"postpartum hemorrhage" management

"abortion" management guidelines

WHO ACOG FIGO abortion guidelines 2024 2025 medical management

mkdir -p /home/daytona/workspace/abortion-lecture && ls /home/daytona/workspace/…

~/abortion-lecture/build.js

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// ══════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ══════════════════════════════════════════════════════════════
titleSlide(
  "ABORTION",
  "Classification · Etiology · Clinical Features · Management · Guidelines"
);

// ══════════════════════════════════════════════════════════════
// SLIDE 2 — LEARNING OBJECTIVES
// ══════════════════════════════════════════════════════════════
contentSlide("Learning Objectives", [
  "Define abortion and distinguish spontaneous from induced types",
  "Classify clinical types of spontaneous abortion with their features",
  "Identify aetiology and risk factors for pregnancy loss",
  "Describe diagnostic workup: β-hCG, ultrasound, lab investigations",
  "Apply stepwise management for each type of abortion",
  "Outline medical (misoprostol/mifepristone) and surgical options",
  "Recognize and manage complications: septic abortion, DIC",
  "Interpret current WHO 2022 & ACOG 2024 guidelines on safe abortion care"
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 3 — DEFINITION
// ══════════════════════════════════════════════════════════════
contentSlide("Definition of Abortion", [
  { text: "WHO Definition:", bold: true, sub: ["Expulsion or extraction of an embryo/fetus weighing ≤500 g (or <20 weeks gestation) from the mother"] },
  { text: "Traditional definition:", bold: true, sub: ["Termination of pregnancy before viability — i.e., before 28 weeks (older texts) or before 20 weeks (modern definition)"] },
  { text: "Incidence:", bold: true, sub: ["Approximately 20–40% of all pregnancies abort spontaneously", "~75% of spontaneous abortions occur before 8 weeks gestation", "Globally: ~56 million abortions per year (2010–2014)"] },
  { text: "Key fact:", bold: true, sub: ["'Viability' now set at 22–24 weeks with NICU support in high-resource settings"] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 4 — SECTION 1 COVER
// ══════════════════════════════════════════════════════════════
sectionCover("01", "Classification", "Types of Abortion");

// ══════════════════════════════════════════════════════════════
// SLIDE 5 — CLASSIFICATION OVERVIEW
// ══════════════════════════════════════════════════════════════
contentSlide("Classification of Abortion", [
  { text: "A. By Cause:", bold: true, sub: ["1. Spontaneous abortion (miscarriage) — unintentional, no intervention", "2. Induced abortion — deliberate termination (therapeutic or elective)"] },
  { text: "B. By Gestational Age:", bold: true, sub: ["Early abortion: ≤12 weeks", "Late abortion: 13–20 weeks"] },
  { text: "C. By Safety (WHO):", bold: true, sub: ["Safe: performed by trained personnel using WHO-recommended methods", "Less safe: only one criterion met", "Unsafe: neither criterion met — accounts for ~25 million abortions/year"] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 6 — TYPES TABLE (SPONTANEOUS)
// ══════════════════════════════════════════════════════════════
tableSlide(
  "Clinical Types of Spontaneous Abortion",
  ["Type", "Bleeding", "Cervical Os", "Products Passed", "Management"],
  [
    ["Threatened", "Yes (mild–mod)", "CLOSED", "None", "Conservative; pelvic rest"],
    ["Inevitable", "Moderate–heavy", "OPEN", "None yet", "Evacuation of uterus"],
    ["Incomplete", "Heavy", "Open", "Partial", "Uterine evacuation (MVA/D&C)"],
    ["Complete", "Decreasing", "Closed/closing", "All passed", "Observation; follow-up"],
    ["Missed", "Absent or scant", "Closed", "None (fetal death)", "Medical or surgical evacuation"],
    ["Septic", "Variable ± foul", "Usually open", "Variable", "IV antibiotics + evacuation"],
    ["Recurrent", "Repeated (≥3)", "Varies", "Varies", "Investigate cause; specialist referral"],
  ]
);

// ══════════════════════════════════════════════════════════════
// SLIDE 7 — SECTION 2 COVER
// ══════════════════════════════════════════════════════════════
sectionCover("02", "Aetiology & Risk Factors", "Why does pregnancy loss occur?");

// ══════════════════════════════════════════════════════════════
// SLIDE 8 — FOETAL CAUSES
// ══════════════════════════════════════════════════════════════
twoColumnSlide(
  "Aetiology of Spontaneous Abortion",
  "Fetal / Genetic Causes",
  [
    "Chromosomal abnormalities — MOST COMMON (50–60%)",
    "Autosomal trisomies (most frequent)",
    "Monosomy X (Turner syndrome)",
    "Triploidy / tetraploidy",
    "Structural chromosomal defects",
    "Single gene disorders",
    "Teratogen exposure"
  ],
  "Maternal Causes",
  [
    "Advanced maternal age (>35 yrs)",
    "Uterine anomalies (septate, bicornuate uterus)",
    "Incompetent cervix",
    "Antiphospholipid syndrome (APS)",
    "Hypothyroidism / uncontrolled DM",
    "PCOS",
    "Infections: TORCH, syphilis, HIV",
    "Thrombophilias",
    "Smoking, alcohol, heavy metals"
  ]
);

// ══════════════════════════════════════════════════════════════
// SLIDE 9 — RISK FACTORS
// ══════════════════════════════════════════════════════════════
contentSlide("Risk Factors for Pregnancy Loss", [
  { text: "Non-modifiable:", bold: true, sub: ["Advanced maternal age (risk doubles after 35, >50% after 40)", "Prior pregnancy loss (3+ losses → recurrent pregnancy loss)", "Genetic: balanced chromosomal translocation in either parent"] },
  { text: "Modifiable / Treatable:", bold: true, sub: ["Antiphospholipid syndrome — treatable with LMWH + aspirin", "Thyroid disease — normalize TSH before conception", "Obesity, uncontrolled diabetes", "Smoking (doubles risk), alcohol, cocaine"] },
  { text: "Uterine factors:", bold: true, sub: ["Submucosal fibroids, intrauterine adhesions (Asherman's)", "Uterine septum — surgical correction improves outcomes"] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 10 — SECTION 3 COVER
// ══════════════════════════════════════════════════════════════
sectionCover("03", "Diagnosis & Investigations", "Clinical assessment and workup");

// ══════════════════════════════════════════════════════════════
// SLIDE 11 — CLINICAL FEATURES
// ══════════════════════════════════════════════════════════════
contentSlide("Clinical Features", [
  { text: "Symptoms:", bold: true, sub: ["Vaginal bleeding (most common presenting complaint)", "Lower abdominal cramps / pelvic pain", "Passage of tissue or clots", "Shoulder tip pain (if intraperitoneal bleed — rule out ectopic!)"] },
  { text: "Signs:", bold: true, sub: ["Assess hemodynamic stability first (BP, HR)", "Per-speculum: amount/source of bleeding, cervical os status, visible tissue", "Bimanual: uterine size, tenderness (adnexal mass → ectopic)"] },
  { text: "Red flags:", bold: true, sub: ["Hemodynamic instability → hemorrhagic shock", "Fever + offensive discharge → septic abortion", "Unilateral adnexal tenderness → rule out ectopic (DO NOT MISS)"] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 12 — INVESTIGATIONS
// ══════════════════════════════════════════════════════════════
contentSlide("Investigations", [
  { text: "1. Serum β-hCG:", bold: true, sub: ["Quantitative — diagnose pregnancy, assess viability", "Discriminatory zone: 1,500–2,000 mIU/mL — intrauterine pregnancy should be visible on TVUS", "Serial β-hCG (48-hr rise): Normal IUP rises ≥53%; plateau/fall → ectopic or non-viable"] },
  { text: "2. Ultrasound (TVUS preferred):", bold: true, sub: ["Gestational sac visible at 4.5 wks, yolk sac at 5 wks, fetal pole + cardiac activity at 6 wks", "CRL >7 mm without cardiac activity = missed abortion", "Mean sac diameter >25 mm without embryo = anembryonic pregnancy (blighted ovum)"] },
  { text: "3. Blood investigations:", bold: true, sub: ["CBC (assess blood loss), blood group and Rh factor, coagulation screen (PT, APTT, fibrinogen) if heavy bleeding", "Urine/blood culture if septic abortion suspected"] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 13 — SECTION 4 COVER
// ══════════════════════════════════════════════════════════════
sectionCover("04", "Management", "Evidence-based, type-specific treatment");

// ══════════════════════════════════════════════════════════════
// SLIDE 14 — THREATENED ABORTION
// ══════════════════════════════════════════════════════════════
contentSlide("Management: Threatened Abortion", [
  "Definition: Vaginal bleeding in first half of pregnancy with CLOSED cervical os",
  "~50% will progress to complete abortion; ~50% continue normally",
  { text: "Management:", bold: true, sub: [
    "No proven intervention prevents miscarriage — miscarriage cannot be stopped if destined to occur",
    "Pelvic rest: avoid intercourse and tampons (reduce infection risk)",
    "Bed rest: NOT proven effective (may advise for reassurance)",
    "Progesterone supplementation: ACOG 2023 — use only if recurrent pregnancy loss history",
    "Serial β-hCG + repeat TVUS in 1–2 weeks to assess viability",
    "Reassure and discharge with clear return precautions"
  ] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 15 — INEVITABLE + INCOMPLETE ABORTION
// ══════════════════════════════════════════════════════════════
contentSlide("Management: Inevitable & Incomplete Abortion", [
  { text: "Inevitable Abortion (open os, no tissue passed):", bold: true, sub: [
    "Hemodynamically stable → misoprostol 800 mcg vaginally/sublingually OR manual vacuum aspiration (MVA)",
    "Unstable → surgical evacuation immediately"
  ] },
  { text: "Incomplete Abortion (partial tissue passed, open os):", bold: true, sub: [
    "Medical: Misoprostol 600 mcg oral OR 800 mcg vaginal (WHO recommended)",
    "Surgical: Manual Vacuum Aspiration (MVA) — preferred in < 12 weeks; D&C for later gestation",
    "Expectant management: acceptable if clinically stable (complete passage in 7–14 days in most)"
  ] },
  { text: "Rh negative patients:", bold: true, sub: [
    "Anti-D immunoglobulin — give within 72 hours",
    "ACOG / SMFM 2024: Anti-D NOT required if gestation < 12 weeks (updated guidance)"
  ] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 16 — MISSED ABORTION
// ══════════════════════════════════════════════════════════════
contentSlide("Management: Missed Abortion", [
  "Definition: Fetal death <20 weeks without expulsion of tissue (os closed)",
  { text: "3 options (patient choice after counselling):", bold: true, sub: [
    "1. Expectant: wait for natural expulsion (may take 2–4 weeks; risk DIC if prolonged)",
    "2. Medical: Mifepristone 200 mg oral followed 24–48 hrs later by misoprostol 800 mcg vaginal",
    "3. Surgical: MVA (<12 wks) or D&E (12–20 wks)"
  ] },
  { text: "WHO 2022 Recommendation:", bold: true, sub: [
    "Mifepristone + misoprostol combination preferred over misoprostol alone — higher efficacy",
    "Misoprostol alone effective where mifepristone unavailable"
  ] },
  "Monitor with TVUS after 1–2 weeks to confirm complete expulsion"
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 17 — SEPTIC ABORTION
// ══════════════════════════════════════════════════════════════
contentSlide("Management: Septic Abortion", [
  "Infection during any stage of abortion — OBSTETRIC EMERGENCY",
  { text: "Features:", bold: true, sub: ["Fever >38°C, offensive/purulent vaginal discharge, uterine tenderness, tachycardia", "May progress to septic shock and DIC"] },
  { text: "Management — ABC first:", bold: true, sub: [
    "A–C resuscitation: IV fluids, oxygen, catheterise (urine output monitoring)",
    "Broad-spectrum IV antibiotics IMMEDIATELY: e.g., Ampicillin + Gentamicin + Metronidazole",
    "Uterine evacuation — DO NOT delay after antibiotic loading dose (within 6–12 hours)",
    "Blood cultures × 2 before antibiotics if possible",
    "Monitor for DIC: CBC, PT, APTT, fibrinogen, D-dimer"
  ] },
  "Hysterectomy reserved for: perforation, clostridial infection, gas gangrene, failure of conservative management"
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 18 — RECURRENT PREGNANCY LOSS
// ══════════════════════════════════════════════════════════════
contentSlide("Recurrent Pregnancy Loss (RPL)", [
  "Definition: ≥3 consecutive pregnancy losses < 20 weeks (ACOG) | ≥2 losses (ESHRE 2023 / SOGC 2025)",
  "Affects ~1–2% of couples trying to conceive",
  { text: "Investigation (SOGC 2025 / ESHRE 2023):", bold: true, sub: [
    "Antiphospholipid antibodies (lupus anticoagulant, anticardiolipin IgG/IgM, anti-β2GPI)",
    "Parental karyotype (if products of conception show structural chromosomal abnormality)",
    "Uterine cavity assessment: sonohysterography or hysteroscopy",
    "Thrombophilia screen (selected cases)",
    "Thyroid function (TSH, anti-TPO antibodies)"
  ] },
  { text: "Treatment:", bold: true, sub: [
    "APS: LMWH + low-dose aspirin significantly reduces pregnancy loss",
    "Septum: hysteroscopic resection",
    "Thyroid: normalize TSH before next conception",
    "~50% of couples with unexplained RPL achieve live birth with supportive care alone"
  ] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 19 — SECTION 5 COVER
// ══════════════════════════════════════════════════════════════
sectionCover("05", "Induced Abortion", "Medical & Surgical Methods");

// ══════════════════════════════════════════════════════════════
// SLIDE 20 — MEDICAL ABORTION
// ══════════════════════════════════════════════════════════════
contentSlide("Medical Abortion — Methods & Regimens", [
  { text: "Mifepristone + Misoprostol (combination — GOLD STANDARD, WHO Essential Medicine):", bold: true, sub: [
    "≤12 weeks: Mifepristone 200 mg PO → 24–48 hrs later → Misoprostol 800 mcg vaginally/sublingually",
    "13–24 weeks: Mifepristone 200 mg → 36–48 hrs → Misoprostol 400 mcg SL q3h (max 5 doses)",
    "Efficacy: 95–98% complete abortion"
  ] },
  { text: "Misoprostol alone (where mifepristone unavailable):", bold: true, sub: [
    "800 mcg vaginally/sublingually — repeated doses",
    "Efficacy ~80–85% (lower than combination)"
  ] },
  { text: "Mechanism:", bold: true, sub: [
    "Mifepristone: antiprogestogen → sensitizes uterus to prostaglandins",
    "Misoprostol: PGE1 analogue → cervical ripening + uterine contractions"
  ] },
  "Side effects: cramping, nausea/vomiting, diarrhoea, fever (check for sepsis if fever persists >24 hrs)"
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 21 — SURGICAL ABORTION
// ══════════════════════════════════════════════════════════════
contentSlide("Surgical Abortion — Methods", [
  { text: "Manual Vacuum Aspiration (MVA):", bold: true, sub: [
    "Gestational age: up to 12–14 weeks",
    "Technique: local anaesthesia, cervical dilatation, aspiration via handheld syringe",
    "Safe, effective, can be performed at primary care level"
  ] },
  { text: "Electric Vacuum Aspiration (EVA) / Suction Curettage:", bold: true, sub: [
    "Similar to MVA but uses electric pump; used up to 14 weeks",
    "D&C (sharp curettage) — now largely replaced by vacuum aspiration (WHO)"
  ] },
  { text: "Dilation and Evacuation (D&E):", bold: true, sub: [
    "13–24 weeks gestation",
    "Requires pre-operative cervical preparation (osmotic dilators / misoprostol)",
    "Performed in hospital/OR under IV sedation or general anaesthesia"
  ] },
  { text: "Complications of surgical abortion:", bold: true, sub: [
    "Perforation, cervical injury, hemorrhage, infection, Asherman's syndrome (intrauterine adhesions), incomplete abortion, anaesthetic complications"
  ] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 22 — SECTION 6 COVER
// ══════════════════════════════════════════════════════════════
sectionCover("06", "Current Guidelines", "WHO 2022 · ACOG 2024 · SOGC 2025");

// ══════════════════════════════════════════════════════════════
// SLIDE 23 — WHO 2022 ABORTION CARE GUIDELINE (2nd Ed)
// ══════════════════════════════════════════════════════════════
contentSlide("WHO Abortion Care Guideline 2022 (2nd Edition)", [
  { text: "Key Recommendations:", bold: true },
  "Medical abortion (mifepristone + misoprostol) is RECOMMENDED as first-line for all gestational ages",
  "Misoprostol alone acceptable where mifepristone unavailable",
  "Vacuum aspiration (manual or electric) preferred over sharp curettage — sharp curettage should be phased out",
  "Self-managed medication abortion at home is SAFE and RECOMMENDED for ≤12 weeks in appropriate settings",
  "Task sharing to mid-level providers (nurses, midwives) — same safety as physician-provided care",
  { text: "Revised in August 2025 (Recommendation 22 updated):", bold: true, sub: [
    "No change to core clinical recommendations — update relates to service delivery context"
  ] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 24 — ACOG 2024 KEY UPDATES
// ══════════════════════════════════════════════════════════════
contentSlide("ACOG 2024 Key Updates", [
  { text: "Anti-D Immunoglobulin (RhD):", bold: true, sub: [
    "ACOG Clinical Practice Update 2024 + SMFM 2024:",
    "Anti-D immunoglobulin NOT required after spontaneous or induced abortion at < 12 weeks gestation",
    "Previously given to all Rh-negative patients — now evidence shows very low risk of sensitization < 12 wks"
  ] },
  { text: "Self-Managed Abortion (ACOG Committee Statement No. 13, Dec 2024):", bold: true, sub: [
    "Clinicians should be prepared to provide non-judgmental care to patients who self-manage abortion",
    "Not inherently dangerous when using FDA-approved medications per WHO protocols"
  ] },
  { text: "Medication Abortion 14–27+6 weeks (SFP/SMFM 2025):", bold: true, sub: [
    "Mifepristone + misoprostol regimen recommended for second trimester abortion",
    "Evidence supports safety and efficacy throughout second trimester"
  ] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 25 — SOGC 2025 / ESHRE 2023 RPL
// ══════════════════════════════════════════════════════════════
contentSlide("Recurrent Pregnancy Loss: SOGC Guideline 2025", [
  "Guideline No. 464 published December 2025 (SOGC)",
  { text: "Definition update:", bold: true, sub: ["≥2 consecutive pregnancy losses now sufficient for full RPL investigation (previously ≥3)"] },
  { text: "Recommended investigations:", bold: true, sub: [
    "Antiphospholipid antibodies (mandatory)",
    "Uterine cavity assessment (hysteroscopy / SIS)",
    "Parental karyotype (selective — when products show structural chromosomal defect)",
    "Thrombophilia screen — inherited (limited evidence; selective use)"
  ] },
  { text: "Management:", bold: true, sub: [
    "APS: LMWH + low-dose aspirin 75–100 mg/day from positive pregnancy test",
    "Progesterone: 200 mg vaginally TDS — for unexplained RPL with ≥2 prior losses (PROMISE trial)",
    "Psychological support is part of standard care"
  ] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 26 — COMPLICATIONS OF ABORTION
// ══════════════════════════════════════════════════════════════
contentSlide("Complications of Abortion", [
  { text: "Immediate (within 24 hrs):", bold: true, sub: [
    "Hemorrhage — most common complication of incomplete/unsafe abortion",
    "Uterine perforation (0.1–0.3% with surgical abortion)",
    "Cervical laceration",
    "Failed abortion / ongoing pregnancy"
  ] },
  { text: "Short-term (1–4 weeks):", bold: true, sub: [
    "Infection → endometritis, salpingitis → sepsis",
    "Septic shock + DIC (especially unsafe abortion)",
    "Retained products of conception"
  ] },
  { text: "Long-term:", bold: true, sub: [
    "Asherman's syndrome (intrauterine adhesions) — amenorrhoea, hypomenorrhoea, infertility",
    "Cervical incompetence (repeated dilations)",
    "Psychological impact — grief, anxiety (provide supportive counselling)"
  ] },
  "Unsafe abortion causes ~47,000 maternal deaths/year globally (WHO)"
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 27 — POST-ABORTION CARE
// ══════════════════════════════════════════════════════════════
contentSlide("Post-Abortion Care", [
  { text: "Immediate post-procedure:", bold: true, sub: [
    "Confirm complete evacuation with TVUS and/or falling β-hCG",
    "Vital signs monitoring for 1–2 hours",
    "Pain management (NSAIDs)"
  ] },
  { text: "Contraceptive counselling (integrate with abortion care — WHO):", bold: true, sub: [
    "Ovulation can resume as early as 2 weeks post-abortion",
    "IUD / implant: can be inserted immediately post-procedure",
    "DMPA injection: same day",
    "Combined hormonal contraception: start same day or within 7 days"
  ] },
  { text: "Follow-up:", bold: true, sub: [
    "Review in 1–2 weeks (medical abortion) or 2–4 weeks (surgical)",
    "Rh-negative women < 12 wks: Anti-D no longer required per ACOG/SMFM 2024",
    "Rh-negative women ≥ 12 wks: give Anti-D 300 mcg within 72 hours"
  ] }
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 28 — SUMMARY TABLE
// ══════════════════════════════════════════════════════════════
tableSlide(
  "Quick Summary: Management by Type",
  ["Type", "Key Feature", "Preferred Treatment", "Guideline Reference"],
  [
    ["Threatened", "Closed os, bleeding", "Conservative, pelvic rest", "Expectant"],
    ["Inevitable", "Open os, no tissue", "Misoprostol or MVA", "WHO 2022"],
    ["Incomplete", "Open os, partial tissue", "Misoprostol 600 mcg PO or MVA", "WHO 2022"],
    ["Missed", "Closed os, fetal death", "Mifepristone + Misoprostol (1st line)", "WHO 2022"],
    ["Septic", "Fever + open os", "IV ABx + uterine evacuation", "Emergency protocol"],
    ["Recurrent (RPL)", "≥2 losses", "Investigate & treat cause (APS → LMWH+ASA)", "SOGC 2025"],
    ["Induced (≤12 wk)", "Medical termination", "Mifepristone 200mg + Misoprostol 800mcg", "WHO 2022, ACOG"],
    ["Induced (13–24 wk)", "Surgical / medical", "D&E or mifepristone + misoprostol", "SFP/SMFM 2025"],
  ]
);

// ══════════════════════════════════════════════════════════════
// SLIDE 29 — KEY TAKE-HOME MESSAGES
// ══════════════════════════════════════════════════════════════
contentSlide("Key Take-Home Messages", [
  "Always rule out ECTOPIC pregnancy before managing any early pregnancy bleeding",
  "Cervical os status is the SINGLE MOST IMPORTANT physical sign in classifying abortion type",
  "Chromosomal abnormality is the most common cause of spontaneous abortion (~50–60%)",
  "Mifepristone + Misoprostol is the WHO-recommended first-line for missed/incomplete/induced abortion",
  "Septic abortion = obstetric emergency — start IV antibiotics and evacuate within 6–12 hours",
  "APS is the most important TREATABLE cause of recurrent pregnancy loss",
  "Anti-D immunoglobulin NOT required for Rh-negative women at < 12 weeks (ACOG/SMFM 2024 update)",
  "Unsafe abortion kills ~47,000 women/year — access to safe abortion is a public health priority"
]);

// ══════════════════════════════════════════════════════════════
// SLIDE 30 — REFERENCES
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.12, fill: { color: ACCENT } });
  s.addText("References & Guidelines", {
    x: 0.4, y: 0.2, w: 9.2, h: 0.7, fontSize: 22, bold: true, color: WHITE, fontFace: "Calibri"
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  const refs = [
    { text: "1. WHO Abortion Care Guideline, 2nd Edition (2022, updated August 2025). World Health Organization.", options: { breakLine: true, fontSize: 13, color: "C8D8F0", fontFace: "Calibri" } },
    { text: "2. ACOG Clinical Practice Update: RhD Immune Globulin After Abortion at < 12 Weeks. Obstet Gynecol. 2024.", options: { breakLine: true, fontSize: 13, color: "C8D8F0", fontFace: "Calibri" } },
    { text: "3. ACOG Committee Statement No. 13: Self-Managed Abortion. Obstet Gynecol. 2024 Dec;144(6):e152-e159.", options: { breakLine: true, fontSize: 13, color: "C8D8F0", fontFace: "Calibri" } },
    { text: "4. Motan T et al. SOGC Guideline No. 464: Recurrent Pregnancy Loss. J Obstet Gynaecol Can. 2025 Dec. (PMID 41176277)", options: { breakLine: true, fontSize: 13, color: "C8D8F0", fontFace: "Calibri" } },
    { text: "5. SFP/SMFM Clinical Recommendation: Medication Abortion 14-27+6 Weeks. 2025.", options: { breakLine: true, fontSize: 13, color: "C8D8F0", fontFace: "Calibri" } },
    { text: "6. Tintinalli's Emergency Medicine, 9th Ed. Chapter 98: Spontaneous Abortion.", options: { breakLine: true, fontSize: 13, color: "C8D8F0", fontFace: "Calibri" } },
    { text: "7. Berek & Novak's Gynecology, 16th Ed. Chapter 14: Abortion.", options: { breakLine: true, fontSize: 13, color: "C8D8F0", fontFace: "Calibri" } },
    { text: "8. Gallos ID et al. Uterotonic agents for preventing PPH: network meta-analysis. Cochrane 2025. (PMID 40237648)", options: { fontSize: 13, color: "C8D8F0", fontFace: "Calibri" } },
  ];
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}

// ══════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/abortion-lecture/Abortion_MBBS_Lecture.pptx" })
  .then(() => console.log("SUCCESS: Presentation written."))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

cd /home/daytona/workspace/abortion-lecture && node build.js