokers aged >35 years.',CORAL,'[15]'),('Combined oral contraceptives','Smoking in women >35 years increases circulatory and thromboembolic risk.',GOLD,'[16]'),('Preferred contraception','Consider non-hormonal methods or IUDs rather than estrogen-containing pills in smokers >35 years.',TEAL,'[17]')]): y=1.48+i*1.55;card(s,1.1,y,11.05,1.1,WHITE);tag(s,1.32,y+.37,.55,ref,c);text(s,2.1,y+.19,3.45,.27,h,18,DEEP,True);text(s,5.15,y+.16,6.35,.45,d,15,INK) text(s,1.1,6.38,10.8,.24,'These are additional high-yield points, not substitutes for current local clinical guidance.',13,SLATE,True,PP_ALIGN.CENTER) foot(s,'Source material: MTP [15]; COC and contraception cautions [16,17].');notes(s,'Use this as a viva extension slide. State the source material’s mifepristone caution in heavy smokers older than 35. For combined oral contraceptives, smoking over age 35 raises circulatory and thromboembolic risk, so non-estrogen methods such as IUDs are preferred. Check local protocols.') #13 history card s=prs.slides.add_slide(blank);bg(s,'cream');header(s,'Clinical assessment','The tobacco history in 60 seconds',13) qs=[('TYPE','What product? Cigarette, bidi, hookah, vaping, smokeless tobacco?'),('QUANTITY','How many per day? Time to first cigarette after waking?'),('DEPENDENCE','Cravings, withdrawal, prior attempts and barriers?'),('ENVIRONMENT','Who smokes at home? Work exposure? Alcohol or other drugs?')] for i,(h,d) in enumerate(qs): x=.85+(i%2)*6.0;y=1.55+(i//2)*2.25;card(s,x,y,5.5,1.7,WHITE);circle(s,x+.35,y+.4,.58,TEAL if i%2==0 else CORAL,str(i+1),15);text(s,x+1.2,y+.28,3.85,.25,h,16,DEEP,True);text(s,x+1.2,y+.7,3.85,.5,d,14,INK) text(s,.95,6.33,11.1,.32,'Ask permission, listen, document, and offer help at every contact.',19,TEAL,True,PP_ALIGN.CENTER) foot(s,'Source material: tobacco history and other substance-use assessment.');notes(s,'Demonstrate the history rather than reading the slide. Start with “Would it be okay if I ask about tobacco or nicotine use?” Assess type, quantity, dependence and environmental exposure. Also ask about alcohol and drugs. Document the response and revisit it.') #14 5As flowchart s=prs.slides.add_slide(blank);bg(s);header(s,'Management: a clear, repeatable pathway','The 5 A’s',14) steps=[('ASK','Identify tobacco and nicotine exposure.',TEAL),('ADVISE','Clear, personalised advice to quit.',CORAL),('ASSESS','Readiness, dependence and barriers.',GOLD),('ASSIST','Quit plan, counselling and support.',SKY),('ARRANGE','Follow-up and relapse prevention.',TEAL)] for i,(h,d,c) in enumerate(steps): x=.48+i*2.53;card(s,x,2.0,2.05,2.7,WHITE);shape(s,MSO_SHAPE.ROUNDED_RECTANGLE,x,2.0,2.05,.67,c);text(s,x,2.17,2.05,.24,h,16,WHITE,True,PP_ALIGN.CENTER);circle(s,x+.72,2.95,.58,c,str(i+1),15);text(s,x+.2,3.72,1.65,.5,d,14,INK,False,PP_ALIGN.CENTER) if i<4:arrow(s,x+2.08,3.35,x+2.45,3.35,SLATE,2) text(s,1.2,5.58,10.8,.48,'First-line in pregnancy: behavioural intervention + smoking-cessation counselling.',23,DEEP,True,PP_ALIGN.CENTER) foot(s,'Source material: management approach; ACOG Committee Opinion No. 807 (2020).');notes(s,'Explain each A. ASK routinely. ADVISE clearly but compassionately. ASSESS readiness, dependence, prior attempts and barriers. ASSIST with a quit plan, behavioural counselling, trigger management and family support. ARRANGE follow-up for abstinence, withdrawal, relapse and postpartum prevention.') #15 decision flowchart s=prs.slides.add_slide(blank);bg(s,'cream');header(s,'The patient journey','Management flowchart for your SDL',15) # flow nodes nodes=[(5.0,.95,3.0,.62,'PREGNANT WOMAN',DEEP),(5.0,1.95,3.0,.62,'ASK ABOUT TOBACCO USE',TEAL),(5.0,2.95,3.0,.62,'SMOKER / NICOTINE USER?',GOLD)] for x,y,w,h,t,c in nodes:shape(s,MSO_SHAPE.ROUNDED_RECTANGLE,x,y,w,h,c);text(s,x,y,w,h,t,16,WHITE,True,PP_ALIGN.CENTER) arrow(s,6.5,1.57,6.5,1.9);arrow(s,6.5,2.57,6.5,2.9) # no arrow(s,5.0,3.26,2.2,4.03,TEAL);card(s,.65,4.0,3.1,1.35,WHITE);text(s,.85,4.22,2.7,.25,'NO',17,TEAL,True,PP_ALIGN.CENTER);text(s,.9,4.6,2.6,.32,'Prevent passive exposure\nRe-screen later',15,INK,False,PP_ALIGN.CENTER) # yes arrow(s,8.0,3.26,10.0,4.03,CORAL);card(s,9.55,4.0,3.15,1.35,WHITE);text(s,9.75,4.22,2.75,.25,'YES',17,CORAL,True,PP_ALIGN.CENTER);text(s,9.78,4.6,2.7,.32,'Advise → assess dependence\nBehavioural counselling',15,INK,False,PP_ALIGN.CENTER) # bottom arrow(s,11.1,5.38,11.1,5.78,TEAL);shape(s,MSO_SHAPE.ROUNDED_RECTANGLE,8.65,5.85,4.9,.8,DEEP);text(s,8.65,6.05,4.9,.3,'FOLLOW-UP + POSTPARTUM RELAPSE PREVENTION',14,WHITE,True,PP_ALIGN.CENTER) text(s,.86,6.25,6.2,.24,'If unable to quit: consider supervised NRT / specialist support after individual risk-benefit assessment.',13,CORAL,True) foot(s,'Source material: management flow; ACOG Committee Opinion No. 807 (2020); CDC.');notes(s,'Present this slowly. If no active smoking is reported, actively prevent passive exposure and re-screen. If yes, use the 5 A’s. Behavioural support is first-line. If the patient remains unable to quit, consider NRT or specialist support only after individual clinician-led risk-benefit assessment. Maintain postpartum contact.') #16 therapy s=prs.slides.add_slide(blank);bg(s);header(s,'Treatment: what you should say in a viva','Behavioural care first; pharmacotherapy is individualised',16) for i,(h,d,c) in enumerate([('Behavioural interventions','Counselling, motivational interviewing, cognitive behavioural therapy, quit plan, trigger management and social support.',TEAL),('Nicotine replacement therapy','May be considered when behavioural care alone is insufficient. Delivers nicotine without combustion products. Needs clinician supervision.',GOLD),('Bupropion / varenicline','Know the names. In pregnancy, any pharmacotherapy requires careful individual risk-benefit assessment and current local guidance.',CORAL)]): y=1.43+i*1.55;card(s,.95,y,11.3,1.16,WHITE);circle(s,1.28,y+.3,.55,c,str(i+1),15);text(s,2.08,y+.17,3.2,.25,h,18,DEEP,True);text(s,5.25,y+.14,6.2,.54,d,14,INK) shape(s,MSO_SHAPE.ROUNDED_RECTANGLE,1.25,6.25,10.9,.48,ROSE);text(s,1.43,6.36,10.5,.18,'Do not portray e-cigarettes or another tobacco product as a safe alternative in pregnancy.',13,RED,True,PP_ALIGN.CENTER) foot(s,'Source material: NRT and cessation drugs; ACOG Committee Opinion No. 807 (2020); CDC, 2025.');notes(s,'Behavioural support is foundational. NRT may be considered after an individualised clinician-led discussion when behavioural methods alone fail, because it avoids combustible tobacco products but still exposes the fetus to nicotine. Mention bupropion and varenicline as cessation drugs, but avoid recommending routine use without current guidance.') #17 counselling s=prs.slides.add_slide(blank);bg(s,'dark');header(s,'Counselling that helps','A patient-centred closing message',17,'dark') card(s,.95,1.55,11.2,3.95,RGBColor(42,76,91));text(s,1.45,2.0,10.1,.28,'USE THIS IN CLINICAL PRACTICE',11,RGBColor(175,224,214),True,PP_ALIGN.CENTER) text(s,1.55,2.62,9.95,1.25,'“Smoking can reduce the oxygen and blood supply reaching your baby. Stopping completely is the best step. Even if you stop later in pregnancy, it can still help. We can make a plan and support you.”',27,WHITE,True,PP_ALIGN.CENTER) text(s,1.55,4.55,9.95,.33,'Also: avoid passive smoke, involve family, identify triggers, arrange follow-up and continue support after birth.',16,RGBColor(207,238,232),False,PP_ALIGN.CENTER) text(s,.98,6.27,11.3,.26,'Breastfeeding should be encouraged while ongoing cessation support continues; keep the infant away from smoke exposure.',16,RGBColor(196,232,223),True,PP_ALIGN.CENTER) notes(s,'Read the quotation in a warm, non-threatening way. Reinforce that quitting at any stage can help. Advice must include passive smoke avoidance, family support, trigger identification and follow-up. Tobacco use is not an absolute contraindication to breastfeeding, but cessation and a smoke-free environment should be strongly supported.') #18 exam/viva s=prs.slides.add_slide(blank);bg(s,'cream');header(s,'Rapid viva recap','The 10-point answer in 90 seconds',18) points=['Smoking = nicotine + carbon monoxide + toxic chemicals.','Nicotine → uteroplacental vasoconstriction.','CO → carboxyhaemoglobin → fetal hypoxia.','Placental dysfunction → FGR / low birth weight.','Placenta previa, abruption, PPROM and preterm labour may occur.','Miscarriage and perinatal morbidity / mortality increase.','Ask about active and passive smoking at booking and thereafter.','Take a tobacco history: type, quantity, dependence and household exposure.','Manage with 5 A’s and behavioural cessation support first.','Consider supervised NRT / specialist support if unable to quit; prevent postpartum relapse.'] for i,p in enumerate(points): x=.8+(i%2)*6.0;y=1.35+(i//2)*.99;circle(s,x,y+.1,.35,TEAL if i%2==0 else CORAL,str(i+1),10);text(s,x+.52,y,5.1,.53,p,15,INK,False) foot(s,'High-yield synthesis of source material [1]-[17] and standard obstetric guidance.');notes(s,'Use these as closing revision points. Ask the learner to reproduce this sequence aloud: smoking, nicotine plus CO, vasoconstriction plus hypoxia, placental dysfunction, FGR and adverse outcomes, then 5 A’s management.') #19 refs s=prs.slides.add_slide(blank);bg(s);header(s,'References','Core sources and source-map note',19) refs=[ 'Dutta DC. D.C. Dutta’s Textbook of Obstetrics. 9th ed. Konar H, ed. Jaypee Brothers Medical Publishers; 2018.', 'Fishman’s Pulmonary Diseases and Disorders. 6th ed. McGraw Hill. Section: “Smoking During Pregnancy”.', 'American College of Obstetricians and Gynecologists. Tobacco and Nicotine Cessation During Pregnancy. Committee Opinion No. 807. Obstet Gynecol. 2020;135:e221-e229.', 'Centers for Disease Control and Prevention. Smoking, Pregnancy, and Babies; Tobacco and reproductive health. Accessed October 2026.', 'Freijah II, Jones KA, Coleman T. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2026. PMID: 42011820.' ] for i,r in enumerate(refs): card(s,.83,1.3+i*1.0,11.75,.72,WHITE);text(s,1.05,1.48+i*1.0,11.25,.28,r,13,INK) shape(s,MSO_SHAPE.ROUNDED_RECTANGLE,.83,6.4,11.75,.48,MINT);text(s,1.05,6.51,11.2,.18,'Note: Page-specific labels [1]-[17] in slides follow the source material supplied by the presenter. Verify exact pages against the edition used in your department.',10,TEAL,True,PP_ALIGN.CENTER) notes(s,'D.C. Dutta is listed as the principal obstetric text. The source material supplied with the request used bracketed page-wise citations but did not include page numbers. These labels have been preserved without fabricating page numbers. Verify exact pages in your copy before presenting.') prs.save(OUT);print(OUT) ''') PY python "/tmp/workspace/smoking-pregnancy-ppt/src/create_redesigned.py"

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/smoking-pregnancy-ppt/output/Smoking_in_Pregnancy_SDL_Redesigned.pptx') prs=Presentation(str(p)) print('exists=',p.exists(),'bytes=',p.stat().st_size,'slides=',len(prs.slides)) assert len(prs.slides)==19 for i,sl in enumerate(prs.slides,1): ts=[sh.text.replace('\n',' / ') for sh in sl.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()] notes=sl.notes_slide.notes_text_frame.text.strip() print(f'{i:02d}: {ts[0][:72] if ts else "NO TEXT"} | notes={len(notes)} | shapes={len(sl.shapes)}') assert len(notes)>80, f'notes missing slide {i}' print('verification passed') PY python - <<'PY' from zipfile import ZipFile p='/tmp/workspace/smoking-pregnancy-ppt/output/Smoking_in_Pregnancy_SDL_Redesigned.pptx' with ZipFile(p) as z: notes=[x for x in z.namelist() if x.startswith('ppt/notesSlides/notesSlide') and x.endswith('.xml')] slides=[x for x in z.namelist() if x.startswith('ppt/slides/slide') and x.endswith('.xml')] print('slide XML',len(slides),'notes XML',len(notes)) PY