Create presentation on following topics - abortion, MTP, ectopic pregn

Create presentation on following topics - abortion, MTP, ectopic pregnancy

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mkdir -p /home/daytona/workspace/abortion-mtp-ectopic && ls /home/daytona/workspace/abortion-mtp-ectopic/

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~/abortion-mtp-ectopic/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Abortion, MTP & Ectopic Pregnancy";
pres.author = "Medical Education";

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// ═══════════════════════════════════════════════════════════════
// SLIDE 1: TITLE
// ═══════════════════════════════════════════════════════════════
titleSlide(
  "Abortion, MTP &\nEctopic Pregnancy",
  "Classification | Management | Legal Framework | Clinical Approach"
);

// ═══════════════════════════════════════════════════════════════
// SLIDE 2: OUTLINE
// ═══════════════════════════════════════════════════════════════
contentSlide("Presentation Outline", [
  { text: "PART 1: Abortion", options:{ bold:true, fontSize:18, color:C.teal, breakLine:true } },
  { text: "  Definition, classification, types, clinical features & management", options:{ fontSize:16, color:C.slate, breakLine:true } },
  { text: "PART 2: Medical Termination of Pregnancy (MTP)", options:{ bold:true, fontSize:18, color:C.teal, breakLine:true } },
  { text: "  MTP Act 1971, 2021 Amendment, indications, techniques, consent", options:{ fontSize:16, color:C.slate, breakLine:true } },
  { text: "PART 3: Ectopic Pregnancy", options:{ bold:true, fontSize:18, color:C.teal, breakLine:true } },
  { text: "  Epidemiology, risk factors, diagnosis, management — expectant / medical / surgical", options:{ fontSize:16, color:C.slate, breakLine:true } },
]);

// ═══════════════════════════════════════════════════════════════
// SECTION 1: ABORTION
// ═══════════════════════════════════════════════════════════════
sectionDivider("PART 1", "Abortion", C.navy);

// Slide 3: Definition & Classification
contentSlide("Abortion — Definition & Classification", [
  { text: "DEFINITION", options:{ bold:true, fontSize:17, color:C.teal, breakLine:true } },
  { text: "Expulsion or extraction of a fetus/embryo weighing <500 g (or <20–22 weeks gestation) from the uterus, irrespective of whether it is alive or dead.", options:{ fontSize:16, color:C.slate, breakLine:true } },
  { text: "", options:{ breakLine:true } },
  { text: "MAJOR CLASSIFICATION", options:{ bold:true, fontSize:17, color:C.teal, breakLine:true } },
  { text: "Spontaneous Abortion — Occurs naturally without medical/surgical intervention", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Induced Abortion — Deliberately terminated; subdivided into:", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "    • Therapeutic (legal) — medical indication, legal regulation (MTP Act)", options:{ fontSize:14, color:C.slate, breakLine:true } },
  { text: "    • Criminal — outside legal framework, by unqualified persons", options:{ fontSize:14, color:C.slate, breakLine:true } },
  { text: "Missed Abortion — Fetal death without expulsion; 'blighted ovum' if no embryo forms", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Unsafe Abortion — Performed by unskilled persons or in unsafe environments", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
]);

// Slide 4: Types of Spontaneous Abortion (Table)
tableSlide(
  "Types of Spontaneous Abortion",
  ["Type", "os", "Bleeding", "Products Expelled", "Management"],
  [
    ["Threatened", "Closed", "Present", "None", "Bed rest, progesterone support, monitoring"],
    ["Inevitable", "Open", "Heavy", "None yet", "Hospitalize; surgical evacuation if needed"],
    ["Incomplete", "Open", "Heavy", "Partial", "Immediate uterine evacuation (MVA/D&C)"],
    ["Complete", "Closed", "Decreasing", "All expelled", "Confirm by USG; expectant if stable"],
    ["Missed", "Closed", "Absent/minimal", "Retained", "Medical (mifepristone + misoprostol) or surgical"],
    ["Septic", "May be open", "Variable + purulent", "Variable", "IV antibiotics + urgent evacuation"],
    ["Recurrent", "Variable", "Variable", "Variable", "≥3 consecutive losses; investigate for cause"],
  ],
  [2.2, 1.3, 1.3, 1.7, 2.7]
);

// Slide 5: Spontaneous Abortion — Risk Factors & Etiology
twoColSlide(
  "Spontaneous Abortion — Etiology",
  "Fetal / Embryonic Causes",
  [
    "Chromosomal abnormalities (50–60% of 1st trimester losses)",
    "Trisomies: most common (trisomy 16 most frequent)",
    "Monosomy X (Turner syndrome)",
    "Polyploidy (triploidy, tetraploidy)",
    "Structural chromosomal defects",
    "Single gene defects — rare",
  ],
  "Maternal / Uterine Causes",
  [
    "Uterine anomalies — septate uterus (most common correctable cause)",
    "Cervical incompetence — painless 2nd trimester loss",
    "Antiphospholipid syndrome (APS) — key cause of recurrent loss",
    "Thrombophilias (Factor V Leiden, Prothrombin mutation)",
    "Endocrine: hypothyroidism, uncontrolled DM, PCOS",
    "Infections: TORCH, bacterial vaginosis",
    "Advanced maternal age (>35 years)",
    "Smoking, alcohol, NSAID use",
  ]
);

// Slide 6: Management of Spontaneous Abortion
contentSlide("Management of Spontaneous Abortion", [
  { text: "THREATENED ABORTION", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Bed rest (debated), progesterone supplementation (in luteal phase defect), avoid coitus; monitor beta-hCG & USG", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "INEVITABLE / INCOMPLETE ABORTION", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Uterine evacuation: Manual Vacuum Aspiration (MVA) preferred up to 12 weeks; Electric Vacuum Aspiration (EVA) or sharp curettage (D&C) for larger gestations", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "MISSED ABORTION", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Medical: Mifepristone 200 mg PO then Misoprostol 800 mcg vaginally after 24–48 h", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "Surgical if medical fails or patient preference: MVA / D&C", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "SEPTIC ABORTION", options:{ bold:true, fontSize:16, color:C.red, breakLine:true } },
  { text: "Triple antibiotic cover (ampicillin + gentamicin + metronidazole); urgent uterine evacuation after stabilization; ICU care if needed", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "RECURRENT PREGNANCY LOSS (RPL) — ≥3 consecutive losses", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Investigate: Karyotype both partners, APS panel, thyroid, HSG/hysteroscopy; treat underlying cause", options:{ fontSize:15, color:C.slate } },
]);

// Slide 7: Complications of Unsafe Abortion
contentSlide("Complications of Unsafe Abortion", [
  { text: "Global burden: ~25 million unsafe abortions/year; 47,000 deaths annually (WHO)", options:{ bold:true, fontSize:16, color:C.red, breakLine:true } },
  { text: "Immediate Complications", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Hemorrhage (most common cause of immediate death)", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Uterine perforation — risk of bowel/bladder injury", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Sepsis — endometritis, peritonitis, septicemia", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Retained products of conception (RPOC)", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Delayed / Long-term Complications", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Infertility — from intrauterine adhesions (Asherman syndrome) or tubal damage", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Chronic pelvic inflammatory disease (PID)", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Psychological sequelae", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Legal abortion mortality: 0.7 per 100,000 procedures; maternal mortality: 8.8 per 100,000 live births (abortion at any gestation is safer than term delivery)", options:{ fontSize:14, italic:true, color:C.gray } },
]);

// ═══════════════════════════════════════════════════════════════
// SECTION 2: MTP
// ═══════════════════════════════════════════════════════════════
sectionDivider("PART 2", "Medical Termination of Pregnancy (MTP)", C.teal);

// Slide 8: MTP Act Overview
contentSlide("MTP Act 1971 — Overview", [
  { text: "Enacted 1971; amended 2002, 2003, 2021", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Aim: Reduce maternal morbidity & mortality from unsafe abortions; ensure safe, legal abortion by qualified practitioners", options:{ fontSize:16, color:C.slate, breakLine:true } },
  { text: "", options:{ breakLine:true } },
  { text: "KEY SECTIONS", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Section 3 — When pregnancy may be terminated (indications)", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Section 4 — Approved places (government hospital / certified private facility)", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Section 5 — Emergency termination (single RMP, no time limit for life-saving)", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Section 5A (2021) — Confidentiality; disclosure punishable with fine + imprisonment", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "", options:{ breakLine:true } },
  { text: "RMP (Registered Medical Practitioner): Must be registered under IMC Act / State Medical Register with O&G training or recognized government training", options:{ fontSize:14, italic:true, color:C.gray } },
]);

// Slide 9: MTP Gestational Limits Table
tableSlide(
  "MTP Act — Permissible Gestational Limits",
  ["Gestational Age", "No. of Opinions", "Conditions / Category"],
  [
    ["Up to 20 weeks", "1 RMP", "Risk to life; grave physical/mental injury; contraceptive failure (married OR unmarried — post 2021); rape/incest"],
    ["20 to 24 weeks", "2 RMPs", "Special categories: rape/incest survivors, minors, divorcees/widows, women with disabilities, fetal anomalies, disasters/emergencies"],
    ["Beyond 24 weeks", "State Medical Board", "Substantial fetal anomalies only; no upper limit — must be approved by Medical Board"],
    ["Any gestational age", "1 RMP (Section 5)", "Emergency — immediate termination to save life of pregnant woman"],
  ],
  [2.2, 2.0, 5.3]
);

// Slide 10: MTP 2021 Amendment
contentSlide("MTP Amendment Act 2021 — Key Changes", [
  { text: "1. Extended gestational limit", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Upper limit raised from 20 to 24 weeks for special categories of women", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "2. Unmarried women included", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Contraceptive failure clause extended to unmarried women (earlier only married women)", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "3. Medical Board for >24 weeks", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "State-level Medical Board mandatory for fetal anomalies beyond 24 weeks", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "4. Confidentiality (Section 5A)", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "No RMP shall reveal identity/details of woman except to authorized person; punishable offence", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "5. Consent", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Adult woman (≥18): own consent only | Minor (<18) or mentally ill: guardian consent required | Husband consent NOT required", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "Ethical Principles: Autonomy | Beneficence | Non-maleficence | Justice | Confidentiality", options:{ bold:true, fontSize:14, italic:true, color:C.tealLt } },
]);

// Slide 11: MTP Techniques by Gestational Age
tableSlide(
  "MTP Techniques by Gestational Age",
  ["Gestational Age", "Method", "Details"],
  [
    ["Up to 9 weeks", "Medical Abortion", "Mifepristone 200 mg PO + Misoprostol 800 mcg vaginally/buccally after 24–48 h"],
    ["9–12 weeks", "MVA / EVA", "Manual or Electric Vacuum Aspiration under local anesthesia; prophylactic doxycycline"],
    ["12–20 weeks", "D&E (Dilation & Evacuation)", "Preceded by cervical preparation (laminaria/misoprostol); surgical evacuation"],
    ["13–24 weeks", "Medical induction", "Mifepristone + misoprostol; oxytocin augmentation; hospitalization required"],
    [">24 weeks (rare)", "Induction + delivery", "Medical Board approval; feticidal injection (digoxin) + laminaria + misoprostol/oxytocin"],
    ["Any trimester (emergency)", "Hysterotomy / Hysterectomy", "Reserved for failed medical/surgical methods or life-threatening complications"],
  ],
  [2.0, 2.5, 5.0]
);

// Slide 12: Medical Abortion — Mifepristone + Misoprostol
contentSlide("Medical Abortion — Mifepristone + Misoprostol", [
  { text: "MIFEPRISTONE (RU-486)", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Antiprogesterone; competitively binds progesterone receptors; softens cervix; sensitizes uterus to prostaglandins", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "Dose: 200 mg orally (as effective as 600 mg)", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "MISOPROSTOL", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "PGE1 analogue; causes uterine contractions and cervical ripening", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "Dose (up to 9 weeks): 800 mcg vaginally or 400 mcg buccally/sublingually, 24–48 h after mifepristone", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "Dose (13–24 weeks): 800 mcg vaginally, then 400 mcg q3h vaginally or 400 mcg buccally q3h (ACOG)", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "EFFICACY: ~95–98% complete abortion rate in first trimester; ~80–90% in second trimester", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "Follow-up: USG or serial serum beta-hCG to confirm complete abortion; watch for retained POC, infection, ongoing pregnancy", options:{ fontSize:14, italic:true, color:C.gray } },
]);

// ═══════════════════════════════════════════════════════════════
// SECTION 3: ECTOPIC PREGNANCY
// ═══════════════════════════════════════════════════════════════
sectionDivider("PART 3", "Ectopic Pregnancy", C.slate);

// Slide 13: Definition & Epidemiology
contentSlide("Ectopic Pregnancy — Definition & Epidemiology", [
  { text: "DEFINITION", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Implantation of a fertilized ovum outside the endometrial cavity of the uterus", options:{ fontSize:16, color:C.slate, breakLine:true } },
  { text: "", options:{ breakLine:true } },
  { text: "SITES (frequency)", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Fallopian tube: ~97% (Ampulla 70%, Isthmus 12%, Fimbria 11%, Cornual/Interstitial 3%)", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Ovary, cervix, abdominal cavity, cesarean scar — rare but serious", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "EPIDEMIOLOGY", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Incidence: 0.64–2.0% of all pregnancies", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Leading obstetric cause of maternal death in the first trimester", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "50% of cases receive medical evaluation ≥2 times before correct diagnosis (high index of suspicion required)", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Incidence increased with rise of ART (IVF), PID, prior tubal surgery", options:{ bullet:true, fontSize:15, color:C.slate } },
]);

// Slide 14: Risk Factors
twoColSlide(
  "Ectopic Pregnancy — Risk Factors",
  "HIGH RISK",
  [
    "Prior ectopic pregnancy (recurrence risk 10–25%)",
    "Prior tubal surgery / sterilization",
    "Prior salpingitis / PID (Chlamydia, Gonorrhoea)",
    "Documented tubal pathology",
    "In-utero DES exposure",
    "IVF / ART conception",
  ],
  "MODERATE / LOW RISK",
  [
    "IUD in situ (if failure occurs, risk of ectopic increased)",
    "Prior abdominal/pelvic surgery",
    "Current cigarette smoking",
    "Multiple sexual partners",
    "Age >35 years",
    "Vaginal douching",
    "Early age of first intercourse",
  ]
);

// Slide 15: Clinical Features
contentSlide("Ectopic Pregnancy — Clinical Features", [
  { text: "CLASSIC TRIAD (present in <50% of cases)", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "1. Amenorrhea  2. Pelvic pain (colicky / constant)  3. Vaginal bleeding", options:{ fontSize:16, color:C.slate, breakLine:true } },
  { text: "", options:{ breakLine:true } },
  { text: "OTHER SYMPTOMS", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } },
  { text: "Shoulder tip pain (diaphragmatic irritation by hemoperitoneum) — PATHOGNOMONIC of rupture", options:{ bullet:true, fontSize:15, color:C.red, breakLine:true } },
  { text: "Syncope / dizziness — significant hemoperitoneum", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Rectal pressure or urgency (blood in pouch of Douglas)", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Nausea, vomiting, breast tenderness", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "SIGNS", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } },
  { text: "Adnexal mass / tenderness; cervical excitation tenderness (Chandelier sign)", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } },
  { text: "Hypotension / tachycardia in ruptured ectopic (IMPORTANT: bradycardia can occur paradoxically)", options:{ bullet:true, fontSize:15, color:C.red, breakLine:true } },
  { text: "Blood in peritoneal cavity does NOT consistently correlate with vital sign changes (Bezold-Jarisch reflex)", options:{ fontSize:14, italic:true, color:C.gray } },
]);

// Slide 16: Investigations
contentSlide("Ectopic Pregnancy — Investigations", [
  { text: "1. Serum beta-hCG", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Quantitative: Serial measurements; in normal IUP, hCG doubles every 48 h (>66% rise)", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "Suboptimal rise (<66%) or plateau: suspect ectopic or failing IUP", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "Discriminatory zone: 1500–3000 mIU/mL — IUP should be visible on TVS above this level", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "2. Transvaginal Ultrasound (TVS) — INVESTIGATION OF CHOICE", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Empty uterine cavity (no IUP) + positive hCG = ectopic until proven otherwise", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "Adnexal mass separate from ovary; free fluid (hemoperitoneum) in POD", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "\"Ring of fire\" sign on Doppler — peripheral vascularity of ectopic sac", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "3. Culdocentesis (historical, rarely used now)", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } },
  { text: "Aspiration of non-clotting blood (hematocrit >15%) from POD = positive tap (ruptured ectopic)", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "4. Progesterone level (adjunct): <5 ng/mL suggests non-viable pregnancy; >25 ng/mL suggests viable IUP", options:{ fontSize:14, color:C.gray } },
]);

// Slide 17: Management — Overview
contentSlide("Management of Ectopic Pregnancy — Overview", [
  { text: "THREE STRATEGIES: Expectant | Medical (Methotrexate) | Surgical", options:{ bold:true, fontSize:17, color:C.teal, breakLine:true } },
  { text: "Choice depends on: hemodynamic stability, USG findings (size, cardiac activity, free fluid), serum beta-hCG level, patient compliance, and preference", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "", options:{ breakLine:true } },
  { text: "EXPECTANT MANAGEMENT (selected patients)", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Criteria: Hemodynamically stable + asymptomatic + declining beta-hCG + ectopic <35 mm + no cardiac activity", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "hCG <1500 IU/L; confirm decline on days 4 and 7; weekly until <20 IU/L", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "Success rate ~70% when hCG <200 mIU/mL and falling", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "⚠ Risk of rupture persists — must counsel and ensure immediate access to emergency care", options:{ bold:true, fontSize:15, color:C.red } },
]);

// Slide 18: Medical Management — Methotrexate
contentSlide("Medical Management — Methotrexate", [
  { text: "Mechanism: Folic acid antagonist; inhibits dihydrofolate reductase; blocks DNA synthesis; targets actively dividing trophoblast", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "SINGLE-DOSE PROTOCOL: MTX 50 mg/m² IM on Day 1; measure hCG on Day 4 & 7; expect 15% fall by Day 4–7", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } },
  { text: "MULTI-DOSE PROTOCOL: MTX 1 mg/kg IM on Days 1,3,5,7 alternating with Leucovorin 0.1 mg/kg IM on Days 2,4,6,8", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } },
  { text: "ABSOLUTE CONTRAINDICATIONS to MTX", options:{ bold:true, fontSize:15, color:C.red, breakLine:true } },
  { text: "IUP • Hemodynamic instability • Ruptured ectopic • Breastfeeding • Immunodeficiency • Significant anemia/leukopenia/thrombocytopenia • Active PUD/pulmonary disease • Hepatic/renal dysfunction • Known sensitivity", options:{ fontSize:14, color:C.slate, breakLine:true } },
  { text: "RELATIVE CONTRAINDICATIONS", options:{ bold:true, fontSize:15, color:C.red, breakLine:true } },
  { text: "Ectopic >4 cm • Embryonic cardiac motion on TVS • hCG >5000 mIU/mL • Unable to comply with follow-up", options:{ fontSize:14, color:C.slate, breakLine:true } },
  { text: "Avoid pregnancy for 3 months post-MTX (teratogenicity risk). Avoid folic acid, NSAIDs, alcohol during treatment.", options:{ fontSize:14, italic:true, color:C.gray } },
]);

// Slide 19: Surgical Management
contentSlide("Surgical Management of Ectopic Pregnancy", [
  { text: "LAPAROSCOPIC APPROACH — preferred over laparotomy in stable patients (less morbidity, faster recovery)", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "LAPAROTOMY — for hemodynamically unstable patients (ruptured ectopic with massive hemoperitoneum)", options:{ bold:true, fontSize:16, color:C.red, breakLine:true } },
  { text: "", options:{ breakLine:true } },
  { text: "SALPINGECTOMY (preferred surgical option)", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } },
  { text: "Removal of the affected tube; preferred when contralateral tube is healthy or tube is severely damaged; lower persistent ectopic risk", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "SALPINGOSTOMY (tube-conserving)", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } },
  { text: "Linear incision over ectopic; pregnancy tissue removed; tube left open to heal by secondary intention", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "Preferred when contralateral tube is damaged/absent; 5–8% risk of persistent trophoblast (monitor hCG)", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "SALPINGOTOMY — incision closed with sutures (higher persistent ectopic rate than salpingostomy)", options:{ fontSize:15, color:C.slate, breakLine:true } },
  { text: "POST-OP: Anti-D immunoglobulin 300 mcg IM for all Rh-negative women", options:{ bold:true, fontSize:15, color:C.gold } },
]);

// Slide 20: Treatment Selection Algorithm
tableSlide(
  "Ectopic Pregnancy — Treatment Selection",
  ["Parameter", "Expectant", "Medical (MTX)", "Surgical"],
  [
    ["Hemodynamic status", "Stable", "Stable", "Any (laparotomy if unstable)"],
    ["Serum beta-hCG", "<1500 IU/L (falling)", "1500–5000 IU/L", ">5000 IU/L or any"],
    ["Ectopic size", "<35 mm", "<35–40 mm", "Any / ≥35 mm"],
    ["Cardiac activity", "Absent", "Absent", "Present or absent"],
    ["Pain", "None", "Mild-moderate", "Any"],
    ["Follow-up compliance", "Essential", "Essential", "Not required"],
    ["Risk of failure", "~30%", "~15–20%", "<1%"],
  ],
  [2.8, 2.0, 2.2, 2.5]
);

// ═══════════════════════════════════════════════════════════════
// SLIDE 21: CLINICAL PEARLS & KEY EXAM POINTS
// ═══════════════════════════════════════════════════════════════
contentSlide("Clinical Pearls & Key Points for PG Exams", [
  { text: "ABORTION", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Cervical OS is the key to differentiating threatened (closed) vs. inevitable (open) abortion", options:{ bullet:true, fontSize:14, color:C.slate, breakLine:true } },
  { text: "Most common cause of 1st trimester miscarriage: chromosomal anomaly (50–60%); most common: trisomy", options:{ bullet:true, fontSize:14, color:C.slate, breakLine:true } },
  { text: "Septic abortion: requires antibiotics FIRST, then evacuation (not evacuation first)", options:{ bullet:true, fontSize:14, color:C.red, breakLine:true } },
  { text: "MTP ACT", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "2021: 20 wks (1 RMP), 20–24 wks (2 RMPs for special categories), >24 wks (Medical Board)", options:{ bullet:true, fontSize:14, color:C.slate, breakLine:true } },
  { text: "Unmarried women NOW covered under contraceptive failure clause", options:{ bullet:true, fontSize:14, color:C.slate, breakLine:true } },
  { text: "Husband's consent is NOT required under the MTP Act", options:{ bullet:true, fontSize:14, color:C.red, breakLine:true } },
  { text: "ECTOPIC PREGNANCY", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } },
  { text: "Shoulder tip pain = ruptured ectopic (diaphragmatic irritation by hemoperitoneum)", options:{ bullet:true, fontSize:14, color:C.red, breakLine:true } },
  { text: "Paradoxical bradycardia can occur in significant hemoperitoneum — do not be falsely reassured", options:{ bullet:true, fontSize:14, color:C.red, breakLine:true } },
  { text: "Anti-D to all Rh-negative women after ectopic surgery", options:{ bullet:true, fontSize:14, color:C.slate, breakLine:true } },
  { text: "Salpingostomy: monitor hCG post-op (5–8% persistent trophoblast risk)", options:{ bullet:true, fontSize:14, color:C.slate } },
]);

// Slide 22: Thank You / End
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    { text: "Abortion: ", options:{ bold:true, color:C.gold } },
    { text: "Know your types, recognize complications early, manage sepsis aggressively\n", options:{ color:"D0EEF0" } },
    { text: "MTP Act: ", options:{ bold:true, color:C.gold } },
    { text: "2021 amendment — 24 weeks, unmarried women, Medical Board, confidentiality\n", options:{ color:"D0EEF0" } },
    { text: "Ectopic: ", options:{ bold:true, color:C.gold } },
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  s.addText("Sources: Berek & Novak's Gynecology | Bailey & Love's Surgery | Forensic Medicine & Toxicology (2026) | Creasy & Resnik's MFM | Roberts & Hedges' Emergency Medicine", 
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// ─── Write file ────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/abortion-mtp-ectopic/Abortion_MTP_Ectopic.pptx" })
  .then(() => console.log("PPTX written successfully"))
  .catch(err => { console.error(err); process.exit(1); });

Editing File

~/abortion-mtp-ectopic/build.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/abortion-mtp-ectopic/build.js'

Running Command

cat > /home/daytona/workspace/abortion-mtp-ectopic/build.js << 'ENDBUILD' const pptxgen = require("pptxgenjs"); const pres = new pptxgen(); pres.layout = "LAYOUT_16x9"; pres.title = "Abortion, MTP & Ectopic Pregnancy"; pres.author = "Medical Education"; const C = { navy: "0A2342", teal: "1A6B72", tealLt: "24919A", red: "C0392B", gold: "D4A017", white: "FFFFFF", offWhite:"F4F6F9", gray: "6C757D", ltGray: "DEE2E6", slate: "2C3E50", }; function titleSlide(title, subtitle) { const s = pres.addSlide(); s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color:C.navy } }); s.addShape(pres.ShapeType.rect, { x:0, y:4.5, w:10, h:1.125, fill:{ color:C.teal } }); s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.15, h:5.625, fill:{ color:C.gold } }); s.addText(title, { x:0.4, y:1.2, w:9.2, h:1.8, fontSize:40, bold:true, color:C.white, fontFace:"Calibri", align:"left", valign:"middle" }); if (subtitle) s.addText(subtitle, { x:0.4, y:3.1, w:9.2, h:0.7, fontSize:20, color:"B0C4DE", fontFace:"Calibri", align:"left" }); 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// ── SECTION DIVIDER: ABORTION ── sectionDivider("PART 1", "Abortion", C.navy); // ── SLIDE 3: Definition & Classification ── contentSlide("Abortion — Definition & Classification", [ { text: "DEFINITION", options:{ bold:true, fontSize:17, color:C.teal, breakLine:true } }, { text: "Expulsion or extraction of a fetus/embryo weighing <500 g (or <20–22 weeks gestation) from the uterus, irrespective of viability", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: " ", options:{ breakLine:true } }, { text: "MAJOR CLASSIFICATION", options:{ bold:true, fontSize:17, color:C.teal, breakLine:true } }, { text: "Spontaneous Abortion — natural; without intervention", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } }, { text: "Induced Abortion — deliberate termination:", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } }, { text: " Therapeutic (legal) — under MTP Act by qualified RMP", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: " Criminal — outside legal framework, by unqualified persons", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "Missed Abortion — fetal death with retained products; no expulsion", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } }, { text: "Unsafe Abortion — performed by unskilled personnel or in unsafe conditions (~25 million/year; 47,000 maternal deaths annually — WHO)", options:{ bullet:true, fontSize:15, color:C.red } }, ]); // ── SLIDE 4: Types of Spontaneous Abortion ── tableSlide("Types of Spontaneous Abortion", ["Type", "Cervical OS", "Bleeding", "POC Status", "Management"], [ ["Threatened", "Closed", "Present (mild)", "Intact", "Bed rest; progesterone; USG monitoring"], ["Inevitable", "Open", "Heavy", "Not yet passed", "Hospitalize; surgical evacuation if not spontaneous"], ["Incomplete", "Open", "Heavy", "Partial passage", "Urgent uterine evacuation (MVA / D&C)"], ["Complete", "Closed", "Decreasing", "All expelled", "Confirm by USG; expectant if stable"], ["Missed", "Closed", "Absent / minimal", "Retained", "Medical: mifepristone + misoprostol; or surgical (MVA)"], ["Septic", "Open (usually)", "Variable + purulent discharge", "Variable", "IV antibiotics FIRST, then urgent evacuation"], ["Recurrent (RPL)", "Variable", "Variable", "Variable", ">=3 losses: karyotype, APS panel, uterine imaging"], ], [1.8, 1.3, 1.7, 1.7, 3.0] ); // ── SLIDE 5: Etiology ── twoColSlide("Spontaneous Abortion — Etiology", "Fetal / Embryonic", [ "Chromosomal anomalies: 50–60% of 1st trimester losses", "Trisomies (trisomy 16 most common single type)", "Monosomy X (Turner syndrome)", "Polyploidy — triploidy, tetraploidy", "Structural chromosomal rearrangements", "Single gene defects (rare)", ], "Maternal / Uterine", [ "Uterine septum (most common correctable structural cause)", "Cervical incompetence (painless 2nd trimester loss)", "Antiphospholipid syndrome (APS) — key in RPL", "Thrombophilias: Factor V Leiden, Prothrombin mutation", "Endocrine: hypothyroidism, PCOS, uncontrolled DM", "Infections: TORCH, bacterial vaginosis", "Advanced maternal age >35 years", "Smoking, alcohol, NSAIDs, high caffeine intake", ] ); // ── SLIDE 6: Management ── contentSlide("Management of Spontaneous Abortion", [ { text: "THREATENED", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Bed rest (limited evidence); progesterone supplementation (luteal phase defect); avoid coitus; serial USG + hCG", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "INEVITABLE / INCOMPLETE", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Manual Vacuum Aspiration (MVA) preferred up to 12 weeks; EVA or sharp curettage for larger gestations; pre-op doxycycline prophylaxis", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "MISSED ABORTION", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Medical: Mifepristone 200 mg PO then Misoprostol 800 mcg vaginally after 24–48 h", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "Surgical if medical fails or >13 weeks: MVA or D&E", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "SEPTIC ABORTION", options:{ bold:true, fontSize:16, color:C.red, breakLine:true } }, { text: "IV ampicillin + gentamicin + metronidazole; uterine evacuation after antibiotic stabilization; ICU care if septic shock", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "RECURRENT PREGNANCY LOSS (RPL)", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Investigate: karyotype both partners, APS panel, thyroid function, HSG/hysteroscopy for uterine anomaly; treat underlying cause; low-dose aspirin + LMWH for APS", options:{ fontSize:14, color:C.slate } }, ]); // ── SECTION DIVIDER: MTP ── sectionDivider("PART 2", "Medical Termination of Pregnancy (MTP)", C.teal); // ── SLIDE 7: MTP Act Overview ── contentSlide("MTP Act 1971 — Overview", [ { text: "Enacted 1971; Amended 2002, 2003, 2021", options:{ bold:true, fontSize:17, color:C.teal, breakLine:true } }, { text: "AIM: Reduce maternal mortality from unsafe abortions; provide safe, legal termination by qualified practitioners only", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: " ", options:{ breakLine:true } }, { text: "KEY SECTIONS", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Section 3 — Conditions under which pregnancy may be terminated", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } }, { text: "Section 4 — Approved places: government hospitals or certified private facilities with adequate aseptic / resuscitation / blood transfusion facilities", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } }, { text: "Section 5 — Emergency: single RMP, no gestational limit, to save the woman's life", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } }, { text: "Section 5A (2021) — Confidentiality: identity of woman must not be revealed; punishable by fine + imprisonment", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } }, { text: "RMP: Must be registered under IMC Act / State Medical Register + hold recognized O&G training", options:{ fontSize:13, italic:true, color:C.gray } }, ]); // ── SLIDE 8: Gestational Limits Table ── tableSlide("MTP Act — Permissible Gestational Limits (Post-2021)", ["Gestational Age", "Opinions Required", "Category / Conditions"], [ ["Up to 20 weeks", "1 RMP", "Risk to life of woman; grave physical or mental injury; contraceptive failure (married OR unmarried); rape/incest (mental anguish presumed)"], ["20 to 24 weeks", "2 RMPs", "Rape/incest survivors; minors; widows/divorcees; women with disabilities; fetal anomalies; disaster/emergency victims"], ["Beyond 24 weeks", "State Medical Board", "Substantial fetal anomalies detected at any gestation; no upper gestational limit — Board approval mandatory"], ["Any gestation (Emergency)", "1 RMP (Sec 5)", "Immediate risk to life of pregnant woman; no gestational limit applies"], ], [2.0, 1.8, 5.7] ); // ── SLIDE 9: 2021 Amendment ── contentSlide("MTP Amendment Act 2021 — Key Changes", [ { text: "1. Extended gestational limit", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Upper limit increased from 20 to 24 weeks for special categories", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "2. Unmarried women included", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Contraceptive failure clause now extends to unmarried women (previously married women only)", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "3. State Medical Board", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Mandatory for termination beyond 24 weeks due to substantial fetal anomalies", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "4. Confidentiality clause (Section 5A)", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "No RMP shall disclose name or other particulars of the woman; punishable offence", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "5. Consent requirements", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Adult (>=18 yrs): own written consent only | Minor (<18) or mentally ill: guardian consent | Husband's consent NOT legally required", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "Ethical framework: Autonomy | Beneficence | Non-maleficence | Justice | Confidentiality", options:{ bold:true, fontSize:13, italic:true, color:C.tealLt } }, ]); // ── SLIDE 10: MTP Techniques ── tableSlide("MTP Techniques by Gestational Age", ["Gestational Age", "Method", "Details"], [ ["Up to 9 weeks", "Medical Abortion", "Mifepristone 200 mg PO + Misoprostol 800 mcg vaginally/buccally after 24–48 h; ~95–98% complete abortion rate"], ["9–12 weeks", "MVA / EVA", "Manual or Electric Vacuum Aspiration under LA; cervical preparation with misoprostol 400 mcg 3–4 h prior"], ["12–20 weeks", "Dilation & Evacuation (D&E)", "Preceded by osmotic cervical dilators (laminaria) or misoprostol; larger bore cannula + forceps"], ["13–24 weeks", "Medical Induction", "Mifepristone + misoprostol; repeat dosing every 3 h (vaginal or buccal); oxytocin augmentation; hospital admission"], [">24 weeks (Board approval)", "Combined Induction + Delivery", "Feticidal injection (digoxin) + serial laminaria over 2–3 days + misoprostol/oxytocin + assisted delivery"], ["Emergency / Failed", "Hysterotomy / Hysterectomy", "Last resort; life-threatening complications or failed all other methods"], ], [2.0, 2.5, 5.0] ); // ── SLIDE 11: Mifepristone + Misoprostol ── contentSlide("Medical Abortion — Mifepristone + Misoprostol", [ { text: "MIFEPRISTONE (RU-486)", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Antiprogestogen; competitively binds progesterone receptors; causes decidual breakdown, cervical softening, sensitizes uterus to prostaglandins; Dose: 200 mg PO", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "MISOPROSTOL", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Synthetic PGE1 analogue; induces uterine contractions and cervical ripening", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "First trimester: 800 mcg vaginally or 400 mcg buccally 24–48 h after mifepristone", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "Second trimester: 800 mcg vaginally then 400 mcg q3h vaginally or buccally (ACOG protocol)", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "EFFICACY", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "~95–98% complete abortion rate in first trimester; ~80–90% in second trimester", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "FOLLOW-UP", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "USG or serial serum beta-hCG at 2 weeks; confirm complete abortion; watch for retained POC, ongoing pregnancy, endometritis", options:{ fontSize:14, color:C.slate } }, ]); // ── SECTION DIVIDER: ECTOPIC ── sectionDivider("PART 3", "Ectopic Pregnancy", C.slate); // ── SLIDE 12: Definition & Epidemiology ── contentSlide("Ectopic Pregnancy — Definition & Epidemiology", [ { text: "DEFINITION: Implantation of a fertilized ovum outside the endometrial cavity of the uterus", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: " ", options:{ breakLine:true } }, { text: "SITES (by frequency)", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Fallopian tube ~97%: Ampullary 70% | Isthmic 12% | Fimbrial 11% | Interstitial/Cornual 3%", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } }, { text: "Non-tubal (<3%): Ovarian | Cervical | Abdominal | Cesarean scar — rare but life-threatening", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } }, { text: " ", options:{ breakLine:true } }, { text: "EPIDEMIOLOGY", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Incidence: 0.64–2.0% of all pregnancies; increasing with rise of PID, ART, prior tubal surgery", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } }, { text: "Leading obstetric cause of first-trimester maternal death", options:{ bullet:true, fontSize:15, color:C.red, breakLine:true } }, { text: "In a series of 300 consecutive cases: 50% received >=2 medical evaluations before correct diagnosis — HIGH INDEX OF SUSPICION IS ESSENTIAL", options:{ bullet:true, fontSize:14, italic:true, color:C.gray } }, ]); // ── SLIDE 13: Risk Factors ── twoColSlide("Ectopic Pregnancy — Risk Factors", "HIGH RISK", [ "Prior ectopic pregnancy (recurrence: 10–25%)", "Prior tubal surgery (including sterilization)", "Prior salpingitis / PID (Chlamydia, Gonorrhoea)", "Documented tubal pathology on HSG", "In-utero DES (diethylstilbestrol) exposure", "IVF / ART conception", ], "MODERATE / LOW RISK", [ "IUD in situ (if contraceptive fails, high ectopic risk)", "Prior abdominopelvic surgery (appendicectomy, etc.)", "Current cigarette smoking", "Multiple sexual partners", "Age >35 years", "Vaginal douching", "History of sexually transmitted infections", ] ); // ── SLIDE 14: Clinical Features ── contentSlide("Ectopic Pregnancy — Clinical Features", [ { text: "CLASSIC TRIAD (present in <50% — do not rely on it)", options:{ bold:true, fontSize:16, color:C.red, breakLine:true } }, { text: "1. Amenorrhea (6–8 weeks) 2. Lower abdominal / pelvic pain 3. Vaginal bleeding (dark, scanty)", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: " ", options:{ breakLine:true } }, { text: "FEATURES OF RUPTURE (EMERGENCY)", options:{ bold:true, fontSize:16, color:C.red, breakLine:true } }, { text: "Sudden severe lower abdominal pain radiating to shoulder (diaphragmatic irritation by hemoperitoneum) — HALLMARK of rupture", options:{ bullet:true, fontSize:15, color:C.red, breakLine:true } }, { text: "Syncope / collapse; hypotension; tachycardia (or paradoxical bradycardia — Bezold-Jarisch reflex)", options:{ bullet:true, fontSize:15, color:C.red, breakLine:true } }, { text: " ", options:{ breakLine:true } }, { text: "ON EXAMINATION", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } }, { text: "Cervical excitation tenderness (Chandelier sign) — pathognomonic of hemoperitoneum", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } }, { text: "Adnexal mass / tenderness; fullness in POD", options:{ bullet:true, fontSize:15, color:C.slate, breakLine:true } }, { text: "Signs of peritonism if ruptured (guarding, rigidity, rebound tenderness)", options:{ bullet:true, fontSize:15, color:C.slate } }, ]); // ── SLIDE 15: Investigations ── contentSlide("Ectopic Pregnancy — Investigations", [ { text: "1. Serum Quantitative Beta-hCG", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Normal IUP: doubles >66% every 48 h | Suboptimal rise or plateau: suspect ectopic/failing IUP", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "Discriminatory zone: 1500–3000 mIU/mL — IUP should be visible on TVS above this; absence strongly suggests ectopic", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "2. Transvaginal Ultrasound (TVS) — FIRST-LINE INVESTIGATION", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Empty uterus + positive hCG = ectopic until proven otherwise", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "Adnexal mass separate from ovary; free fluid (hemoperitoneum) in POD", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "\"Ring of fire\" sign on Doppler: peripheral vascularity of ectopic gestational sac", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "3. Progesterone (adjunct)", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } }, { text: "<5 ng/mL suggests non-viable pregnancy (ectopic or miscarriage); >25 ng/mL suggests viable IUP", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "4. Culdocentesis (historical)", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } }, { text: "Positive tap: non-clotting blood, hematocrit >15% from pouch of Douglas; largely replaced by TVS", options:{ fontSize:14, color:C.gray } }, ]); // ── SLIDE 16: Management Overview ── contentSlide("Management Overview — Three Strategies", [ { text: "DECISION FACTORS: Hemodynamic stability | TVS findings (size, cardiac activity, free fluid) | Serum beta-hCG | Patient compliance & preference", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } }, { text: " ", options:{ breakLine:true } }, { text: "EXPECTANT MANAGEMENT", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "Criteria: Stable + asymptomatic + hCG <1500 IU/L (falling) + ectopic <35 mm + no cardiac activity", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "Monitor hCG Days 4 and 7; >=15% fall is reassuring; weekly until <20 IU/L", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "Success rate ~70% if initial hCG <200 mIU/mL and clearly declining", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "WARN PATIENT: risk of rupture persists; ensure immediate hospital access if pain worsens", options:{ bold:true, fontSize:15, color:C.red, breakLine:true } }, { text: " ", options:{ breakLine:true } }, { text: "MEDICAL (Methotrexate): for stable patients with hCG 1500–5000 IU/L; ectopic <35–40 mm; no cardiac activity", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "SURGICAL: for unstable patients, hCG >5000 IU/L, ectopic >=35 mm, cardiac activity present, or patient preference", options:{ fontSize:15, color:C.slate } }, ]); // ── SLIDE 17: Methotrexate ── contentSlide("Medical Management — Methotrexate (MTX)", [ { text: "MECHANISM: Folic acid antagonist; inhibits dihydrofolate reductase; blocks DNA/RNA synthesis; targets rapidly dividing trophoblastic tissue", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "~35% of ectopic patients are candidates for primary MTX therapy", options:{ fontSize:14, italic:true, color:C.gray, breakLine:true } }, { text: " ", options:{ breakLine:true } }, { text: "SINGLE-DOSE PROTOCOL (most common)", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "MTX 50 mg/m2 IM Day 1; measure hCG Day 4 and Day 7; expect >=15% fall between Day 4–7; if inadequate fall, repeat dose", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "MULTI-DOSE PROTOCOL", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "MTX 1 mg/kg IM Days 1,3,5,7 alternating with Leucovorin 0.1 mg/kg IM Days 2,4,6,8", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "ABSOLUTE CONTRAINDICATIONS", options:{ bold:true, fontSize:15, color:C.red, breakLine:true } }, { text: "IUP | Hemodynamic instability | Ruptured ectopic | Breastfeeding | Immunodeficiency | Bone marrow suppression | Active pulmonary / peptic ulcer disease | Hepatic/renal dysfunction | Hypersensitivity to MTX", options:{ fontSize:13, color:C.slate, breakLine:true } }, { text: "RELATIVE CONTRAINDICATIONS: Ectopic >4 cm | Cardiac activity | hCG >5000 mIU/mL | Unable to comply with follow-up", options:{ fontSize:13, color:C.slate, breakLine:true } }, { text: "Post-MTX: avoid pregnancy 3 months; avoid folic acid, NSAIDs, alcohol during treatment", options:{ bold:true, fontSize:13, italic:true, color:C.gray } }, ]); // ── SLIDE 18: Surgical Management ── contentSlide("Surgical Management of Ectopic Pregnancy", [ { text: "LAPAROSCOPY — preferred in hemodynamically stable patients (less morbidity, faster recovery, equivalent outcomes)", options:{ bold:true, fontSize:16, color:C.teal, breakLine:true } }, { text: "LAPAROTOMY — for hemodynamically UNSTABLE patients with massive hemoperitoneum", options:{ bold:true, fontSize:16, color:C.red, breakLine:true } }, { text: " ", options:{ breakLine:true } }, { text: "SALPINGECTOMY (PREFERRED)", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } }, { text: "Removal of entire affected tube; preferred when contralateral tube is healthy, tube is severely damaged, or patient has completed childbearing", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "Lower risk of persistent trophoblast compared to salpingostomy", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "SALPINGOSTOMY (tube-conserving; preferred when only tube remaining)", options:{ bold:true, fontSize:15, color:C.teal, breakLine:true } }, { text: "Linear incision over ectopic sac; pregnancy tissue removed; tube left to heal by secondary intention; 5–8% risk of persistent ectopic (monitor hCG post-op)", options:{ fontSize:15, color:C.slate, breakLine:true } }, { text: "Surgical management is preferred if: hCG >5000 mIU/mL | Cardiac activity on TVS | Ectopic >=35 mm | Significant pain | Rising hCG despite MTX", options:{ fontSize:14, color:C.slate, breakLine:true } }, { text: "POST-OP: Anti-D immunoglobulin 300 mcg IM for ALL Rh-negative women after ectopic surgery", options:{ bold:true, fontSize:15, color:C.gold } }, ]); // ── SLIDE 19: Treatment Selection Table ── tableSlide("Ectopic Pregnancy — Treatment Selection Guide", ["Parameter", "Expectant", "Medical (MTX)", "Surgical"], [ ["Hemodynamic status", "Stable", "Stable", "Any; laparotomy if unstable"], ["Beta-hCG (mIU/mL)", "<1500 (falling)", "1500–5000", ">5000 or any"], ["Ectopic size", "<35 mm", "<35–40 mm", "Any / >=35 mm"], ["Fetal cardiac activity", "Absent", "Absent", "Present or absent"], ["Free fluid / rupture", "None", "Minimal", "Any"], ["Follow-up compliance", "Essential (mandatory)", "Essential (mandatory)", "Not required"], ["Approx. success rate", "~70% if hCG <200", "~85–90%", ">99%"], ["Future fertility concern", "Preserved", "Preserved", "Salpingostomy > salpingectomy"], ], [2.5, 1.8, 2.2, 3.0] ); // ── SLIDE 20: Clinical Pearls ── contentSlide("Clinical Pearls & High-Yield Points (PG Exams)", [ { text: "ABORTION", options:{ bold:true, fontSize:17, color:C.teal, breakLine:true } }, { text: "OS state is the key distinction: Threatened (closed) vs. Inevitable/Incomplete (open)", options:{ bullet:true, fontSize:14, color:C.slate, breakLine:true } }, { text: "Most common cause of 1st trimester loss: chromosomal anomaly (50–60%); most common: trisomy", options:{ bullet:true, fontSize:14, color:C.slate, breakLine:true } }, { text: "Septic abortion: antibiotics BEFORE evacuation — not evacuation first", options:{ bullet:true, fontSize:14, color:C.red, breakLine:true } }, { text: "MTP ACT", options:{ bold:true, fontSize:17, color:C.teal, breakLine:true } }, { text: "2021: <=20 wks (1 RMP) | 20–24 wks (2 RMPs, special categories) | >24 wks (Medical Board)", options:{ bullet:true, fontSize:14, color:C.slate, breakLine:true } }, { text: "Husband's consent is NOT required under the MTP Act", options:{ bullet:true, fontSize:14, color:C.red, breakLine:true } }, { text: "Unmarried women now covered under contraceptive failure clause (2021 Amendment)", options:{ bullet:true, fontSize:14, color:C.slate, breakLine:true } }, { text: "ECTOPIC PREGNANCY", options:{ bold:true, fontSize:17, color:C.teal, breakLine:true } }, { text: "Shoulder tip pain = ruptured ectopic (diaphragmatic irritation by hemoperitoneum)", options:{ bullet:true, fontSize:14, color:C.red, breakLine:true } }, { text: "Paradoxical bradycardia can occur with massive hemoperitoneum — do NOT be falsely reassured", options:{ bullet:true, fontSize:14, color:C.red, breakLine:true } }, { text: "MTX absolute contraindication: ruptured ectopic, IUP, hemodynamic instability", options:{ bullet:true, fontSize:14, color:C.slate, breakLine:true } }, { text: "Anti-D immunoglobulin for ALL Rh-negative women post-ectopic surgery", options:{ bullet:true, fontSize:14, color:C.slate } }, ]); // ── SLIDE 21: SUMMARY (end slide) ── { const s = pres.addSlide(); s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color:C.navy } }); s.addShape(pres.ShapeType.rect, { x:0, y:2.45, w:10, h:0.12, fill:{ color:C.gold } }); s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.2, h:5.625, fill:{ color:C.teal } }); s.addText("Summary", { x:0.4, y:0.5, w:9, h:1.0, fontSize:42, bold:true, color:C.white, fontFace:"Calibri", align:"left" }); s.addText([ { text: "Abortion: ", options:{ bold:true, color:C.gold } }, { text: "Know the types, differentiate by OS status, manage sepsis aggressively\n", options:{ color:"D0EEF0" } }, { text: "MTP Act: ", options:{ bold:true, color:C.gold } }, { text: "2021 amendment — 24-week limit, unmarried women, Medical Board, strict confidentiality\n", options:{ color:"D0EEF0" } }, { text: "Ectopic Pregnancy: ", options:{ bold:true, color:C.gold } }, { text: "High suspicion + TVS + serial hCG. Choose expectant / MTX / surgery based on stability & hCG", options:{ color:"D0EEF0" } }, ], { x:0.4, y:2.7, w:9, h:2.5, fontSize:17, fontFace:"Calibri", valign:"top" }); s.addText("Sources: Berek & Novak's Gynecology | Bailey & Love's Surgery (28e) | Essentials of Forensic Medicine & Toxicology (2026) | Creasy & Resnik's MFM | Roberts & Hedges' Emergency Medicine", { x:0.4, y:5.2, w:9.2, h:0.3, fontSize:9, color:C.gray, fontFace:"Calibri" }); } pres.writeFile({ fileName: "/home/daytona/workspace/abortion-mtp-ectopic/Abortion_MTP_Ectopic.pptx" }) .then(() => console.log("DONE")) .catch(err => { console.error(err); process.exit(1); }); ENDBUILD echo "File written"

Running Command

cd /home/daytona/workspace/abortion-mtp-ectopic && node build.js 2>&1

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cd /home/daytona/workspace/abortion-mtp-ectopic && libreoffice --headless --convert-to pdf Abortion_MTP_Ectopic.pptx --outdir . 2>&1

Running Command

cp /home/daytona/workspace/abortion-mtp-ectopic/Abortion_MTP_Ectopic.pptx /tmp/input.pptx && libreoffice --headless --convert-to pdf /tmp/input.pptx --outdir /tmp/ 2>&1 && cp /tmp/input.pdf /home/daytona/workspace/abortion-mtp-ectopic/Abortion_MTP_Ectopic.pdf && ls -lh /home/daytona/workspace/abortion-mtp-ectopic/

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Presentation Structure (21 slides)

PART 1 — Abortion (6 slides)

Definition & major classification (spontaneous / induced / missed / unsafe)
Types of spontaneous abortion with an OS-state-based comparison table (threatened, inevitable, incomplete, complete, missed, septic, RPL)
Etiology — two-column layout: fetal/chromosomal causes vs. maternal/uterine causes
Management by type (threatened, incomplete, missed, septic, RPL)
Complications of unsafe abortion + global mortality figures

PART 2 — MTP (4 slides)

MTP Act 1971 overview with key sections
Gestational limits table (post-2021): ≤20 wks, 20–24 wks, >24 wks, emergency
2021 Amendment — all 5 key changes (extended limit, unmarried women, Medical Board, confidentiality, consent)
MTP techniques by gestational age + Mifepristone/Misoprostol protocols with efficacy data

PART 3 — Ectopic Pregnancy (6 slides)

Definition, sites (tubal 97%, non-tubal), epidemiology
Risk factors (high vs. moderate/low) — two-column layout
Clinical features including classic triad + rupture signs, paradoxical bradycardia
Investigations: TVS (first-line), discriminatory zone, beta-hCG patterns, ring of fire sign
Management overview (expectant / MTX / surgical)
MTX — mechanism, single-dose vs. multi-dose protocol, absolute & relative contraindications
Surgical options (laparoscopy vs. laparotomy, salpingectomy vs. salpingostomy) + Anti-D
Treatment selection comparison table

Final slide: Clinical pearls and high-yield exam points

Sources: Berek & Novak's Gynecology, Bailey & Love's Surgery (28e), Essentials of Forensic Medicine & Toxicology (2026 edition) for MTP Act, Creasy & Resnik's Maternal-Fetal Medicine, Roberts & Hedges' Emergency Medicine.

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