mkdir -p /home/daytona/workspace/labour-management-pptx && ls /home/daytona/work…

~/labour-management-pptx/build.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Management of First and Second Stage of Labour";
pres.author = "Obstetrics & Gynaecology";

// ─── COLOUR PALETTE ───
const DARK_BG   = "0D2B45";   // deep navy  (title + section dividers)
const MID_BG    = "10415A";   // teal-navy  (secondary slides)
const ACCENT    = "3CB4E5";   // sky blue   (headings / highlights)
const GOLD      = "F0A500";   // amber gold (key figures / numbers)
const LIGHT_TXT = "FFFFFF";
const DARK_TXT  = "1A1A2E";
const CARD_BG   = "F4F9FC";   // very light blue-white
const DIVIDER   = "3CB4E5";
const RED_WARN  = "D73C3C";
const GREEN_OK  = "28A065";

// ─── HELPER: add dark slide with title ───
function darkSlide(title, subtitle) {
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_BG } });
  // accent bar left
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.08, h: 5.625, fill: { color: ACCENT } });
  sl.addText(title, {
    x: 0.35, y: 1.6, w: 9.3, h: 1.2,
    fontSize: 36, bold: true, color: LIGHT_TXT, fontFace: "Calibri", align: "center"
  });
  if (subtitle) {
    sl.addText(subtitle, {
      x: 0.35, y: 2.95, w: 9.3, h: 0.7,
      fontSize: 18, color: ACCENT, fontFace: "Calibri", align: "center", italic: true
    });
  }
  return sl;
}

// ─── HELPER: content slide with title bar ───
function contentSlide(title, accentColor) {
  accentColor = accentColor || ACCENT;
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: "FFFFFF" } });
  // Header bar
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.72, fill: { color: DARK_BG } });
  sl.addText(title, {
    x: 0.3, y: 0.08, w: 9.4, h: 0.56,
    fontSize: 20, bold: true, color: LIGHT_TXT, fontFace: "Calibri", valign: "middle"
  });
  // bottom accent line
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.45, w: 10, h: 0.175, fill: { color: accentColor } });
  return sl;
}

// ─── HELPER: two-column card slide ───
function twoColSlide(title, leftTitle, leftItems, rightTitle, rightItems, leftColor, rightColor) {
  leftColor  = leftColor  || ACCENT;
  rightColor = rightColor || GOLD;
  const sl = contentSlide(title);

  // LEFT card
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.9, w: 4.5, h: 4.4, fill: { color: CARD_BG }, line: { color: leftColor, width: 1.5 } });
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.9, w: 4.5, h: 0.42, fill: { color: leftColor } });
  sl.addText(leftTitle, { x: 0.3, y: 0.9, w: 4.4, h: 0.42, fontSize: 13, bold: true, color: LIGHT_TXT, fontFace: "Calibri", valign: "middle" });
  sl.addText(leftItems.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < leftItems.length - 1, fontSize: 12, color: DARK_TXT, fontFace: "Calibri" } })),
    { x: 0.35, y: 1.38, w: 4.3, h: 3.8 });

  // RIGHT card
  sl.addShape(pres.ShapeType.rect, { x: 5.25, y: 0.9, w: 4.5, h: 4.4, fill: { color: CARD_BG }, line: { color: rightColor, width: 1.5 } });
  sl.addShape(pres.ShapeType.rect, { x: 5.25, y: 0.9, w: 4.5, h: 0.42, fill: { color: rightColor } });
  sl.addText(rightTitle, { x: 5.3, y: 0.9, w: 4.4, h: 0.42, fontSize: 13, bold: true, color: LIGHT_TXT, fontFace: "Calibri", valign: "middle" });
  sl.addText(rightItems.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < rightItems.length - 1, fontSize: 12, color: DARK_TXT, fontFace: "Calibri" } })),
    { x: 5.35, y: 1.38, w: 4.3, h: 3.8 });

  return sl;
}

// ─── HELPER: bullet slide ───
function bulletSlide(title, sections) {
  // sections = [{heading, items}]
  const sl = contentSlide(title);
  let y = 0.88;
  sections.forEach(sec => {
    if (sec.heading) {
      sl.addText(sec.heading, { x: 0.35, y, w: 9.3, h: 0.35, fontSize: 13, bold: true, color: ACCENT, fontFace: "Calibri", margin: 0 });
      y += 0.37;
    }
    const items = sec.items.map((t, i) => ({
      text: t,
      options: { bullet: true, breakLine: i < sec.items.length - 1, fontSize: 12, color: DARK_TXT, fontFace: "Calibri", indentLevel: sec.indent || 0 }
    }));
    sl.addText(items, { x: 0.5, y, w: 9.1, h: sec.items.length * 0.42 });
    y += sec.items.length * 0.42 + 0.12;
  });
  return sl;
}

// ─── HELPER: section divider ───
function sectionDivider(label, subtitle) {
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: MID_BG } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 2.5, w: 10, h: 0.06, fill: { color: GOLD } });
  sl.addText(label, {
    x: 0.5, y: 1.5, w: 9, h: 1.2,
    fontSize: 40, bold: true, color: GOLD, fontFace: "Calibri", align: "center"
  });
  if (subtitle) {
    sl.addText(subtitle, {
      x: 0.5, y: 2.8, w: 9, h: 0.7,
      fontSize: 18, color: LIGHT_TXT, fontFace: "Calibri", align: "center", italic: true
    });
  }
  return sl;
}

// ─── SLIDE 1: TITLE ───
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_BG } });
  // decorative circles
  sl.addShape(pres.ShapeType.ellipse, { x: 7.5, y: -0.8, w: 3.5, h: 3.5, fill: { color: ACCENT, transparency: 85 } });
  sl.addShape(pres.ShapeType.ellipse, { x: -0.8, y: 3.5, w: 2.5, h: 2.5, fill: { color: GOLD, transparency: 80 } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: GOLD } });
  sl.addText("Management of First &\nSecond Stage of Labour", {
    x: 0.4, y: 0.9, w: 9.2, h: 2.0,
    fontSize: 36, bold: true, color: LIGHT_TXT, fontFace: "Calibri", align: "center"
  });
  sl.addShape(pres.ShapeType.rect, { x: 2.5, y: 3.05, w: 5, h: 0.04, fill: { color: ACCENT } });
  sl.addText("A Detailed Clinical Guide for Postgraduate Residents", {
    x: 0.4, y: 3.2, w: 9.2, h: 0.5,
    fontSize: 16, color: ACCENT, fontFace: "Calibri", align: "center", italic: true
  });
  sl.addText("Obstetrics & Gynaecology  |  2026", {
    x: 0.4, y: 5.0, w: 9.2, h: 0.4,
    fontSize: 12, color: "7EB8D4", fontFace: "Calibri", align: "center"
  });
}

// ─── SLIDE 2: OVERVIEW / TABLE OF CONTENTS ───
{
  const sl = contentSlide("Outline");
  const topics = [
    { num: "01", text: "Definitions & Stages of Labour" },
    { num: "02", text: "First Stage — Latent Phase: Assessment & Management" },
    { num: "03", text: "First Stage — Active Phase: Progress & Monitoring" },
    { num: "04", text: "Intrapartum Fetal Monitoring (EFM & CTG Interpretation)" },
    { num: "05", text: "Analgesia in Labour" },
    { num: "06", text: "Abnormal First Stage: Diagnosis & Interventions" },
    { num: "07", text: "Second Stage: Definition, Duration & Conduct" },
    { num: "08", text: "Delivery Technique: Cardinal Movements & Episiotomy" },
    { num: "09", text: "Abnormal Second Stage: Management" },
    { num: "10", text: "Key Take-home Points" },
  ];
  topics.forEach((t, i) => {
    const yy = 0.85 + i * 0.46;
    sl.addShape(pres.ShapeType.rect, { x: 0.3, y: yy, w: 0.45, h: 0.35, fill: { color: ACCENT } });
    sl.addText(t.num, { x: 0.3, y: yy, w: 0.45, h: 0.35, fontSize: 11, bold: true, color: LIGHT_TXT, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    sl.addText(t.text, { x: 0.85, y: yy + 0.02, w: 8.8, h: 0.32, fontSize: 13, color: DARK_TXT, fontFace: "Calibri", valign: "middle" });
  });
}

// ─── SECTION DIVIDER: FIRST STAGE ───
sectionDivider("FIRST STAGE OF LABOUR", "Cervical Stage — from onset to full dilatation (10 cm)");

// ─── SLIDE 3: DEFINITIONS ───
{
  const sl = contentSlide("Definitions & Normal Stages");
  // 4 info boxes
  const boxes = [
    { label: "FIRST STAGE", color: ACCENT,   x: 0.2,  y: 0.88, desc: "Onset of labour → Full cervical dilatation (10 cm)\nLatent + Active phases" },
    { label: "SECOND STAGE", color: GOLD,    x: 5.1,  y: 0.88, desc: "Full dilatation → Delivery of the fetus\nPassive + Active (pushing) phases" },
    { label: "THIRD STAGE",  color: GREEN_OK, x: 0.2,  y: 3.05, desc: "Delivery of fetus → Delivery of placenta & membranes\nPhysiological or Active management" },
    { label: "FOURTH STAGE", color: RED_WARN, x: 5.1,  y: 3.05, desc: "First 1–2 hours postpartum\nMonitoring for PPH, uterine tone, vitals" },
  ];
  boxes.forEach(b => {
    sl.addShape(pres.ShapeType.rect, { x: b.x, y: b.y,     w: 4.6, h: 0.42, fill: { color: b.color } });
    sl.addShape(pres.ShapeType.rect, { x: b.x, y: b.y+0.42, w: 4.6, h: 1.85, fill: { color: CARD_BG }, line: { color: b.color, width: 1 } });
    sl.addText(b.label, { x: b.x+0.05, y: b.y, w: 4.5, h: 0.42, fontSize: 13, bold: true, color: LIGHT_TXT, fontFace: "Calibri", valign: "middle", margin: 4 });
    sl.addText(b.desc, { x: b.x+0.1, y: b.y+0.5, w: 4.4, h: 1.6, fontSize: 12, color: DARK_TXT, fontFace: "Calibri" });
  });
}

// ─── SLIDE 4: PHASES OF FIRST STAGE ───
twoColSlide(
  "First Stage of Labour — Phases",
  "LATENT PHASE",
  [
    "Onset of regular contractions → 3–4 cm dilatation",
    "Cervical effacement & early dilatation",
    "Duration: up to 20 hr (nullipara), 14 hr (multipara)",
    "Contractions: irregular, 5–10 min apart",
    "Management: Supportive (ambulation, hydration)",
    "Therapeutic narcosis if exhausted/prolonged",
    "Avoid unnecessary intervention",
    "Augmentation only if clinical indication exists"
  ],
  "ACTIVE PHASE",
  [
    "3–4 cm → 10 cm dilatation",
    "Rate: ≥1 cm/hr (nullipara), ≥1.2 cm/hr (multipara)",
    "Contractions: 3–5 per 10 min, 45–60 sec duration",
    "Regular vaginal examinations every 4 hours",
    "Descent of presenting part begins",
    "Oxytocin augmentation if progress <1 cm/hr",
    "ARM to augment if membranes intact & slow progress",
    "Continuous fetal monitoring recommended"
  ],
  ACCENT, GOLD
);

// ─── SLIDE 5: ASSESSMENT ON ADMISSION ───
bulletSlide("Assessment on Admission in Labour", [
  { heading: "History", items: ["Gestational age (EDD), parity, previous obstetric history", "Onset & frequency of contractions, status of membranes (SROM?)", "Fetal movement, antenatal complications, blood group, GBS status"] },
  { heading: "Examination", items: ["Vitals: BP, pulse, temp, RR; urinalysis", "Abdominal: fundal height, lie, presentation, engagement (fifths palpable)", "Leopold maneuvers to confirm fetal lie & position", "FHR auscultation; CTG if any concern"] },
  { heading: "Vaginal Examination (VE)", items: ["Cervical dilatation, effacement, consistency & position (Bishop Score)", "Fetal presenting part: station (ischial spines = 0)", "Membranes: intact / ruptured; colour of liquor if draining", "VE deferred if APH until placenta previa excluded"] },
]);

// ─── SLIDE 6: PARTOGRAPH ───
{
  const sl = contentSlide("The Partograph — Monitoring Labour Progress");
  // Alert line box
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.88, w: 9.5, h: 0.5, fill: { color: DARK_BG } });
  sl.addText("WHO Partograph: Plot cervical dilatation vs time — Alert Line & Action Line", {
    x: 0.3, y: 0.88, w: 9.4, h: 0.5, fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri", valign: "middle"
  });

  const rows = [
    ["Parameter", "Details"],
    ["Cervical Dilatation", "Plotted from active phase (≥4 cm). Starts on Alert Line."],
    ["Alert Line", "Expected minimum progress: 1 cm/hr. Crosses from 4 cm (begins)."],
    ["Action Line", "4 hours to the right of Alert Line. Crossing = intervention needed."],
    ["Fetal HR", "Every 30 min in latent; every 15 min in active phase"],
    ["Contractions", "Frequency, duration, strength per 10 min"],
    ["Liquor", "C = clear, M = meconium, B = blood, A = absent"],
    ["Descent", "Fifths of head above pelvic brim (5 = not engaged, 0 = fully engaged)"],
    ["Moulding", "0, 1+, 2+, 3+"],
    ["Maternal vitals", "BP, pulse, temp, urine output per hour"],
  ];
  rows.forEach((row, i) => {
    const yy = 1.48 + i * 0.39;
    const isHeader = i === 0;
    sl.addShape(pres.ShapeType.rect, { x: 0.25, y: yy, w: 2.8, h: 0.37, fill: { color: isHeader ? ACCENT : (i % 2 === 0 ? CARD_BG : "EAF4FA") }, line: { color: ACCENT, width: 0.5 } });
    sl.addShape(pres.ShapeType.rect, { x: 3.1,  y: yy, w: 6.65, h: 0.37, fill: { color: isHeader ? ACCENT : (i % 2 === 0 ? CARD_BG : "EAF4FA") }, line: { color: ACCENT, width: 0.5 } });
    sl.addText(row[0], { x: 0.3,  y: yy+0.02, w: 2.7,  h: 0.33, fontSize: isHeader ? 12 : 11, bold: isHeader, color: isHeader ? LIGHT_TXT : DARK_TXT, fontFace: "Calibri", valign: "middle" });
    sl.addText(row[1], { x: 3.15, y: yy+0.02, w: 6.55, h: 0.33, fontSize: isHeader ? 12 : 11, bold: isHeader, color: isHeader ? LIGHT_TXT : DARK_TXT, fontFace: "Calibri", valign: "middle" });
  });
}

// ─── SLIDE 7: FETAL MONITORING — CTG ───
{
  const sl = contentSlide("Intrapartum Fetal Monitoring — CTG Interpretation");
  sl.addText("DR C BRAVADO Systematic Approach", {
    x: 0.3, y: 0.82, w: 9.4, h: 0.38, fontSize: 14, bold: true, color: ACCENT, fontFace: "Calibri"
  });

  const ctgItems = [
    { code: "DR",  label: "Define Risk",       desc: "Low vs high risk; review obstetric history" },
    { code: "C",   label: "Contractions",       desc: "Frequency, duration — avoid hyperstimulation" },
    { code: "BRa", label: "Baseline Rate",      desc: "Normal: 110–160 bpm; Tachycardia >160; Bradycardia <110" },
    { code: "V",   label: "Variability",        desc: "Normal: 5–25 bpm. Reduced <5 bpm ≥40 min = concerning" },
    { code: "A",   label: "Accelerations",      desc: ">15 bpm rise, >15 sec. Reassuring sign of fetal well-being" },
    { code: "D",   label: "Decelerations",      desc: "Early (head compression) / Late (UPI) / Variable (cord compression)" },
    { code: "O",   label: "Overall Assessment", desc: "Normal / Suspicious / Pathological — act accordingly" },
  ];
  ctgItems.forEach((item, i) => {
    const yy = 1.3 + i * 0.56;
    sl.addShape(pres.ShapeType.rect, { x: 0.25, y: yy, w: 0.7, h: 0.44, fill: { color: ACCENT } });
    sl.addText(item.code, { x: 0.25, y: yy, w: 0.7, h: 0.44, fontSize: 12, bold: true, color: LIGHT_TXT, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    sl.addText(item.label, { x: 1.05, y: yy+0.02, w: 2.5, h: 0.4, fontSize: 12, bold: true, color: DARK_TXT, fontFace: "Calibri", valign: "middle" });
    sl.addText(item.desc,  { x: 3.7,  y: yy+0.02, w: 6.1, h: 0.4, fontSize: 12, color: DARK_TXT, fontFace: "Calibri", valign: "middle" });
    sl.addShape(pres.ShapeType.line, { x: 0.25, y: yy+0.46, w: 9.5, h: 0, line: { color: "D0E8F2", width: 0.5 } });
  });
}

// ─── SLIDE 8: CTG CATEGORIES ───
{
  const sl = contentSlide("CTG Classification & Management");
  const cats = [
    { cat: "NORMAL",      color: GREEN_OK, criteria: ["Baseline 110–160 bpm", "Variability 5–25 bpm", "Accelerations present", "No late/variable decelerations"], action: "Continue routine monitoring. No intervention needed." },
    { cat: "SUSPICIOUS",  color: GOLD,     criteria: ["1 non-reassuring feature:", "Baseline 100–109 or 161–180 bpm", "Variability <5 bpm for 30–50 min", "Prolonged deceleration >3 min"], action: "Increase vigilance. Correct reversible causes (position, oxytocin). Notify senior." },
    { cat: "PATHOLOGICAL",color: RED_WARN, criteria: ["≥2 non-reassuring features, OR", "≥1 abnormal feature:", "Baseline <100 or >180 bpm", "Sinusoidal pattern ≥10 min", "Variable/late decels with poor variability"], action: "Urgent review. FBS if feasible. Consider immediate delivery. Category 1 CS if needed." },
  ];
  cats.forEach((c, i) => {
    const yy = 0.86;
    const xx = 0.25 + i * 3.25;
    sl.addShape(pres.ShapeType.rect, { x: xx, y: yy, w: 3.1, h: 0.44, fill: { color: c.color } });
    sl.addText(c.cat, { x: xx, y: yy, w: 3.1, h: 0.44, fontSize: 14, bold: true, color: LIGHT_TXT, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    sl.addShape(pres.ShapeType.rect, { x: xx, y: yy+0.44, w: 3.1, h: 2.6, fill: { color: CARD_BG }, line: { color: c.color, width: 1 } });
    sl.addText(c.criteria.map((t, j) => ({ text: t, options: { bullet: true, breakLine: j < c.criteria.length - 1, fontSize: 11, color: DARK_TXT, fontFace: "Calibri" } })),
      { x: xx+0.1, y: yy+0.52, w: 2.9, h: 2.4 });
    sl.addShape(pres.ShapeType.rect, { x: xx, y: yy+3.1, w: 3.1, h: 0.08, fill: { color: c.color } });
    sl.addShape(pres.ShapeType.rect, { x: xx, y: yy+3.18, w: 3.1, h: 1.5, fill: { color: CARD_BG }, line: { color: c.color, width: 1 } });
    sl.addText("ACTION: " + c.action, { x: xx+0.1, y: yy+3.22, w: 2.9, h: 1.35, fontSize: 11, color: c.color, bold: true, fontFace: "Calibri", wrap: true });
  });
}

// ─── SLIDE 9: ANALGESIA IN LABOUR ───
twoColSlide(
  "Analgesia in Labour",
  "NON-PHARMACOLOGICAL",
  [
    "Breathing techniques & Lamaze",
    "Continuous labour support (doula/midwife)",
    "Hydrotherapy (warm water immersion)",
    "TENS (Transcutaneous Electrical Nerve Stimulation)",
    "Ambulation & position changes",
    "Massage & counterpressure",
    "Heat/cold application"
  ],
  "PHARMACOLOGICAL",
  [
    "Entonox (50% N₂O/O₂) — inhalational, quick onset",
    "Systemic opioids: Pethidine 50–100 mg IM (may cause neonatal resp. depression — have naloxone ready)",
    "Epidural analgesia: GOLD STANDARD\n  - Bolus LA (bupivacaine 0.1%) + fentanyl\n  - Combined spinal-epidural (CSE)\n  - Continuous infusion / PCEA",
    "Spinal analgesia for rapid analgesia",
    "Pudendal nerve block: 2nd stage / instrumental"
  ],
  ACCENT, GOLD
);

// ─── SLIDE 10: ABNORMAL FIRST STAGE ───
{
  const sl = contentSlide("Abnormal First Stage — Dystocia");
  sl.addText("3Ps Framework: Powers • Passenger • Passage", {
    x: 0.3, y: 0.82, w: 9.4, h: 0.4, fontSize: 14, bold: true, color: ACCENT, fontFace: "Calibri"
  });

  const items = [
    { cat: "POWERS", color: ACCENT,   bg: "EAF7FF", items: ["Uterine hypotonia: inadequate contractions", "Dx: <3 contractions/10 min or <25 mmHg intensity", "Rx: ARM + Oxytocin augmentation (titrate carefully)", "Hyperstimulation (>5 contractions/10 min) → stop oxytocin, tocolysis if fetal distress"] },
    { cat: "PASSENGER", color: GOLD,  bg: "FFF8E7", items: ["CPD: head too large for pelvis (X-ray pelvimetry)", "Malposition: OP, OT — trial of rotation (manual / forceps)", "Malpresentation: face, brow, compound — assess individually", "Macrosomia: shoulder dystocia risk — have protocol ready"] },
    { cat: "PASSAGE", color: GREEN_OK, bg: "EAFAF1", items: ["Pelvic contraction (android/platypelloid pelvis)", "Soft tissue obstruction: fibroids, cervical rigidity", "True CPD or borderline → Trial of labour → CS if fails", "Obstructed labour: prolonged + caput/moulding 3+ → immediate CS"] },
  ];
  items.forEach((item, i) => {
    const xx = 0.25 + i * 3.25;
    sl.addShape(pres.ShapeType.rect, { x: xx, y: 1.32, w: 3.1, h: 0.42, fill: { color: item.color } });
    sl.addText(item.cat, { x: xx, y: 1.32, w: 3.1, h: 0.42, fontSize: 13, bold: true, color: LIGHT_TXT, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    sl.addShape(pres.ShapeType.rect, { x: xx, y: 1.74, w: 3.1, h: 3.6, fill: { color: item.bg }, line: { color: item.color, width: 1 } });
    sl.addText(item.items.map((t, j) => ({ text: t, options: { bullet: true, breakLine: j < item.items.length - 1, fontSize: 11, color: DARK_TXT, fontFace: "Calibri" } })),
      { x: xx+0.1, y: 1.82, w: 2.9, h: 3.4 });
  });
}

// ─── SECTION DIVIDER: SECOND STAGE ───
sectionDivider("SECOND STAGE OF LABOUR", "Expulsive Stage — from full dilatation to delivery of the fetus");

// ─── SLIDE 11: SECOND STAGE DEFINITION ───
twoColSlide(
  "Second Stage of Labour — Definition & Duration",
  "DEFINITION & PHASES",
  [
    "Begins: Full cervical dilatation (10 cm)",
    "Ends: Complete delivery of the fetus",
    "PASSIVE phase: Full dilatation but no urge to push (fetus descending passively)",
    "ACTIVE phase: Active maternal pushing with contractions",
    "Pushing should begin when urge felt or presenting part ≤+2 station",
  ],
  "NORMAL DURATION",
  [
    "Nulliparous (no epidural): ≤2 hours",
    "Nulliparous (with epidural): ≤3 hours",
    "Multiparous (no epidural): ≤1 hour",
    "Multiparous (with epidural): ≤2 hours",
    "Prolonged 2nd stage increases risk of: PPH, infection, neonatal acidosis, obstetric anal sphincter injury (OASI)",
    "Continuous fetal monitoring mandatory"
  ],
  ACCENT, GOLD
);

// ─── SLIDE 12: CARDINAL MOVEMENTS ───
{
  const sl = contentSlide("Cardinal Movements of Labour (Vertex Presentation)");
  const moves = [
    { n: "1", title: "Engagement",    desc: "Biparietal diameter passes through pelvic inlet; head at 0 station" },
    { n: "2", title: "Descent",       desc: "Progressive descent through pelvis; occurs throughout labour" },
    { n: "3", title: "Flexion",       desc: "Chin on chest — smallest diameter (suboccipitobregmatic 9.5 cm) presents" },
    { n: "4", title: "Internal Rotation", desc: "Occiput rotates anteriorly to OA position as head reaches pelvic floor" },
    { n: "5", title: "Extension",     desc: "Head extends at vulva; occiput under symphysis pubis as pivot" },
    { n: "6", title: "Restitution",   desc: "Head rotates back to original position (undoes internal rotation)" },
    { n: "7", title: "External Rotation", desc: "Shoulders align with AP diameter of outlet; head rotates to face thigh" },
    { n: "8", title: "Expulsion",     desc: "Anterior then posterior shoulder delivered; rest of body follows" },
  ];
  moves.forEach((m, i) => {
    const col = i < 4 ? 0 : 1;
    const row = i < 4 ? i : i - 4;
    const xx = 0.25 + col * 5.0;
    const yy = 0.88 + row * 1.14;
    sl.addShape(pres.ShapeType.rect, { x: xx, y: yy, w: 0.5, h: 0.5, fill: { color: ACCENT } });
    sl.addText(m.n, { x: xx, y: yy, w: 0.5, h: 0.5, fontSize: 13, bold: true, color: LIGHT_TXT, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    sl.addText(m.title, { x: xx+0.6, y: yy+0.02, w: 3.8, h: 0.28, fontSize: 13, bold: true, color: DARK_BG, fontFace: "Calibri", valign: "middle" });
    sl.addText(m.desc, { x: xx+0.6, y: yy+0.3, w: 4.1, h: 0.7, fontSize: 11, color: DARK_TXT, fontFace: "Calibri", wrap: true });
    sl.addShape(pres.ShapeType.line, { x: xx, y: yy+1.05, w: 4.65, h: 0, line: { color: "DDEEF5", width: 0.5 } });
  });
}

// ─── SLIDE 13: CONDUCT OF DELIVERY ───
bulletSlide("Conduct of Normal Delivery — Second Stage", [
  { heading: "Preparation", items: [
    "Position: Dorsal lithotomy / left lateral (Sim's) / all-fours / upright — patient's choice",
    "Ensure radiant warmer on, neonatal resuscitation equipment ready",
    "Sterile draping; scrub perineum with sterile saline",
    "Pudendal nerve block or perineal infiltration with lignocaine if needed"
  ]},
  { heading: "Pushing Technique", items: [
    "Directed pushing: Valsalva (closed glottis) with contractions — 3 pushes × 10 sec per contraction",
    "Breathing/open glottis (laboring down) — preferred with epidural in passive phase",
    "Coach mother between contractions; encourage rest"
  ]},
  { heading: "Head Delivery", items: [
    "Ritgen maneuver: steady pressure on occiput; upward pressure on fetal chin via perineum",
    "Control head delivery to reduce perineal trauma",
    "Check for nuchal cord — slip over head or double-clamp-cut if tight",
    "Suction mouth and nose if meconium-stained liquor"
  ]},
  { heading: "Shoulder & Body Delivery", items: [
    "Gentle downward traction for anterior shoulder, upward for posterior",
    "Body delivers by lateral flexion",
    "Note time of birth; Apgar at 1 and 5 minutes"
  ]},
]);

// ─── SLIDE 14: EPISIOTOMY ───
twoColSlide(
  "Episiotomy — Indications, Technique & Repair",
  "INDICATIONS (Selective — NOT routine)",
  [
    "Instrumental delivery (forceps/ventouse)",
    "Fetal distress requiring expedited delivery",
    "Rigid perineum threatening severe tear",
    "Shoulder dystocia",
    "Preterm delivery (evidence limited)",
    "Previous severe perineal trauma",
    "Mediolateral preferred over midline — lower risk of 3rd/4th degree tear"
  ],
  "REPAIR (3-LAYER CLOSURE)",
  [
    "Ensure adequate analgesia (local infiltration / epidural top-up)",
    "Layer 1 — Vaginal mucosa: continuous suture (Vicryl 2/0) from apex",
    "Layer 2 — Perineal muscles: interrupted or continuous sutures",
    "Layer 3 — Skin: continuous subcuticular suture (Vicryl 2/0 or 3/0)",
    "Rectal examination post-repair to ensure no suture through rectum",
    "Document: extent of tear, repair technique, sutures used, analgesia given"
  ],
  ACCENT, GOLD
);

// ─── SLIDE 15: ABNORMAL SECOND STAGE ───
{
  const sl = contentSlide("Abnormal Second Stage — Recognition & Management");
  sl.addText("Prolonged Second Stage + Fetal Distress = Urgent Intervention", {
    x: 0.3, y: 0.82, w: 9.4, h: 0.38, fontSize: 13, bold: true, color: RED_WARN, fontFace: "Calibri"
  });

  const cols = [
    { title: "FETAL DISTRESS", color: RED_WARN, bg: "FFF0F0", items: [
      "CTG: late decels + ↓variability, prolonged bradycardia",
      "Meconium-stained liquor (grade II/III)",
      "Scalp pH <7.20 or lactate >4.8 mmol/L",
      "Action: Stop oxytocin, left lateral position, O₂, IV hydration",
      "If not delivered imminently → instrumental or Category 1 CS"
    ]},
    { title: "ARREST OF DESCENT", color: GOLD, bg: "FFFBEA", items: [
      "No progress in 1 hour (nullipara) despite active pushing",
      "Assess: rotation, asynclitism, moulding",
      "If head ≤+2 station and no CPD → instrumental delivery",
      "Ventouse (vacuum): preferred if OP or asynclitism",
      "Forceps: preferred if face presentation or <34 wks",
      "If head high / CPD → CS"
    ]},
    { title: "SHOULDER DYSTOCIA", color: "8B44AC", bg: "FAF0FF", items: [
      "Call for help immediately (HELPERR mnemonic)",
      "H — Call for Help",
      "E — Episiotomy (if needed for maneuvers)",
      "L — Legs (McRoberts: hyperflex thighs)",
      "P — Suprapubic Pressure (Rubin II)",
      "E — Enter (internal rotational maneuvers)",
      "R — Remove posterior arm",
      "R — Roll to all-fours (Gaskin maneuver)"
    ]},
  ];
  cols.forEach((c, i) => {
    const xx = 0.25 + i * 3.25;
    sl.addShape(pres.ShapeType.rect, { x: xx, y: 1.32, w: 3.1, h: 0.42, fill: { color: c.color } });
    sl.addText(c.title, { x: xx, y: 1.32, w: 3.1, h: 0.42, fontSize: 12, bold: true, color: LIGHT_TXT, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    sl.addShape(pres.ShapeType.rect, { x: xx, y: 1.74, w: 3.1, h: 3.7, fill: { color: c.bg }, line: { color: c.color, width: 1 } });
    sl.addText(c.items.map((t, j) => ({ text: t, options: { bullet: true, breakLine: j < c.items.length - 1, fontSize: 11, color: DARK_TXT, fontFace: "Calibri" } })),
      { x: xx+0.1, y: 1.82, w: 2.9, h: 3.5 });
  });
}

// ─── SLIDE 16: KEY TAKEAWAYS ───
{
  const sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_BG } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.8, fill: { color: ACCENT } });
  sl.addText("Key Take-Home Points", { x: 0.4, y: 0.1, w: 9.2, h: 0.6, fontSize: 22, bold: true, color: LIGHT_TXT, fontFace: "Calibri", align: "center", valign: "middle" });

  const points = [
    { icon: "01", text: "Active phase begins at ≥3–4 cm. Expected progress ≥1 cm/hr. Plot on partograph and act at Action Line." },
    { icon: "02", text: "CTG must be interpreted systematically (DR C BRAVADO). Pathological CTG = urgent escalation." },
    { icon: "03", text: "Oxytocin augmentation requires continuous CTG — watch for hyperstimulation (>5 contractions/10 min)." },
    { icon: "04", text: "Epidural does NOT mandate CS. Prolong active 2nd stage allowance (nullipara 3 hr, multipara 2 hr with epidural)." },
    { icon: "05", text: "Shoulder dystocia — HELPERR. Call for help first. McRoberts + suprapubic pressure resolves >50% of cases." },
    { icon: "06", text: "Episiotomy is SELECTIVE, not routine. Document all perineal trauma and repair carefully." },
    { icon: "07", text: "Obstructed labour = emergency. Moulding 3+, absent liquor, maternal ketosis → immediate senior review + CS." },
  ];

  points.forEach((p, i) => {
    const yy = 0.96 + i * 0.64;
    sl.addShape(pres.ShapeType.rect, { x: 0.35, y: yy, w: 0.48, h: 0.48, fill: { color: GOLD } });
    sl.addText(p.icon, { x: 0.35, y: yy, w: 0.48, h: 0.48, fontSize: 12, bold: true, color: DARK_BG, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    sl.addText(p.text, { x: 0.95, y: yy+0.04, w: 8.7, h: 0.44, fontSize: 12, color: LIGHT_TXT, fontFace: "Calibri", valign: "middle", wrap: true });
  });
}

// ─── SLIDE 17: REFERENCES ───
{
  const sl = contentSlide("References");
  const refs = [
    "Creasy & Resnik's Maternal-Fetal Medicine: Principles and Practice, 8th ed. (Elsevier, 2022) — Chapters on Normal Labor and Labor Abnormalities",
    "Rosen's Emergency Medicine: Concepts and Clinical Practice, 9th ed. — Chapter 176: Labor and Delivery",
    "ACOG Practice Bulletin No. 49: Dystocia and Augmentation of Labor",
    "ACOG Practice Bulletin No. 116: Management of Intrapartum Fetal Heart Rate Tracings",
    "NICE Guideline NG235: Intrapartum Care for Healthy Women and Babies (2023 update)",
    "WHO: Managing Complications in Pregnancy and Childbirth — Use of the Partograph",
    "Park's Textbook of Preventive and Social Medicine, 26th ed. — Care during Labour and Childbirth",
    "RCOG Green-top Guideline No. 42: Shoulder Dystocia (2012)",
  ];
  refs.forEach((r, i) => {
    sl.addText(`${i + 1}.  ${r}`, {
      x: 0.35, y: 0.88 + i * 0.58, w: 9.3, h: 0.5,
      fontSize: 11.5, color: DARK_TXT, fontFace: "Calibri", wrap: true
    });
    if (i < refs.length - 1) {
      sl.addShape(pres.ShapeType.line, { x: 0.35, y: 1.36 + i * 0.58, w: 9.3, h: 0, line: { color: "D5E8F0", width: 0.5 } });
    }
  });
}

// ─── FINAL SLIDE ───
darkSlide("Thank You", "Questions & Discussion — Management of First & Second Stage of Labour");

// WRITE FILE
pres.writeFile({ fileName: "/home/daytona/workspace/labour-management-pptx/Labour_Management_First_Second_Stage.pptx" })
  .then(() => console.log("SUCCESS: File written."))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

cd /home/daytona/workspace/labour-management-pptx && node build.js 2>&1

ls -lh /home/daytona/workspace/labour-management-pptx/

Medical infographic titled "Cardinal Movements of Labour" showing all 8 steps in sequence. Clean clinical illustration style with numbered steps in a flowing diagram layout. Each step has a small anatomical diagram of the fetal head position in the pelvis viewed from below or side, plus a short label and description. Steps shown in order: 1. Engagement - biparietal diameter at pelvic inlet, 2. Descent - progressive downward movement, 3. Flexion - chin on chest, smallest diameter, 4. Internal Rotation - occiput rotates to OA position, 5. Extension - head extends under symphysis pubis, 6. Restitution - head rotates back to natural position, 7. External Rotation - shoulders align, 8. Expulsion - delivery of body. Use a navy blue and teal color scheme with gold accent numbers. Include small pelvic cross-section diagrams for each step showing head position. Professional obstetrics textbook quality. Clean white background with clear arrows showing progression between steps. Include a small legend showing fetal head orientation symbols.