B.Sc NURSING - MIDWIFERY / OBG NURSING-I

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// ─── Cover page ─────────────────────────────────────────────────────────────
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      children: [new TextRun({ text: "Midwifery / OBG Nursing - I", bold: true, size: 44, color: TEAL })],
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    new Paragraph({
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      alignment: AlignmentType.CENTER,
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    nbsp(),
    new Paragraph({
      children: [new TextRun({ text: "Semester V  |  Theory: 3 Credits (60 hrs)  |  Practicum: 4 Credits", size: 22, color: "444444" })],
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    new Paragraph({
      children: [new TextRun({ text: "Sources: Creasy & Resnik's Maternal-Fetal Medicine  •  The Developing Human  •  Park's PSM", size: 20, color: "888888", italics: true })],
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// ─── UNIT I ─────────────────────────────────────────────────────────────────
function unit1() {
  return [
    h1("UNIT I – TRENDS, ISSUES & LEGAL ASPECTS IN MIDWIFERY"),

    h2("1.1  Key Indicators in Maternal & Neonatal Health"),
    makeTable(
      ["Indicator","Definition"],
      [
        ["Maternal Mortality Rate (MMR)","Deaths per 1,00,000 live births due to pregnancy/childbirth"],
        ["Infant Mortality Rate (IMR)","Deaths per 1,000 live births in the first year of life"],
        ["Neonatal Mortality Rate (NMR)","Deaths per 1,000 live births in first 28 days"],
        ["Perinatal Mortality Rate","Stillbirths + deaths in first 7 days per 1,000 births"],
        ["Fertility Rate","Average number of children born per woman of reproductive age"],
      ]
    ),
    nbsp(),
    para("Maternal Death Audit – systematic review of every maternal death to identify avoidable causes; guides policy and training improvements."),

    h2("1.2  National Health Programs – RMNCH+A"),
    para("RMNCH+A = Reproductive, Maternal, Newborn, Child Health + Adolescent Health"),
    bullet("R – Reproductive health: family planning, STI care"),
    bullet("M – Maternal health: ANC, safe delivery, PNC"),
    bullet("N – Newborn health: ENBC, NSSK module"),
    bullet("C – Child health: immunization, nutrition"),
    bullet("A – Adolescent health: RKSK, ARSH"),
    nbsp(),
    bullet("LaQshya Program – improves quality of care in labour rooms and maternity OTs in public health facilities"),
    bullet("Dakshata Program – capacity-building for skilled birth attendance at delivery points"),

    h2("1.3  Current Trends in Midwifery"),
    makeTable(
      ["Trend","Description"],
      [
        ["Respectful Maternity Care (RMC)","Care maintaining dignity, privacy, and informed consent"],
        ["Midwifery-Led Care Units (MLCU)","Midwife-managed units for low-risk births"],
        ["Woman-Centred Care","Care planned around the woman's needs and choices"],
        ["Physiologic Birth","Promotion of normal, intervention-free birth"],
        ["Birthing Centres","Low-intervention settings for uncomplicated births"],
        ["Water Birth","Labour/birth in a warm-water pool"],
        ["Lotus Birth","Delayed cord cutting until placenta separates naturally"],
        ["Demedicalization of Birth","Reducing unnecessary medical interventions"],
      ]
    ),
    nbsp(),
    para("ICM Essential Competencies – international framework defining minimum competency standards for midwives globally."),

    h2("1.4  Legal Provisions in Midwifery Practice in India"),
    makeTable(
      ["Law / Act","Key Provision"],
      [
        ["INC Regulations","Governs nursing education and registration in India"],
        ["ICM Code of Ethics","International ethical standards for midwifery practice"],
        ["MTP Act 1971 (amended 2021)","Legal termination up to 24 weeks under specified conditions"],
        ["PNDT Act 1994 (PC&PNDT)","Prohibits sex determination; regulates prenatal diagnostic techniques"],
        ["Surrogacy Regulation Act 2021","Permits only altruistic surrogacy; commercial surrogacy banned"],
        ["Adoption Laws / CARA","Governs inter-country and domestic adoption under JJ Act"],
      ]
    ),
    nbsp(),
    bold("Roles and Scope of the Nurse/Midwife:"),
    bullet("Conduct normal childbirth independently"),
    bullet("Provide ANC and PNC in hospital and community settings"),
    bullet("Essential newborn care and resuscitation"),
    bullet("Family planning counseling and provision"),
    bullet("Identify and refer high-risk cases"),
    bullet("Health education and community outreach with ASHAs"),
    pageBreak(),
  ];
}

// ─── UNIT II ────────────────────────────────────────────────────────────────
function unit2() {
  return [
    h1("UNIT II – ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM"),

    h2("2.1  Female Organs of Reproduction"),
    bold("External Genitalia (Vulva):"),
    para("Mons pubis, labia majora, labia minora, clitoris, vestibule (urethral + vaginal openings), Bartholin's glands, hymen."),
    bold("Internal Genitalia:"),
    bullet("Vagina – muscular canal 8-10 cm; acid pH 3.5-4.5 (Doderlein's bacilli)"),
    bullet("Uterus – pear-shaped; non-pregnant: 7.5 × 5 × 2.5 cm; parts: fundus, body, isthmus, cervix"),
    bullet("Fallopian Tubes – 10 cm; parts: interstitial, isthmus, ampulla (fertilization site), infundibulum"),
    bullet("Ovaries – almond-shaped, 3 × 2 × 1 cm; produce ova and sex hormones"),

    h2("2.2  Female Pelvis"),
    bold("Bones:"),
    para("2 innominate bones (ilium + ischium + pubis), sacrum, coccyx."),
    bold("Joints:"),
    para("Sacroiliac (×2), sacrococcygeal, symphysis pubis (slight mobility in pregnancy due to relaxin)."),
    nbsp(),
    bold("Pelvic Planes & Diameters:"),
    makeTable(
      ["Plane","AP Diameter","Transverse","Oblique"],
      [
        ["Inlet (brim)","11 cm","13 cm","12 cm"],
        ["Mid cavity","12 cm","12 cm","12 cm"],
        ["Outlet","13 cm","11 cm","—"],
      ]
    ),
    nbsp(),
    bold("Pelvic Types – Caldwell-Moloy Classification:"),
    bullet("Gynecoid (round) – most favourable for vaginal delivery – 50%"),
    bullet("Android (heart-shaped/male type) – narrow, poor prognosis for vaginal birth"),
    bullet("Anthropoid (oval AP) – posterior position common"),
    bullet("Platypelloid (flat/wide) – rare; transverse arrest common"),

    h2("2.3  Fetal Skull"),
    bold("Bones:"),
    para("2 frontal, 2 parietal, 2 temporal, 1 occipital, 1 sphenoid (base) – not fully fused at birth, allowing moulding."),
    bold("Sutures:"),
    para("Sagittal (between parietals), coronal (frontal-parietal), lambdoid (parietal-occipital), frontal (between frontals)."),
    bold("Fontanelles:"),
    bullet("Anterior (Bregma) – diamond-shaped; junction of sagittal + coronal + frontal sutures; closes at 18 months"),
    bullet("Posterior (Lambda) – triangle; junction of sagittal + lambdoid sutures; closes at 6-8 weeks"),
    nbsp(),
    bold("Key Diameters of Fetal Skull:"),
    makeTable(
      ["Diameter","Measurement","Clinical Significance"],
      [
        ["Suboccipitobregmatic","9.5 cm","Fully flexed head – most favourable for delivery"],
        ["Suboccipitofrontal","10 cm","Partially deflexed head"],
        ["Occipitofrontal","11.5 cm","Average; vertex presentation"],
        ["Mentovertical","13.5 cm","Brow presentation – LARGEST – may need C-section"],
        ["Submentobregmatic","9.5 cm","Face presentation – favourable"],
      ]
    ),
    nbsp(),
    para("Moulding – temporary reshaping of fetal skull by overlapping of bones during passage through birth canal. Helps delivery; excessive moulding (3+ on partograph) is pathological."),

    bold("Fetal Lie, Presentation & Position:"),
    bullet("Lie – relationship of long axis of fetus to uterus (longitudinal, transverse, oblique)"),
    bullet("Presentation – part in lower pole (cephalic, breech, shoulder)"),
    bullet("Position – relationship of denominator (occiput in vertex) to maternal pelvis"),
    bullet("Attitude – flexion (normal) vs extension"),
    bullet("Engagement – widest diameter has passed through pelvic inlet"),

    h2("2.4  Menstrual Cycle"),
    makeTable(
      ["Phase","Days","Dominant Hormone","Endometrial Change","Cervical Mucus"],
      [
        ["Menstrual","1–4","Low E + P","Shedding","Scanty"],
        ["Follicular (Proliferative)","5–13","Rising Estrogen","Proliferation; glands elongate","Watery, ferning, stretchy (spinnbarkeit)"],
        ["Ovulation","Day 14","LH surge","Mature; ready for implantation","Maximum, transparent"],
        ["Luteal (Secretory)","15–28","Progesterone dominant","Secretory; glycogen-rich, coiled glands","Thick, non-ferning"],
      ]
    ),
    nbsp(),
    para("If no fertilization: corpus luteum degenerates → progesterone/estrogen fall → menstruation on day 28."),
    para("Progesterone raises basal body temperature ~0.5°C after ovulation – basis of BBT method of contraception."),

    h2("2.5  Fertilization, Conception & Implantation"),
    bullet("Fertilization – in the ampulla of fallopian tube, within 12-24 hrs of ovulation"),
    bullet("Sperm viability: 2-5 days; Ovum viability: 12-24 hours"),
    bullet("Only one sperm enters ovum → zona reaction prevents polyspermy"),
    bullet("Zygote (2n = 46 chromosomes) → cleavage → morula (day 3-4) → blastocyst (day 4-5)"),
    bullet("Implantation – day 6-10; posterior uterine wall; HCG secreted to maintain corpus luteum"),

    h2("2.6  Placental Development & Functions"),
    para("The placenta is a fetomaternal organ with two components:"),
    bullet("Fetal part – derived from chorionic sac (villous chorion)"),
    bullet("Maternal part – derived from endometrium (decidua basalis)"),
    nbsp(),
    bold("Decidua Regions:"),
    bullet("Decidua basalis – deep to conceptus; forms maternal side of placenta"),
    bullet("Decidua capsularis – overlies and covers the conceptus"),
    bullet("Decidua parietalis – remainder of uterine lining"),
    nbsp(),
    bold("Functions of the Placenta (NREEH):"),
    makeTable(
      ["Function","Details"],
      [
        ["Nutrition","Glucose, amino acids, fatty acids pass to fetus via active transport/diffusion"],
        ["Respiration","O₂ from mother to fetus; CO₂ from fetus to mother (diffusion)"],
        ["Excretion","Fetal waste products (urea, creatinine, bilirubin) pass to maternal blood"],
        ["Endocrine","Produces HCG, HPL, estrogen, progesterone, relaxin"],
        ["Host Defence / Immunological","Transmits IgG (passive immunity); partial barrier to infection"],
      ]
    ),
    nbsp(),
    bold("Placental Barrier (4 layers):"),
    para("Syncytiotrophoblast → Cytotrophoblast → Connective tissue → Fetal capillary endothelium (thins as pregnancy advances)."),
    para("At term: 500-600 g, 15-20 cm diameter, 2-3 cm thick (~1/6 fetal weight)."),

    h2("2.7  Fetal Growth & Developmental Milestones"),
    makeTable(
      ["Week","Key Development"],
      [
        ["4","Heart begins beating; neural tube forms"],
        ["8","All major organs formed; embryo becomes fetus"],
        ["12","External genitalia differentiated; spontaneous movement begins"],
        ["16","Quickening felt by multiparae; lanugo appears; urine production starts"],
        ["20","Quickening in primiparae; vernix caseosa; myelination begins"],
        ["24","Viability with NICU support; surfactant production begins"],
        ["28","Eyelids open; ~1 kg; subcutaneous fat deposition starts"],
        ["36","Lanugo disappearing; sole creases appearing"],
        ["40","Full term; 3-3.5 kg, ~50 cm; lungs mature"],
      ]
    ),

    h2("2.8  Fetal Circulation"),
    bold("Three shunts that bypass lungs and liver:"),
    bullet("Foramen ovale – right atrium → left atrium (bypasses lungs)"),
    bullet("Ductus arteriosus – pulmonary artery → descending aorta (bypasses lungs)"),
    bullet("Ductus venosus – umbilical vein → inferior vena cava (bypasses liver)"),
    bullet("Umbilical vein (×1) – carries OXYGENATED blood from placenta to fetus"),
    bullet("Umbilical arteries (×2) – carry DEOXYGENATED blood from fetus to placenta"),
    para("At birth: lungs expand → pulmonary resistance falls → foramen ovale closes (becomes fossa ovalis), ductus arteriosus closes (becomes ligamentum arteriosum), ductus venosus closes (becomes ligamentum venosum)."),
    pageBreak(),
  ];
}

// ─── UNIT III ───────────────────────────────────────────────────────────────
function unit3() {
  return [
    h1("UNIT III – ASSESSMENT & MANAGEMENT OF NORMAL PREGNANCY"),

    h2("3.1  Pre-conception Care"),
    para("Goals: optimize health BEFORE conception; identify and reduce risk factors."),
    bullet("Folic acid 400 mcg/day – start 3 months before conception; prevents neural tube defects"),
    bullet("Rubella immunization (2 doses if not immune; avoid pregnancy for 1 month after)"),
    bullet("Manage chronic conditions: diabetes, hypertension, thyroid disorders"),
    bullet("BMI optimization; weight loss if obese"),
    bullet("Genetic counseling if family history of hereditary conditions"),
    bullet("Avoidance of teratogens (alcohol, smoking, Category X drugs)"),
    bullet("Psychosocial readiness; financial planning; dental care"),

    h2("3.2  Diagnosis of Pregnancy"),
    bold("Presumptive (Subjective) Signs:"),
    bullet("Amenorrhoea"),
    bullet("Nausea and vomiting (morning sickness – 6th to 12th week)"),
    bullet("Breast changes – tingling, enlargement, darkening of areola, Montgomery's tubercles"),
    bullet("Quickening – fetal movements felt (18-20 wks primi; 16-18 wks multi)"),
    bullet("Frequency of micturition (1st and 3rd trimester)"),
    bullet("Fatigue and weight gain"),
    nbsp(),
    bold("Probable (Objective) Signs:"),
    bullet("Uterine enlargement proportional to gestational age"),
    bullet("Hegar's sign – softening of lower uterine segment (6-10 wks)"),
    bullet("Goodell's sign – softening of cervix"),
    bullet("Chadwick's/Jacquemier's sign – bluish discoloration of vagina"),
    bullet("Braxton Hicks contractions – painless, irregular (from 16 wks)"),
    bullet("Positive urine/serum HCG pregnancy test"),
    nbsp(),
    bold("Positive (Diagnostic) Signs:"),
    bullet("Fetal heart sounds (10-12 wks by Doppler; 20 wks by Pinard's stethoscope)"),
    bullet("Fetal movements palpated by examiner"),
    bullet("Ultrasound – gestational sac from 5-6 wks; fetal cardiac activity from 6 wks"),

    h2("3.3  EDD Calculation – Naegele's Rule"),
    para("EDD = LMP + 9 months + 7 days  (or LMP + 280 days)"),
    para("Example: LMP = 1 Jan 2025 → EDD = 8 Oct 2025"),

    h2("3.4  Physiological Changes in Pregnancy"),
    makeTable(
      ["System","Key Change"],
      [
        ["Cardiovascular","Blood volume ↑ 40-50%; cardiac output ↑ 30-50%; physiological anaemia; systolic murmur common; BP slightly ↓ in 2nd trimester"],
        ["Respiratory","Tidal volume ↑ 40%; diaphragm raised → breathlessness; alkalosis (PCO₂ ↓)"],
        ["Renal","GFR ↑ 50%; glycosuria/proteinuria can be physiological; ureteral dilatation (R>L)"],
        ["GI","Nausea (HCG), constipation (progesterone), heartburn (relaxed LES), haemorrhoids"],
        ["Haematological","Hb falls to 10.5-11 g/dL (physiological dilution); WBC ↑; ESR ↑; hypercoagulable state (clotting factors ↑)"],
        ["Endocrine","HCG peaks 10-12 wks; HPL anti-insulin; progesterone maintains uterus; relaxin softens ligaments"],
        ["Musculoskeletal","Exaggerated lumbar lordosis; diastasis recti; carpal tunnel syndrome possible"],
        ["Skin","Chloasma (melasma); linea nigra; striae gravidarum; spider naevi"],
      ]
    ),

    h2("3.5  Antenatal Care (ANC) – GoI Schedule"),
    makeTable(
      ["Visit","Gestation","Key Actions"],
      [
        ["1st (Booking)","≤12 weeks","Registration; history; Hb, blood group & Rh, VDRL, HIV, glucose, TSH, urine R/E; dating scan; TT immunization; IFA + calcium start"],
        ["2nd","14-26 weeks","Abdominal exam; anomaly scan 18-20 wks; blood glucose screen; weight; reassess risk"],
        ["3rd","28-34 weeks","Anaemia check; fetal growth; third trimester investigations; anti-D if Rh-ve; birth preparedness"],
        ["4th","36+ weeks","Presentation; engagement; birth plan; breastfeeding counseling; micro birth planning"],
      ]
    ),

    h2("3.6  Abdominal Examination – 4 Manoeuvres of Leopold"),
    bullet("1st Manoeuvre (Fundal) – both hands on fundus; identifies which fetal pole is at fundus"),
    bullet("2nd Manoeuvre (Lateral/Umbilical) – both hands on sides of abdomen; identifies fetal back (firm, smooth) and limbs (knobby, irregular)"),
    bullet("3rd Manoeuvre (Pawlik's Grip) – one hand above pubic symphysis; identifies presenting part; assesses engagement"),
    bullet("4th Manoeuvre (Pelvic) – facing mother's feet; both hands descend into pelvis; assesses descent and attitude of head"),

    bold("Fundal Height (McDonald's rule):"),
    para("Height in cm ≈ weeks of gestation (after 24 weeks). At umbilicus = ~22 wks; at xiphisternum = ~36 wks."),

    h2("3.7  Fetal Wellbeing Assessment"),
    makeTable(
      ["Test","Method","Normal / Reassuring"],
      [
        ["DFMC","Cardiff count-to-10 method; woman counts from 9 am","10 movements in ≤10 hours; alarm if <10"],
        ["NST (Non-Stress Test)","CTG tracing ≥20 min at rest","Reactive: ≥2 accelerations of 15 bpm for 15 sec in 20 min"],
        ["Biophysical Profile (BPP)","USG: breathing, movement, tone, AFV + NST","8-10/10 normal; ≤4/10 = deliver"],
        ["CTG","Continuous electronic FHR monitoring","Baseline 110-160; variability ≥5; accelerations present; no decelerations"],
        ["Umbilical Artery Doppler","Systolic/diastolic ratio","Absent or reversed end-diastolic flow = fetal compromise"],
        ["AFI","Sum of 4 quadrant depths by USG","Normal: 8-25 cm; <5 = oligohydramnios; >25 = polyhydramnios"],
      ]
    ),

    h2("3.8  Danger Signs in Pregnancy"),
    bullet("Severe headache / blurred vision / scotomata (pre-eclampsia)"),
    bullet("Oedema of face, hands, legs – especially sudden onset"),
    bullet("Vaginal bleeding at any trimester"),
    bullet("Reduced or absent fetal movements"),
    bullet("High fever / chills (infection)"),
    bullet("Premature rupture of membranes"),
    bullet("Severe abdominal pain"),
    bullet("Convulsions"),
    bullet("Breathlessness / chest pain"),

    h2("3.9  Nutrition in Pregnancy"),
    makeTable(
      ["Nutrient","Daily Requirement","Key Food Sources"],
      [
        ["Iron","27 mg/day (IFA: 100 mg elemental Fe + 500 mcg folic acid daily)","Green leafy vegetables, jaggery, meat, eggs"],
        ["Folic Acid","400-600 mcg/day","Green leafy vegetables, fortified cereals, pulses"],
        ["Calcium","1200 mg/day","Milk, curd, paneer, ragi, sesame"],
        ["Protein","Extra 25 g/day above baseline","Pulses, eggs, meat, fish, dairy"],
        ["Calories","Extra 300 kcal/day","Balanced diet; avoid empty calories"],
        ["Vitamin D","600 IU/day","Sunlight, fortified milk, fatty fish"],
      ]
    ),
    nbsp(),
    bold("Rh-Negative Management:"),
    bullet("Check indirect Coombs test (ICT) at booking and 28 weeks"),
    bullet("Anti-D immunoglobulin 300 mcg given at 28-30 weeks (antenatal prophylaxis)"),
    bullet("Anti-D within 72 hours of delivery/any sensitizing event (APH, amniocentesis, miscarriage)"),
    bullet("Prevents Rh isoimmunization and hemolytic disease of newborn (HDN)"),
    pageBreak(),
  ];
}

// ─── UNIT IV ────────────────────────────────────────────────────────────────
function unit4() {
  return [
    h1("UNIT IV – PHYSIOLOGY & MANAGEMENT OF LABOUR"),

    h2("4.1  Onset of Labour"),
    bold("True vs False Labour:"),
    makeTable(
      ["Feature","True Labour","False Labour"],
      [
        ["Contractions","Regular, increasing frequency","Irregular, no pattern"],
        ["Interval","Decreasing","No change"],
        ["Intensity","Progressively increasing","No change"],
        ["Cervical effacement/dilation","Progressive","None"],
        ["Show","Usually present","Absent"],
        ["Relief with analgesia","No relief","Often relieved"],
      ]
    ),
    nbsp(),
    bold("Signs of onset of labour:"),
    bullet("Show – blood-stained mucus plug expelled"),
    bullet("Regular painful uterine contractions occurring <10 min apart"),
    bullet("Lightening – descent of presenting part into pelvis (2-4 wks before in primi)"),
    bullet("Rupture of membranes may occur"),

    h2("4.2  Stages of Labour"),
    makeTable(
      ["Stage","Definition","Duration (Primi / Multi)"],
      [
        ["1st Stage (Dilation)","Onset of regular contractions → full cervical dilation (10 cm)","~12 hrs / ~7 hrs"],
        ["  Latent phase","0–4 cm dilation","Up to 20 hrs primi / 14 hrs multi"],
        ["  Active phase","4–10 cm at ≥1 cm/hr","6-8 hrs / 2-4 hrs"],
        ["2nd Stage (Expulsion)","Full dilation → delivery of baby","~50 min / ~20 min (up to 2 hrs with epidural)"],
        ["3rd Stage (Placental)","Delivery of baby → expulsion of placenta","Normally ≤30 min (90% within 15 min)"],
        ["4th Stage (Recovery)","First 1-2 hours after placenta delivery","Intensive monitoring period"],
      ]
    ),

    h2("4.3  Mechanism of Labour – Cardinal Movements (Vertex Presentation)"),
    bullet("1. Engagement – widest fetal head diameter (biparietal) passes through pelvic inlet"),
    bullet("2. Descent – progressive downward movement throughout all stages"),
    bullet("3. Flexion – chin on chest; smallest diameter (suboccipitobregmatic 9.5 cm) presents"),
    bullet("4. Internal Rotation – occiput rotates from transverse to anterior under symphysis"),
    bullet("5. Extension – head is born by extension as it passes under the pubic arch"),
    bullet("6. External Rotation (Restitution) – head rotates to align with shoulders (back to transverse)"),
    bullet("7. Expulsion – anterior shoulder then posterior shoulder delivered; rest of body follows"),

    h2("4.4  Monitoring Labour – Partograph"),
    para("The partograph is a graphical record of labour progress used to detect deviations from normal."),
    nbsp(),
    bold("Components of the Partograph:"),
    bullet("Fetal heart rate – every 30 min in 1st stage; every 5 min in 2nd stage"),
    bullet("Amniotic fluid (colour): C = clear / M = meconium / A = absent / B = blood"),
    bullet("Moulding: 0 / + / ++ / +++"),
    bullet("Cervical dilation – plotted against ALERT and ACTION lines"),
    bullet("Descent of head – in fifths above pelvic brim: 5/5 (free) → 0/5 (fully engaged)"),
    bullet("Uterine contractions – frequency and duration in 10 min window"),
    bullet("Oxytocin dosage, drugs given"),
    bullet("Maternal vitals: BP, pulse, temperature, urine output"),
    nbsp(),
    para("Alert line – starts at 4 cm, advances at 1 cm/hour. Action line – 4 hours to the right of alert line."),
    para("Cervical dilation crossing to the right of alert line = slow progress → review management."),

    h2("4.5  First Stage Care"),
    bullet("IV access, baseline vitals, auscultate FHS every 30 min"),
    bullet("Per vaginal examination to assess dilation, station, effacement, membrane status"),
    bullet("Plot on partograph; reassess if slow progress"),
    bullet("Encourage ambulation and upright positions (lateral, walking, sitting)"),
    bold("Non-pharmacological pain relief:"),
    bullet("Controlled breathing techniques (Lamaze)"),
    bullet("Counter pressure – sacral massage"),
    bullet("Warm compresses / warm bath / hydrotherapy"),
    bullet("TENS (Transcutaneous Electrical Nerve Stimulation)"),
    bullet("Emotional support – birth companion (doula/family member)"),
    bullet("Oral hydration; light diet in early labour; IV fluids if prolonged"),
    bullet("Bladder care – encourage void every 2 hours"),

    h2("4.6  Second Stage Care"),
    bullet("Confirm full dilation before pushing"),
    bullet("Coach woman with breathing; support her birth position of choice"),
    bullet("Birth positions: upright, lateral, squatting, hands-and-knees"),
    bullet("Perineal support and warm compresses to reduce tears"),
    bullet("Watchful waiting – avoid fundal pressure (Kristeller)"),
    bullet("Crowning → gentle head delivery with perineal protection → check for nuchal cord"),
    bullet("Note exact time of birth; assess need for episiotomy (only if necessary)"),
    nbsp(),
    bold("Immediate Newborn Care (after birth):"),
    bullet("Dry and stimulate vigorously with clean dry cloth"),
    bullet("Skin-to-skin contact on mother's chest within 30 seconds"),
    bullet("Delayed cord clamping (1-3 min or until cord stops pulsating)"),
    bullet("Assess breathing – if not breathing → resuscitation"),
    bullet("Initiate breastfeeding within 1 hour of birth"),

    h2("4.7  Third Stage – Active Management (AMTSL)"),
    bold("Components of AMTSL (WHO recommended):"),
    bullet("1. Oxytocin 10 IU IM within 1 minute of baby's birth"),
    bullet("2. Controlled cord traction (Brandt-Andrews method) after signs of separation"),
    bullet("3. Uterine massage after delivery of placenta"),
    nbsp(),
    bold("Signs of placental separation:"),
    bullet("Uterus becomes globular and firmer"),
    bullet("Sudden gush of blood"),
    bullet("Cord lengthens at vulva"),
    bullet("Uterus rises in abdomen"),
    nbsp(),
    bold("Examination of placenta:"),
    bullet("Maternal surface – 15-20 cotyledons; dull red/grey; inspect for completeness"),
    bullet("Fetal surface – shiny, covered by amnion; vessels visible"),
    bullet("Membranes – amnion and chorion; check for completeness"),
    bullet("Umbilical cord – 3 vessels (2 arteries + 1 vein); normal length 50-60 cm"),

    h2("4.8  Fourth Stage – Recovery"),
    bullet("Close observation every 15 min for first 2 hours post-delivery"),
    bullet("Monitor: BP, pulse, fundal height, uterine tone, lochia, perineal site"),
    bullet("Uterus should be firm and contracted at or below umbilicus"),
    bullet("If uterus soft/boggy → bimanual uterine massage → oxytocin"),
    bullet("Ensure breastfeeding initiated; promote mother-baby bonding"),
    bullet("Document birth record completely"),

    h2("4.9  Drugs Used in Labour (GoI Guidelines)"),
    makeTable(
      ["Drug","Indication","Dose"],
      [
        ["Oxytocin","3rd stage AMTSL; augmentation; PPH","10 IU IM; 2-5 IU slow IV (augmentation: 2.5-5 mIU/min titrated)"],
        ["Misoprostol","3rd stage if oxytocin not available; PPH","600 mcg sublingual or oral"],
        ["Magnesium Sulphate","Eclampsia/severe pre-eclampsia","Pritchard: 4g IV + 5g IM each buttock loading; 5g IM 4-hrly maintenance"],
        ["Lignocaine","Perineal infiltration for repair","1% solution up to 20 mL"],
        ["Methylergometrine","PPH (after placenta delivery)","0.2 mg IM; not in hypertension"],
        ["Tranexamic Acid","PPH (within 3 hrs of birth)","1g IV; repeat after 30 min if needed"],
      ]
    ),
    pageBreak(),
  ];
}

// ─── UNIT V ─────────────────────────────────────────────────────────────────
function unit5() {
  return [
    h1("UNIT V – NORMAL PUERPERIUM / POSTNATAL CARE"),

    h2("5.1  Definition & Duration"),
    para("Puerperium – period from delivery of the placenta until the return of the reproductive organs to their pre-pregnant state."),
    para("Duration: 6 weeks (42 days) after delivery."),

    h2("5.2  Physiological Changes – Involution"),
    bold("Uterus:"),
    makeTable(
      ["Time","Uterine Status"],
      [
        ["Immediately post-delivery","1 kg; at level of umbilicus; firm"],
        ["Day 7-10","Midway between symphysis pubis and umbilicus"],
        ["Day 14","No longer palpable abdominally"],
        ["6 weeks","Returns to pre-pregnant size (~60 g)"],
      ]
    ),
    nbsp(),
    bold("Lochia (Uterine Discharge):"),
    makeTable(
      ["Type","Duration","Colour","Composition"],
      [
        ["Lochia Rubra","Days 1-4","Bright red","Blood, decidua, mucus, epithelial cells"],
        ["Lochia Serosa","Days 5-14","Pink / brownish","Serous exudate, WBCs, few RBCs"],
        ["Lochia Alba","Day 14 onward","Pale yellow / white","Leucocytes, decidua, mucus, microorganisms"],
      ]
    ),
    para("Note: Offensive or purulent lochia = endometritis. Heavy fresh bleeding persisting = subinvolution or retained products."),
    nbsp(),
    bold("Other changes:"),
    bullet("Cervix – soft immediately; internal os closed by day 3"),
    bullet("Vagina – oedematous; regains tone by 6 weeks"),
    bullet("Perineum – oedema and bruising; heals by 2 weeks"),
    bullet("WBC leukocytosis (up to 20,000/µL) in first 24 hrs – physiological"),
    bullet("Diuresis increases in first few days as pregnancy-related oedema resolves"),
    bullet("Hematocrit rises transiently then normalises"),

    h2("5.3  Breasts & Lactation"),
    bold("Stages of milk:"),
    bullet("Colostrum (Days 1-3) – thick, yellow; rich in sIgA, proteins, fat-soluble vitamins A, E, K"),
    bullet("Transitional milk (Day 4-10) – increasing lactose and fat"),
    bullet("Mature milk (Day 10 onward) – foremilk (watery, thirst-quenching); hindmilk (fat-rich, satisfying)"),
    nbsp(),
    bold("Physiology of Lactation:"),
    bullet("Prolactin (anterior pituitary) – stimulates milk production; surges with each feeding"),
    bullet("Oxytocin (posterior pituitary) – milk ejection (let-down reflex); also promotes uterine involution"),
    bullet("Suckling stimulus → hypothalamus → inhibits dopamine → prolactin released"),
    nbsp(),
    bold("Benefits of Breastfeeding:"),
    bullet("Passive immunity via sIgA; protects against diarrhoea, respiratory infections"),
    bullet("Optimal nutrition; easily digestible; correct temperature and composition"),
    bullet("Mother-infant bonding and emotional security"),
    bullet("Reduces maternal risk of breast and ovarian cancer"),
    bullet("LAM (Lactational Amenorrhea Method) – 98% effective if: <6 months old + exclusive BF + amenorrhea"),
    bullet("WHO recommendation: Exclusive breastfeeding for 6 months; continue up to 2 years with complementary feeds"),

    h2("5.4  Postnatal Care Schedule"),
    makeTable(
      ["Time","Assessment","Interventions"],
      [
        ["1st hour","Fundus, lochia, BP, pulse, perineum every 15 min","Uterine massage if boggy; oxytocin; initiate breastfeeding"],
        ["2-24 hrs","Vitals, voiding, lochia, breastfeeding","Encourage ambulation; perineal care; adequate analgesia"],
        ["Day 1-3","Lochia, breast, bowel function, wound","Sitz bath; hygiene education; observe for milk coming in"],
        ["Day 4-7","Breastfeeding, baby weight, emotional state","Support breastfeeding; screen for PPD (Edinburgh scale)"],
        ["6 weeks","Full postnatal check; cervical smear","Contraception counseling; return of menstruation discussion"],
      ]
    ),

    h2("5.5  Minor Disorders of Puerperium"),
    makeTable(
      ["Disorder","Cause","Management"],
      [
        ["After-pains","Uterine contractions; worse in multiparae and breastfeeding","Analgesics (ibuprofen, paracetamol); reassurance"],
        ["Perineal discomfort","Episiotomy / tear repair","Ice packs, sitz bath, topical anaesthetics, analgesics"],
        ["Breast engorgement","Milk accumulation Days 2-4","Frequent feeding, warm compresses, manual expression"],
        ["Cracked nipples","Poor latch technique","Correct latch; lanolin cream; express and feed"],
        ["Haemorrhoids","Pregnancy/delivery straining","Sitz bath, stool softeners, topical steroids"],
        ["Urinary retention","Perineal pain, oedema","Encourage void; catheterize if >500 mL retained"],
        ["Constipation","Dehydration, reduced mobility, opioids","Increase fluids, fibre; laxatives if needed"],
      ]
    ),

    h2("5.6  Postnatal Mental Health"),
    makeTable(
      ["Condition","Onset","Features","Management"],
      [
        ["Baby Blues","Day 3-5","Tearfulness, anxiety, mood swings; self-limiting within 2 weeks","Reassurance, support, rest"],
        ["Postnatal Depression","Weeks 2-8","Persistent low mood, anxiety, poor bonding, sleep disturbance","Edinburgh EPDS scale; counseling; antidepressants; refer psychiatry"],
        ["Postpartum Psychosis","Days 1-14","Confusion, hallucinations, delusions, mania","Psychiatric emergency; hospital admission; antipsychotics"],
      ]
    ),

    h2("5.7  Postpartum Family Planning"),
    bullet("Progestogen-only pill – safe from day 21 postpartum; suitable for breastfeeding mothers"),
    bullet("PPIUCD – copper T inserted within 10 min of placenta delivery (or 48 hrs); highly effective"),
    bullet("Condoms – from first intercourse postpartum"),
    bullet("Sterilisation – may be done at caesarean or from 6 weeks postpartum"),
    bullet("COC (combined pill) – avoid for 6 months if breastfeeding (reduces milk supply)"),
    pageBreak(),
  ];
}

// ─── UNIT VI ────────────────────────────────────────────────────────────────
function unit6() {
  return [
    h1("UNIT VI – ASSESSMENT & CARE OF THE NORMAL NEONATE"),

    h2("6.1  Newborn Assessment – APGAR Score"),
    para("Assessed at 1 minute (guides resuscitation) and 5 minutes (prognosis)."),
    makeTable(
      ["Sign","Score 0","Score 1","Score 2"],
      [
        ["Appearance (colour)","Blue / pale all over","Body pink, extremities blue","Completely pink"],
        ["Pulse (heart rate)","Absent","< 100 bpm","≥ 100 bpm"],
        ["Grimace (reflex irritability)","No response","Grimace only","Cry, cough, sneeze"],
        ["Activity (muscle tone)","Limp / absent","Some flexion of limbs","Active flexion; vigorous movement"],
        ["Respiration","Absent","Slow, irregular, weak cry","Strong regular cry"],
      ]
    ),
    nbsp(),
    bold("Interpretation:"),
    bullet("7-10 = Normal (no action beyond routine care)"),
    bullet("4-6 = Moderate asphyxia → stimulate, provide oxygen by mask"),
    bullet("0-3 = Severe asphyxia → immediate resuscitation (PPV, chest compressions, drugs)"),

    h2("6.2  Normal Neonate – Characteristics at Term"),
    makeTable(
      ["Parameter","Normal Value"],
      [
        ["Birth weight","2.5 – 4.0 kg (average 3.0-3.5 kg)"],
        ["Length","48 – 52 cm"],
        ["Head circumference","33 – 37 cm (average 34-35 cm)"],
        ["Chest circumference","30 – 33 cm (HC > CC at birth)"],
        ["Pulse","120 – 160 bpm"],
        ["Respiratory rate","40 – 60 breaths/min"],
        ["Temperature","36.5 – 37.5°C"],
        ["Blood glucose (after 24 hrs)","≥ 2.6 mmol/L (47 mg/dL)"],
      ]
    ),

    h2("6.3  Physiological Adaptations at Birth"),
    bullet("Respiratory – lungs expand with first cry; surfactant reduces alveolar surface tension; fluid cleared from lungs"),
    bullet("Cardiovascular – fetal shunts close; pulmonary circulation established; Hb shifts from fetal (HbF) to adult type (HbA)"),
    bullet("Thermoregulation – cold stress at delivery; non-shivering thermogenesis via brown adipose tissue (BAT)"),
    bullet("Metabolic – glucose stores mobilised; liver starts conjugating bilirubin"),
    bullet("Physiological jaundice – bilirubin peaks Day 3-4 (≤15 mg/dL); resolves by Day 10 in term babies"),

    h2("6.4  Essential Newborn Care (ENBC) – WARMTH Principle"),
    makeTable(
      ["Letter","Component","Action"],
      [
        ["W","Warmth","Dry immediately; skin-to-skin contact; KMC for LBW; warm room (25°C); prevent hypothermia"],
        ["A","Airway","Position head neutral; suction only if airways blocked; avoid deep suction"],
        ["R","Resuscitation","If no breathing at 30 sec → PPV; 40-60 breaths/min; room air first"],
        ["M","Mother's Milk","Initiate breastfeeding within 1 hour; exclusive breastfeeding; no prelacteal feeds"],
        ["T","Treatment / Prevention of Infection","Cord care (dry); eye prophylaxis; hygiene; isolate infection"],
        ["H","Hepatitis B + Vit K","Hep B birth dose; Vit K1 1 mg IM – prevents haemorrhagic disease of newborn"],
      ]
    ),

    h2("6.5  Newborn Resuscitation (NRP Algorithm)"),
    bold("Initial Steps (0-30 seconds):"),
    bullet("Warm, dry, stimulate, clear airway (position head; wipe mouth and nose)"),
    bullet("Assess: breathing? heart rate?"),
    nbsp(),
    bold("If HR <100 or gasping/apnea:"),
    bullet("Positive Pressure Ventilation (PPV) with room air – 40-60 breaths/min"),
    bullet("Good chest rise confirms adequate ventilation"),
    nbsp(),
    bold("Re-assess at 30 seconds:"),
    bullet("If HR <60 despite effective PPV → start chest compressions (3:1 ratio with PPV)"),
    bullet("Increase to 100% O₂"),
    nbsp(),
    bold("If HR remains <60:"),
    bullet("Epinephrine 0.1-0.3 mL/kg of 1:10,000 IV/IO"),
    bullet("Consider volume expansion if blood loss suspected: 10 mL/kg NS IV"),

    h2("6.6  Minor Disorders of the Newborn"),
    makeTable(
      ["Condition","Features","Management"],
      [
        ["Physiological jaundice","Appears Day 2-3; peaks Day 3-4; resolves Day 10 (term)","Adequate feeds; phototherapy if bilirubin >threshold"],
        ["Milia","Tiny white sebaceous cysts on nose and cheeks","Disappear spontaneously by 2-4 weeks"],
        ["Erythema toxicum neonatorum","Blotchy erythematous rash with central white/yellow papule","Self-limiting; no treatment needed"],
        ["Neonatal breast swelling","Maternal oestrogen effect; may express milk (witch's milk)","Resolves by 2-3 weeks; do NOT squeeze"],
        ["Caput succedaneum","Oedema of scalp crossing suture lines","Resolves in 1-2 days"],
        ["Cephalohaematoma","Subperiosteal haematoma; does NOT cross suture lines; firm","Resolves in 6-8 weeks; monitor jaundice"],
        ["Mongolian spots","Blue-grey sacral pigmentation; commoner in Indian babies","Fade by age 5; document to avoid abuse confusion"],
        ["Umbilical hernia","Periumbilical fascial defect","Usually closes by 2 years; refer if persists"],
      ]
    ),

    h2("6.7  Immunization Schedule – National Immunization Schedule (NIS)"),
    makeTable(
      ["Age","Vaccine(s)"],
      [
        ["At Birth","BCG, OPV-0, Hepatitis B-1"],
        ["6 Weeks","Pentavalent-1 (DPT+HepB+Hib), OPV-1, IPV-1, Rotavirus-1, PCV-1"],
        ["10 Weeks","Pentavalent-2, OPV-2, Rotavirus-2, PCV-2"],
        ["14 Weeks","Pentavalent-3, OPV-3, IPV-2, Rotavirus-3, PCV-3"],
        ["9-12 Months","Measles/MR-1, Vitamin A (1st dose – 1 lakh IU)"],
        ["16-24 Months","DPT booster, OPV booster, MR-2, Vitamin A (2nd dose)"],
        ["5 Years","DPT 2nd booster"],
        ["10 & 16 Years","Td vaccine"],
        ["Pregnant women","TT/Td (2 doses + 1 booster)"],
      ]
    ),
    pageBreak(),
  ];
}

// ─── UNIT VII ───────────────────────────────────────────────────────────────
function unit7() {
  return [
    h1("UNIT VII – FAMILY WELFARE SERVICES"),

    h2("7.1  Methods of Contraception"),

    h3("A. Hormonal Methods"),
    makeTable(
      ["Method","Composition","Mechanism","Effectiveness (perfect use)"],
      [
        ["Combined OCP (Mala-N/Mala-D)","Estrogen + progestin","Inhibits ovulation; thickens cervical mucus; atrophies endometrium","99.7%"],
        ["Progestogen-only pill (POP / Mini-pill)","Progestogen only","Thickens mucus; thin endometrium; may inhibit ovulation","99% (if taken strictly same time daily)"],
        ["DMPA (Depo-Provera)","Injectable medroxyprogesterone acetate","Inhibits ovulation; 3-monthly injection","99.7%"],
        ["Implant (Implanon/Jadelle)","Etonogestrel subdermal rod","Inhibits ovulation; valid 3-5 years",">99%"],
        ["Emergency Contraception – LNG","Levonorgestrel 1.5 mg","Delays/inhibits ovulation; NOT abortifacient","95% (within 72 hrs)"],
        ["Emergency Contraception – UPA","Ulipristal acetate 30 mg","Delays ovulation; progesterone receptor modulator","98% (within 120 hrs)"],
      ]
    ),

    h3("B. Barrier & Non-hormonal Methods"),
    makeTable(
      ["Method","Description","Effectiveness"],
      [
        ["Male condom (latex)","Covers penis; prevents sperm entering vagina; prevents STIs","98% (perfect use); 85% (typical)"],
        ["Female condom (FC2)","Polyurethane liner inserted into vagina; can be placed in advance","95% (perfect)"],
        ["Diaphragm + spermicide","Dome over cervix; used with nonoxynol-9","88-92%"],
        ["Spermicide alone","Gel/foam/suppository; disrupts sperm membrane","70-80%"],
        ["Copper IUD (Cu-T 380A)","Copper ions toxic to sperm; prevents implantation; 10-yr duration","99.4%"],
        ["PPIUCD","Cu-T inserted within 10 min of placenta delivery","99.4% (same as standard IUD)"],
        ["LNG-IUS (Mirena)","Levonorgestrel-releasing IUD; reduces menstrual blood loss; 5-yr",">99%"],
      ]
    ),

    h3("C. Natural / Traditional Methods"),
    makeTable(
      ["Method","Basis","Reliability / Notes"],
      [
        ["Calendar / Rhythm","Avoid fertile days 10-17 of cycle","Unreliable for irregular cycles; 76-88% typical use"],
        ["Basal Body Temperature (BBT)","Temperature rises ~0.5°C after ovulation","Only retrospective; requires daily measurement"],
        ["Cervical Mucus (Billings)","Spinnbarkeit (stretchy, slippery) near ovulation","Requires 3 months of charting; training needed"],
        ["LAM","Exclusive BF suppresses GnRH/ovulation","98% if: baby <6 months + exclusive BF + amenorrhea (all 3 must apply)"],
        ["Withdrawal (Coitus Interruptus)","Withdrawal before ejaculation","~78% typical; unreliable; pre-ejaculatory fluid contains sperm"],
        ["Abstinence","Avoiding intercourse","100% if consistent; challenging adherence"],
      ]
    ),

    h2("7.2  Permanent Methods"),
    bold("Female Sterilisation (Tubectomy / Tubal Ligation):"),
    bullet("Mini-laparotomy – Pomeroy's method (ligate and excise loop of tube); most common in India post-delivery"),
    bullet("Laparoscopic sterilisation – Filshie clip, Fallope ring, electrocoagulation; preferred for interval sterilisation"),
    bullet("PPTL – postpartum tubectomy; within 48 hrs of delivery (mini-laparotomy)"),
    bullet("Failure rate: 0.5 per 100 woman-years; reversal successful in <30%"),
    nbsp(),
    bold("Male Sterilisation – No-Scalpel Vasectomy (NSV):"),
    bullet("Vas deferens isolated and occluded through tiny puncture; no scalpel needed"),
    bullet("Performed under local anaesthesia; day-care procedure"),
    bullet("Does NOT affect sexual function or testosterone levels"),
    bullet("NOT immediately effective – use contraception for 3 months / 20 ejaculations"),
    bullet("Confirm azoospermia by semen analysis before declaring effective"),
    bullet("Failure rate: 0.1-0.15 per 100 woman-years (more effective than female sterilisation)"),

    h2("7.3  Medical Eligibility Criteria (MEC) – WHO Categories"),
    makeTable(
      ["Category","Meaning","Action"],
      [
        ["1","No restriction – method can be used","Use freely"],
        ["2","Advantages outweigh risks","Generally use; monitor"],
        ["3","Risks outweigh advantages","Generally do NOT use; only if no alternative"],
        ["4","Unacceptable health risk","DO NOT USE"],
      ]
    ),
    nbsp(),
    bold("Example MEC 4 contraindications:"),
    bullet("COC contraindicated (MEC 4) in: current DVT/PE, stroke, migraine with aura, lactating mother <6 wks, uncontrolled hypertension"),
    bullet("IUCD contraindicated (MEC 4) in: current PID, unexplained vaginal bleeding, uterine cavity distortion"),

    h2("7.4  Balanced Counseling Strategy (BCS)"),
    para("A counseling job-aid tool to ensure informed choice:"),
    bullet("Step 1 – Rule out current pregnancy"),
    bullet("Step 2 – Ask about desire for future children"),
    bullet("Step 3 – Discuss all available methods appropriate to the client"),
    bullet("Step 4 – Confirm the client's choice"),
    bullet("Step 5 – Provide or refer for the chosen method"),
    bullet("Step 6 – Schedule follow-up and counsel on side effects"),

    h2("7.5  Role of Nurse / Midwife in Family Planning"),
    bullet("Maintain eligible couple register; update regularly"),
    bullet("Provide IEC (Information, Education, Communication) in community"),
    bullet("Distribute oral contraceptive pills and condoms"),
    bullet("Insert IUCD (after training and certification)"),
    bullet("Conduct PPIUCD insertion post-delivery"),
    bullet("Refer clients for permanent methods (NSV, laparoscopic sterilisation)"),
    bullet("Follow up acceptors; identify and manage side effects"),
    bullet("Motivate community through ASHA / ANM network"),
    bullet("Maintain accurate records and submit monthly reports"),

    h2("7.6  Gender-Based Violence (GBV) in SRH"),
    bold("Types of GBV:"),
    bullet("Physical abuse"),
    bullet("Sexual abuse / rape"),
    bullet("Psychological / emotional abuse"),
    bullet("Economic / financial abuse"),
    bullet("Child marriage; female genital mutilation"),
    nbsp(),
    bold("Key Legislation in India:"),
    makeTable(
      ["Law","Key Provision"],
      [
        ["Protection of Women from Domestic Violence Act 2005","Civil remedies; protection orders; shelter homes"],
        ["IPC 376 (Rape)","Minimum 7 years imprisonment; aggravated cases: 10 yrs to life"],
        ["POCSO Act 2012","Protection of children from sexual offences; mandatory reporting"],
        ["Sexual Harassment at Workplace Act 2013 (POSH)","Internal complaints committee in every organisation"],
        ["IPC 304B (Dowry Death)","Mandatory minimum 7 years; death linked to dowry harassment"],
      ]
    ),
    nbsp(),
    bold("Role of Nurse/Midwife in GBV:"),
    bullet("Universal screening for GBV at every ANC and PNC visit (non-judgmental questions)"),
    bullet("Maintain confidentiality; document injuries objectively"),
    bullet("Provide immediate support: listen, believe, validate"),
    bullet("Know and refer to local support resources, helplines (Childline 1098; Women Helpline 181)"),
    bullet("Mandatory reporting if child is the victim (POCSO)"),

    h2("7.7  Youth-Friendly Services – SRHR"),
    bullet("RKSK (Rashtriya Kishor Swasthya Karyakram) – national adolescent health programme"),
    bullet("ARSH (Adolescent Reproductive and Sexual Health) clinics – confidential; free; one-stop shop"),
    bullet("Services: menstrual health; safe sex; contraception information; STI screening; nutrition; mental health"),
    bullet("Nurses must provide NON-JUDGMENTAL, CONFIDENTIAL care to adolescents"),
    bullet("For MTP under 18 years: parental/guardian consent required; report to police in rape cases"),
    pageBreak(),
  ];
}

// ─── QUICK REVISION ─────────────────────────────────────────────────────────
function quickRevision() {
  return [
    h1("QUICK REVISION – MNEMONICS & KEY VALUES"),

    h2("Mnemonics"),
    makeTable(
      ["Topic","Mnemonic / Memory Aid"],
      [
        ["APGAR score","Appearance, Pulse, Grimace, Activity, Respiration"],
        ["Placenta functions","NREEH – Nutrition, Respiration, Excretion, Endocrine, Host defence"],
        ["Mechanism of labour","ED FI EE – Engagement, Descent, Flexion, Internal rotation, Extension, External rotation (Expulsion)"],
        ["Lochia sequence","RuSA – Rubra → Serosa → Alba"],
        ["Stages of labour","1=Dilation, 2=Expulsion, 3=Placental, 4=Recovery"],
        ["Danger signs in pregnancy","SHARP – Swelling (face/hands), Headache severe, Absent FMs, Rupture of membranes, Pain/Bleeding"],
        ["Fetal shunts","FDA – Foramen ovale, Ductus arteriosus, Ductus venosus"],
        ["AMTSL components","OCM – Oxytocin, Controlled cord traction, Massage"],
      ]
    ),

    h2("Key Values to Remember"),
    makeTable(
      ["Parameter","Normal Value"],
      [
        ["Pregnancy duration","40 weeks (280 days) from LMP"],
        ["Blood volume increase in pregnancy","40-50% (plasma 50%; RBC 20-30%)"],
        ["Fundal height at term","36-37 cm"],
        ["Normal FHR (intrapartum)","110-160 bpm"],
        ["Cervical dilation rate (active phase)","≥ 1 cm / hour"],
        ["Placenta weight at term","500-600 g"],
        ["AFI (normal)","8-25 cm; <5 = oligohydramnios; >25 = polyhydramnios"],
        ["Hb in pregnancy (normal)","≥ 11 g/dL; mild anaemia 7-10.9; severe < 7 g/dL"],
        ["Neonatal temperature (normal)","36.5-37.5°C"],
        ["Normal birth weight","≥ 2.5 kg; LBW < 2.5 kg; VLBW < 1.5 kg"],
        ["Head circumference (term neonate)","33-37 cm"],
        ["Apgar score (normal at 5 min)","7-10"],
        ["Duration of puerperium","6 weeks (42 days)"],
        ["Colostrum secretion duration","Days 1-3"],
        ["Third stage duration (normal)","≤ 30 min (90% within 15 min)"],
        ["Umbilical cord length","50-60 cm; 3 vessels (2 arteries + 1 vein)"],
        ["Cervical dilation at end of 1st stage","10 cm (full dilation)"],
        ["Anti-D prophylaxis dose","300 mcg IM within 72 hours of sensitizing event"],
      ]
    ),

    h2("Important Drug Doses"),
    makeTable(
      ["Drug","Dose","Indication"],
      [
        ["Folic acid","400 mcg/day pre-conception; 500 mcg in IFA tablet","NTD prevention; anaemia"],
        ["Elemental iron (IFA)","100 mg/day from 14 wks","Iron-deficiency anaemia"],
        ["Calcium","500 mg BD (1000 mg total)","Pre-eclampsia prevention; bone health"],
        ["Vitamin K1","1 mg IM at birth","Haemorrhagic disease of newborn"],
        ["Oxytocin (AMTSL)","10 IU IM within 1 min of birth","3rd stage management"],
        ["Magnesium sulphate","4g IV + 5g IM each buttock (Pritchard)","Eclampsia / severe pre-eclampsia"],
        ["LNG emergency contraception","1.5 mg oral within 72 hours","Emergency contraception"],
        ["Epinephrine (neonatal)","0.1-0.3 mL/kg of 1:10,000 solution IV","Neonatal resuscitation (HR <60)"],
      ]
    ),
  ];
}

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