const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Diagnosis and Emergency Management of PPH – Part 4";
pres.author = "Clinical Education";

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
const C = {
  navy:    "0D1B2A",
  crimson: "C0392B",
  teal:    "1ABC9C",
  gold:    "F39C12",
  white:   "FFFFFF",
  light:   "ECF0F1",
  slate:   "2C3E50",
  muted:   "7F8C8D",
  pearl:   "FFF3CD",
  pearlTx: "856404",
  green:   "27AE60",
  purple:  "8E44AD",
  orange:  "E67E22",
  darkRed: "7B241C",
  darkGold:"7B5800",
};

// ─── HELPERS ─────────────────────────────────────────────────────────────────
function addSlideHeader(slide, title, slideNum, accentColor) {
  accentColor = accentColor || C.crimson;
  slide.background = { color: C.navy };
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 0.72,
    fill: { color: accentColor },
    line: { type: "none" },
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 9.3, y: 0.12, w: 0.55, h: 0.44,
    fill: { color: "1E2F3E" },
    line: { type: "none" },
  });
  slide.addText("" + slideNum, {
    x: 9.3, y: 0.12, w: 0.55, h: 0.44,
    fontSize: 11, bold: true, color: C.white,
    align: "center", valign: "middle", margin: 0,
  });
  slide.addText(title, {
    x: 0.25, y: 0, w: 8.9, h: 0.72,
    fontSize: 18, bold: true, color: C.white,
    valign: "middle", margin: 0, fontFace: "Calibri",
  });
}

function addClinicalPearl(slide, text, y) {
  y = y !== undefined ? y : 4.82;
  slide.addShape(pres.ShapeType.rect, {
    x: 0.35, y: y, w: 9.3, h: 0.62,
    fill: { color: C.gold },
    line: { type: "none" },
  });
  slide.addText([
    { text: "💡 Clinical Pearl:  ", options: { bold: true, color: "7B3F00" } },
    { text: text, options: { bold: false, color: "3B2001" } },
  ], {
    x: 0.35, y: y, w: 9.3, h: 0.62,
    fontSize: 11.5, valign: "middle", margin: [0, 10, 0, 10], fontFace: "Calibri",
  });
}

function addKeyPrinciple(slide, text, y) {
  y = y !== undefined ? y : 4.82;
  slide.addShape(pres.ShapeType.rect, {
    x: 0.35, y: y, w: 9.3, h: 0.62,
    fill: { color: "1A3A3A" },
    line: { color: C.teal, pt: 1.5 },
  });
  slide.addText([
    { text: "🔑 Key Principle:  ", options: { bold: true, color: C.teal } },
    { text: text, options: { bold: false, color: C.light } },
  ], {
    x: 0.35, y: y, w: 9.3, h: 0.62,
    fontSize: 11.5, valign: "middle", margin: [0, 10, 0, 10], fontFace: "Calibri",
  });
}

function card(slide, x, y, w, h, color) {
  slide.addShape(pres.ShapeType.rect, {
    x, y, w, h,
    fill: { color: color || C.slate },
    line: { type: "none" },
  });
}

function cardHeader(slide, x, y, w, h, text, textColor, bgColor) {
  slide.addShape(pres.ShapeType.rect, {
    x, y, w, h,
    fill: { color: bgColor || C.slate },
    line: { type: "none" },
  });
  slide.addText(text, {
    x, y, w, h,
    fontSize: 12.5, bold: true, color: textColor || C.teal,
    valign: "middle", margin: [0, 10, 0, 10], fontFace: "Calibri",
  });
}

function bullets(items, opts) {
  opts = opts || {};
  return items.map(function(item, i) {
    return {
      text: item,
      options: {
        bullet: { type: "bullet", characterCode: opts.char || "25B6", color: opts.bulletColor || C.teal },
        color: opts.color || C.light,
        fontSize: opts.fontSize || 11.5,
        breakLine: i < items.length - 1,
        bold: opts.bold || false,
        indentLevel: opts.indent || 0,
      },
    };
  });
}

function numberList(items, opts) {
  opts = opts || {};
  return items.map(function(item, i) {
    return {
      text: (i + 1) + ".  " + item,
      options: {
        bullet: false,
        color: opts.color || C.light,
        fontSize: opts.fontSize || 11.5,
        breakLine: i < items.length - 1,
        bold: opts.bold || false,
        indentLevel: opts.indent || 0,
      },
    };
  });
}

// ─── SLIDE 31: Cause-Specific Management – Treat the 4 Ts ──────────────────
{
  const slide = pres.addSlide();
  addSlideHeader(slide, "Cause-Specific Management: 'Treat the 4 Ts'", 31, C.crimson);

  // Intro banner
  slide.addShape(pres.ShapeType.rect, {
    x: 0.35, y: 0.82, w: 9.3, h: 0.42,
    fill: { color: "3D1A18" },
    line: { color: C.crimson, pt: 1 },
  });
  slide.addText("After Initial Resuscitation — Simultaneously identify and treat the underlying cause.", {
    x: 0.35, y: 0.82, w: 9.3, h: 0.42,
    fontSize: 11.5, bold: true, color: C.crimson, align: "center", valign: "middle",
    margin: 0, fontFace: "Calibri",
  });

  // 4 Ts cards (2x2 grid)
  const tCards = [
    { label: "TONE", icon: "🔴", color: "8B0000", accent: C.crimson,
      mgmt: ["Uterine massage", "Uterotonics (oxytocin, carboprost, ergometrine)", "Balloon tamponade (Bakri balloon)", "Compression sutures (B-Lynch)", "Uterine/internal iliac artery ligation", "Hysterectomy if all else fails"] },
    { label: "TRAUMA", icon: "🔶", color: "6B3800", accent: C.gold,
      mgmt: ["Inspect cervix, vagina & perineum", "Repair lacerations with absorbable sutures", "Evacuate hematomas", "Laparotomy for uterine rupture", "Replace uterine inversion immediately"] },
    { label: "TISSUE", icon: "🟢", color: "0A3A22", accent: C.green,
      mgmt: ["Controlled cord traction", "Manual removal of placenta", "Uterine evacuation for retained fragments", "Ultrasound if uncertain & patient stable", "Avoid forceful removal in placenta accreta"] },
    { label: "THROMBIN", icon: "🟣", color: "3A1A5A", accent: C.purple,
      mgmt: ["Identify & treat coagulopathy", "FFP for prolonged PT/aPTT", "Platelets if < 50,000/µL with bleeding", "Cryoprecipitate if fibrinogen < 2 g/L", "Packed RBCs for blood loss/anemia"] },
  ];

  const positions = [
    { x: 0.25, y: 1.35 }, { x: 5.1, y: 1.35 },
    { x: 0.25, y: 3.20 }, { x: 5.1, y: 3.20 },
  ];

  tCards.forEach(function(t, idx) {
    const p = positions[idx];
    slide.addShape(pres.ShapeType.rect, {
      x: p.x, y: p.y, w: 4.65, h: 1.72,
      fill: { color: t.color },
      line: { color: t.accent, pt: 1.5 },
    });
    // Label strip
    slide.addShape(pres.ShapeType.rect, {
      x: p.x, y: p.y, w: 4.65, h: 0.38,
      fill: { color: t.accent },
      line: { type: "none" },
    });
    slide.addText(t.icon + "  " + t.label, {
      x: p.x, y: p.y, w: 4.65, h: 0.38,
      fontSize: 13, bold: true, color: C.white,
      valign: "middle", margin: [0, 8, 0, 8], fontFace: "Calibri",
    });
    slide.addText(bullets(t.mgmt, { fontSize: 9.8, bulletColor: t.accent, char: "25CF" }), {
      x: p.x, y: p.y + 0.40, w: 4.65, h: 1.28,
      valign: "top", margin: [2, 8, 2, 8], fontFace: "Calibri",
    });
  });

  addKeyPrinciple(slide, "Resuscitation and cause-specific treatment must proceed simultaneously — do not wait.", 4.98);
}

// ─── SLIDE 32: Management of Uterine Atony (Tone) ───────────────────────────
{
  const slide = pres.addSlide();
  addSlideHeader(slide, "Management of Uterine Atony (Tone)  |  Stepwise Approach", 32, C.crimson);

  // Steps column
  card(slide, 0.25, 0.85, 5.6, 4.05, C.slate);
  cardHeader(slide, 0.25, 0.85, 5.6, 0.42, "🔢 Stepwise Protocol", C.teal, "1C2E3E");

  const steps = [
    "Call for help — activate PPH team",
    "Perform uterine massage (bimanual if needed)",
    "Empty the urinary bladder — insert Foley catheter",
    "Start oxytocin infusion immediately",
    "Add methylergometrine (if no hypertension)",
    "Add carboprost (if no asthma)",
    "Give misoprostol sublingually / rectally",
    "Administer tranexamic acid (1 g IV within 3 h)",
    "Continue fluid and blood product replacement",
    "If bleeding persists → balloon tamponade or surgery",
  ];

  slide.addText(steps.map(function(s, i) {
    return {
      text: (i + 1) + ".  " + s,
      options: {
        color: i === 9 ? C.crimson : C.light,
        fontSize: 10.8,
        breakLine: i < steps.length - 1,
        bold: i === 9,
      },
    };
  }), {
    x: 0.25, y: 1.30, w: 5.6, h: 3.48,
    valign: "top", margin: [4, 10, 4, 10], fontFace: "Calibri",
  });

  // Right panel: Uterotonics table
  card(slide, 6.05, 0.85, 3.7, 4.05, "1A2A3A");
  cardHeader(slide, 6.05, 0.85, 3.7, 0.42, "💊 Uterotonics at a Glance", C.gold, "1A2A3A");

  const drugs = [
    { name: "Oxytocin", dose: "10–20 IU IV infusion", note: "First-line" },
    { name: "Ergometrine", dose: "0.2 mg IM/IV", note: "Avoid in HTN" },
    { name: "Carboprost", dose: "250 µg IM q15 min", note: "Avoid in asthma" },
    { name: "Misoprostol", dose: "800–1000 µg SL/R", note: "Low-resource" },
    { name: "TXA", dose: "1 g IV over 10 min", note: "≤3 h of PPH" },
  ];

  drugs.forEach(function(d, i) {
    const ry = 1.30 + i * 0.69;
    const rowColor = i % 2 === 0 ? "1E3040" : "162530";
    slide.addShape(pres.ShapeType.rect, {
      x: 6.05, y: ry, w: 3.7, h: 0.66,
      fill: { color: rowColor }, line: { type: "none" },
    });
    slide.addText(d.name, {
      x: 6.10, y: ry, w: 1.05, h: 0.66,
      fontSize: 10, bold: true, color: C.teal, valign: "middle", margin: [0,4,0,4], fontFace: "Calibri",
    });
    slide.addText(d.dose, {
      x: 7.18, y: ry, w: 1.6, h: 0.66,
      fontSize: 9.5, color: C.light, valign: "middle", margin: [0,2,0,2], fontFace: "Calibri",
    });
    slide.addText(d.note, {
      x: 8.81, y: ry, w: 0.9, h: 0.66,
      fontSize: 8.5, color: C.gold, valign: "middle", margin: [0,2,0,2], fontFace: "Calibri", italic: true,
    });
  });

  addClinicalPearl(slide, "Atony is the commonest cause of PPH (80%). Treat aggressively and early — every minute counts.", 4.98);
}

// ─── SLIDE 33: Bimanual Uterine Compression ──────────────────────────────────
{
  const slide = pres.addSlide();
  addSlideHeader(slide, "Bimanual Uterine Compression", 33, C.crimson);

  // Left: indication + technique
  card(slide, 0.25, 0.85, 5.25, 4.05, C.slate);
  cardHeader(slide, 0.25, 0.85, 5.25, 0.42, "📋 Indication", C.teal, "1C2E3E");
  slide.addText("Persistent bleeding due to uterine atony while definitive treatment is being arranged.", {
    x: 0.35, y: 1.30, w: 5.0, h: 0.65,
    fontSize: 11, color: C.light, valign: "top", fontFace: "Calibri",
    italic: true,
  });

  cardHeader(slide, 0.25, 2.02, 5.25, 0.42, "🖐 Technique", C.gold, "2A1E00");
  const techSteps = [
    "Insert one hand into the vagina — form a fist",
    "Elevate the uterus anteriorly against the abdominal wall",
    "Place the other hand on the abdomen over the uterine fundus",
    "Compress the uterus firmly between both hands",
    "Maintain compression until uterus contracts or help arrives",
  ];
  slide.addText(techSteps.map(function(s, i) {
    return { text: (i + 1) + ".  " + s, options: { color: C.light, fontSize: 11, breakLine: i < techSteps.length - 1 } };
  }), {
    x: 0.35, y: 2.48, w: 5.05, h: 2.25,
    valign: "top", margin: [4, 6, 4, 6], fontFace: "Calibri",
  });

  // Right: advantages + visual label
  card(slide, 5.7, 0.85, 4.0, 2.35, "1A2A1A");
  cardHeader(slide, 5.7, 0.85, 4.0, 0.42, "✅ Advantages", C.green, "1A2A1A");
  const advs = [
    "Immediate reduction in bleeding",
    "No equipment required",
    "Can be performed by any trained provider",
    "Temporary life-saving maneuver",
    "Buys time for uterotonics / surgery",
  ];
  slide.addText(bullets(advs, { fontSize: 11, bulletColor: C.green, char: "2713" }), {
    x: 5.7, y: 1.30, w: 4.0, h: 1.75,
    valign: "top", margin: [4, 10, 4, 10], fontFace: "Calibri",
  });

  // Diagram placeholder box
  slide.addShape(pres.ShapeType.rect, {
    x: 5.7, y: 3.28, w: 4.0, h: 1.60,
    fill: { color: "162530" },
    line: { color: C.teal, pt: 1, dashType: "dash" },
  });
  slide.addText([
    { text: "✋ BIMANUAL COMPRESSION\n", options: { bold: true, color: C.teal, fontSize: 13, breakLine: true } },
    { text: "Internal fist (vaginal hand) elevates uterus\n", options: { color: C.light, fontSize: 10, breakLine: true } },
    { text: "External hand (abdominal) compresses fundus\n", options: { color: C.light, fontSize: 10, breakLine: true } },
    { text: "→ Compress between both hands", options: { color: C.gold, fontSize: 10, bold: true } },
  ], {
    x: 5.7, y: 3.28, w: 4.0, h: 1.60,
    valign: "middle", align: "center", margin: [4, 8, 4, 8], fontFace: "Calibri",
  });

  addClinicalPearl(slide, "Bimanual compression is a bridge — always escalate to uterotonics and definitive management.", 4.98);
}

// ─── SLIDE 34: Balloon Tamponade ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addSlideHeader(slide, "Balloon Tamponade for Uterine Atony", 34, C.crimson);

  // Purpose banner
  slide.addShape(pres.ShapeType.rect, {
    x: 0.35, y: 0.82, w: 9.3, h: 0.40,
    fill: { color: "1A0A0A" },
    line: { color: C.crimson, pt: 1 },
  });
  slide.addText("Purpose: Controls bleeding by applying intracavitary pressure when uterotonics fail.", {
    x: 0.35, y: 0.82, w: 9.3, h: 0.40,
    fontSize: 11, bold: true, color: C.light, align: "center", valign: "middle",
    margin: 0, fontFace: "Calibri",
  });

  // Types card
  card(slide, 0.25, 1.32, 4.55, 2.3, C.slate);
  cardHeader(slide, 0.25, 1.32, 4.55, 0.40, "🫁 Types of Balloon", C.teal, "1C2E3E");
  const types = [
    { name: "Bakri Balloon", note: "Purpose-built for PPH; dual lumen; up to 500 mL", color: C.teal },
    { name: "Condom Catheter", note: "Low-resource setting; highly effective, low cost", color: C.green },
    { name: "Sengstaken-Blakemore", note: "Modified use; gastric balloon in uterus", color: C.gold },
  ];
  types.forEach(function(t, i) {
    const ty = 1.76 + i * 0.62;
    slide.addShape(pres.ShapeType.rect, {
      x: 0.3, y: ty, w: 4.45, h: 0.56, fill: { color: i%2===0?"1E2E3E":"18262E" }, line: { type:"none" },
    });
    slide.addText(t.name, { x: 0.4, y: ty, w: 1.55, h: 0.56, fontSize: 10.5, bold: true, color: t.color, valign: "middle", margin: 0, fontFace: "Calibri" });
    slide.addText(t.note, { x: 1.97, y: ty, w: 2.7, h: 0.56, fontSize: 10, color: C.light, valign: "middle", margin: 0, fontFace: "Calibri" });
  });

  // Indications
  card(slide, 0.25, 3.72, 4.55, 1.15, "1A2A1A");
  cardHeader(slide, 0.25, 3.72, 4.55, 0.40, "📌 Indications", C.green, "1A2A1A");
  slide.addText(bullets(["Persistent uterine atony despite uterotonics", "As a bridge before surgical intervention"], { fontSize: 10.5, bulletColor: C.green }), {
    x: 0.35, y: 4.14, w: 4.35, h: 0.68, valign: "top", margin: [2, 8, 2, 8], fontFace: "Calibri",
  });

  // Right panel: advantages + procedure
  card(slide, 5.0, 1.32, 4.75, 2.3, "1A1A30");
  cardHeader(slide, 5.0, 1.32, 4.75, 0.40, "✅ Advantages", C.purple, "1A1A30");
  const advs = ["Minimally invasive — no incision", "Preserves fertility", "Quick to insert (~5 minutes)", "Success rate ≈ 80–90%", "Can be done under regional anaesthesia"];
  slide.addText(bullets(advs, { fontSize: 10.8, bulletColor: C.purple }), {
    x: 5.1, y: 1.75, w: 4.55, h: 1.82, valign: "top", margin: [2, 8, 2, 8], fontFace: "Calibri",
  });

  // Bakri schematic box
  slide.addShape(pres.ShapeType.rect, {
    x: 5.0, y: 3.72, w: 4.75, h: 1.15,
    fill: { color: "0A1A2A" },
    line: { color: C.teal, pt: 1, dashType: "dash" },
  });
  slide.addText([
    { text: "🎈 Bakri Balloon In Situ\n", options: { bold: true, color: C.teal, fontSize: 12, breakLine: true } },
    { text: "Inserted transcervically → inflated with saline until bleeding stops", options: { color: C.light, fontSize: 10 } },
  ], {
    x: 5.0, y: 3.72, w: 4.75, h: 1.15,
    valign: "middle", align: "center", margin: [4, 8, 4, 8], fontFace: "Calibri",
  });

  addKeyPrinciple(slide, "The 'tamponade test': if balloon controls bleeding, surgery may be avoided. If not → go to theatre.", 4.98);
}

// ─── SLIDE 35: Management of Trauma ─────────────────────────────────────────
{
  const slide = pres.addSlide();
  addSlideHeader(slide, "Management of Trauma (PPH – 2nd T)", 35, C.gold);

  // Examine for panel
  card(slide, 0.25, 0.85, 4.55, 3.55, C.slate);
  cardHeader(slide, 0.25, 0.85, 4.55, 0.40, "🔍 Examine For:", C.gold, "2A2000");
  const examItems = [
    "Cervical tears",
    "Vaginal lacerations",
    "Perineal tears (Grade I–IV)",
    "Episiotomy extension",
    "Uterine rupture",
    "Broad ligament hematoma",
    "Uterine inversion",
  ];
  slide.addText(bullets(examItems, { fontSize: 11.5, bulletColor: C.gold, char: "25CF" }), {
    x: 0.35, y: 1.28, w: 4.35, h: 2.98, valign: "top", margin: [4, 8, 4, 8], fontFace: "Calibri",
  });

  // Treatment panel
  card(slide, 5.0, 0.85, 4.75, 3.55, "1A2A1A");
  cardHeader(slide, 5.0, 0.85, 4.75, 0.40, "🩺 Treatment", C.green, "0A1A0A");
  const txItems = [
    "Ensure adequate lighting & analgesia/anaesthesia",
    "Repair lacerations with absorbable sutures (Vicryl)",
    "Drain large / expanding hematomas",
    "Pack wound if hemostasis is difficult",
    "Laparotomy for uterine rupture",
    "Manual replacement for uterine inversion (Johnson's maneuver)",
    "Inform senior obstetrician early",
  ];
  slide.addText(bullets(txItems, { fontSize: 11, bulletColor: C.green, char: "2714" }), {
    x: 5.1, y: 1.28, w: 4.55, h: 2.98, valign: "top", margin: [4, 8, 4, 8], fontFace: "Calibri",
  });

  // Uterine inversion note
  slide.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 4.48, w: 9.5, h: 0.38,
    fill: { color: "2A0A0A" }, line: { color: C.crimson, pt: 1 },
  });
  slide.addText("⚠  Uterine Inversion: Stop oxytocin → Replace uterus manually (Johnson's) or surgically (Huntington/Haultain) → Restart oxytocin after reduction.", {
    x: 0.25, y: 4.48, w: 9.5, h: 0.38,
    fontSize: 9.8, color: C.crimson, valign: "middle", margin: [0, 8, 0, 8], fontFace: "Calibri",
  });

  addClinicalPearl(slide, "Persistent bleeding with a well-contracted, firm uterus strongly suggests a traumatic cause.", 4.95);
}

// ─── SLIDE 36: Management of Tissue ─────────────────────────────────────────
{
  const slide = pres.addSlide();
  addSlideHeader(slide, "Management of Tissue (PPH – 3rd T)", 36, C.green);

  // Three horizontal cards
  const sections = [
    {
      title: "🫁 Retained Placenta",
      color: "1A2A1A",
      accent: C.green,
      items: [
        "Await up to 30 min after delivery for spontaneous separation",
        "Apply controlled cord traction (Brandt-Andrews)",
        "Manual removal under general or spinal anaesthesia if not expelled",
        "Explore uterine cavity to ensure completeness",
        "Ultrasound if uncertain and patient is hemodynamically stable",
      ],
    },
    {
      title: "🧩 Retained Placental Fragments",
      color: "1A1A2A",
      accent: C.purple,
      items: [
        "Suspect if uterus remains soft despite uterotonics",
        "Uterine exploration and evacuation under aseptic precautions",
        "Use ring forceps or gentle curettage",
        "Send specimen for histology",
      ],
    },
    {
      title: "⚠️ Placenta Accreta Spectrum (PAS)",
      color: "2A1A00",
      accent: C.gold,
      items: [
        "DO NOT attempt forceful manual removal — risk of catastrophic hemorrhage",
        "Anticipate massive hemorrhage — activate MTP early",
        "Conservative management (leaving placenta in situ) may be considered",
        "Caesarean hysterectomy is often required — involve senior surgeon",
        "Interventional radiology (uterine artery embolization) if available",
      ],
    },
  ];

  sections.forEach(function(s, i) {
    const y = 0.85 + i * 1.52;
    card(slide, 0.25, y, 9.5, 1.46, s.color);
    slide.addShape(pres.ShapeType.rect, {
      x: 0.25, y: y, w: 9.5, h: 0.38,
      fill: { color: s.accent === C.green ? "0A2A0A" : s.accent === C.purple ? "1A0A2A" : "2A1A00" },
      line: { type: "none" },
    });
    slide.addText(s.title, {
      x: 0.35, y: y, w: 9.3, h: 0.38,
      fontSize: 12, bold: true, color: s.accent, valign: "middle", margin: [0, 6, 0, 6], fontFace: "Calibri",
    });
    slide.addText(bullets(s.items, { fontSize: 10.2, bulletColor: s.accent, char: "25B6" }), {
      x: 0.35, y: y + 0.40, w: 9.2, h: 1.02,
      valign: "top", margin: [2, 6, 2, 6], fontFace: "Calibri",
    });
  });

  addClinicalPearl(slide, "Always inspect the placenta after every delivery. Any missing cotyledon or ragged margin warrants immediate uterine exploration.", 4.98);
}

// ─── SLIDE 37: Management of Thrombin (Coagulopathy) ────────────────────────
{
  const slide = pres.addSlide();
  addSlideHeader(slide, "Management of Thrombin – Coagulopathy (PPH – 4th T)", 37, C.purple);

  // Principle banner
  slide.addShape(pres.ShapeType.rect, {
    x: 0.35, y: 0.82, w: 9.3, h: 0.40,
    fill: { color: "1A0A2A" }, line: { color: C.purple, pt: 1 },
  });
  slide.addText("Principle: Treat the underlying cause + Replace deficient clotting factors aggressively.", {
    x: 0.35, y: 0.82, w: 9.3, h: 0.40,
    fontSize: 11, bold: true, color: C.light, align: "center", valign: "middle", margin: 0, fontFace: "Calibri",
  });

  // Blood components table (left)
  card(slide, 0.25, 1.32, 5.6, 3.25, C.slate);
  cardHeader(slide, 0.25, 1.32, 5.6, 0.42, "🩸 Blood Components", C.purple, "1C1C3E");

  // Table header row
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  });

  const rows = [
    { comp: "Packed RBCs", ind: "Blood loss / anemia", dose: "Target Hb ≥ 8 g/dL" },
    { comp: "Fresh Frozen\nPlasma (FFP)", ind: "Prolonged PT/aPTT", dose: "10–15 mL/kg; ratio 1:1:1 with pRBC" },
    { comp: "Platelets", ind: "Plt < 50,000/µL\nwith active bleeding", dose: "Target Plt ≥ 50,000/µL" },
    { comp: "Cryoprecipitate", ind: "Fibrinogen < 2 g/L", dose: "10 units; target Fibrinogen ≥ 2 g/L" },
    { comp: "Tranexamic Acid", ind: "PPH within 3 h", dose: "1 g IV; repeat if still bleeding at 30 min" },
  ];

  rows.forEach(function(r, i) {
    const ry = 2.14 + i * 0.44;
    const rc = i % 2 === 0 ? "1E2E3E" : "162530";
    slide.addShape(pres.ShapeType.rect, { x: 0.25, y: ry, w: 5.6, h: 0.42, fill: { color: rc }, line: { type: "none" } });
    slide.addText(r.comp, { x: 0.35, y: ry, w: 1.55, h: 0.42, fontSize: 9.5, bold: true, color: C.teal, valign: "middle", margin: 0, fontFace: "Calibri" });
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    slide.addText(r.dose, { x: 3.65, y: ry, w: 2.1, h: 0.42, fontSize: 9, color: C.gold, valign: "middle", margin: 0, fontFace: "Calibri" });
  });

  // Monitoring panel (right)
  card(slide, 6.05, 1.32, 3.7, 2.0, "1A1A2A");
  cardHeader(slide, 6.05, 1.32, 3.7, 0.42, "📊 Monitoring", C.gold, "1A1A2A");
  const monItems = ["PT / INR", "aPTT", "Platelet count", "Fibrinogen level", "Clinical bleeding response", "Repeat labs every 30–60 min in massive PPH"];
  slide.addText(bullets(monItems, { fontSize: 10.5, bulletColor: C.gold }), {
    x: 6.15, y: 1.77, w: 3.5, h: 1.45, valign: "top", margin: [2, 8, 2, 8], fontFace: "Calibri",
  });

  // MTP box
  slide.addShape(pres.ShapeType.rect, {
    x: 6.05, y: 3.40, w: 3.7, h: 1.17,
    fill: { color: "2A0A0A" }, line: { color: C.crimson, pt: 1.5 },
  });
  slide.addText([
    { text: "🚨 Massive Transfusion Protocol (MTP)\n", options: { bold: true, color: C.crimson, fontSize: 11.5, breakLine: true } },
    { text: "Activate when ≥10 units pRBC in 24 h or ≥4 units in 1 h.\n", options: { color: C.light, fontSize: 10, breakLine: true } },
    { text: "Target ratio: pRBC : FFP : Platelets = 1 : 1 : 1", options: { color: C.gold, fontSize: 10, bold: true } },
  ], {
    x: 6.10, y: 3.42, w: 3.6, h: 1.13, valign: "middle", margin: [4, 8, 4, 8], fontFace: "Calibri",
  });

  addKeyPrinciple(slide, "Coagulopathy in PPH is often dilutional + consumptive. Treat proactively — don't wait for lab confirmation in active hemorrhage.", 4.98);
}

// ─── SLIDE 38: Non-Pneumatic Anti-Shock Garment (NASG) ──────────────────────
{
  const slide = pres.addSlide();
  addSlideHeader(slide, "Non-Pneumatic Anti-Shock Garment (NASG)", 38, C.teal);

  // What is NASG
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    x: 0.35, y: 0.82, w: 9.3, h: 0.50,
    fill: { color: "0A1E1E" }, line: { color: C.teal, pt: 1 },
  });
  slide.addText("A reusable neoprene compression garment that wraps the lower body to redistribute blood from periphery to vital organs.", {
    x: 0.45, y: 0.82, w: 9.1, h: 0.50,
    fontSize: 11, color: C.light, valign: "middle", margin: [0, 6, 0, 6], fontFace: "Calibri", italic: true,
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    {
      title: "📌 Indications", color: "0A1E1E", accent: C.teal,
      items: ["Severe PPH with hypovolemic shock", "Hemorrhagic shock (SBP < 90 mmHg)", "During transport to higher facility", "While awaiting surgical intervention", "Bridge until operating theatre available"],
    },
    {
      title: "✅ Advantages", color: "0A1A0A", accent: C.green,
      items: ["Stabilizes systemic circulation", "Reduces blood flow to lower limbs → autotransfusion effect", "Easy to apply (2–5 min)", "Reusable; low cost", "Reduces mortality in low-resource settings", "WHO endorsed for resource-limited settings"],
    },
    {
      title: "⚠️ Limitations", color: "2A1A00", accent: C.gold,
      items: ["Temporary — not a definitive treatment", "Does not replace blood transfusion or surgery", "Contraindicated in pulmonary edema", "Must be removed in hospital setting", "May mask ongoing blood loss"],
    },
  ];

  cols.forEach(function(col, i) {
    const x = 0.25 + i * 3.2;
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      x: x + 0.1, y: 1.85, w: 2.88, h: 2.65, valign: "top", margin: [2, 6, 2, 6], fontFace: "Calibri",
    });
  });

  // Application steps strip
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    x: 0.25, y: 4.72, w: 9.5, h: 0.44,
    fill: { color: "0A1E1E" }, line: { color: C.teal, pt: 1 },
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    x: 0.35, y: 4.72, w: 9.3, h: 0.44,
    fontSize: 10, color: C.teal, valign: "middle", margin: [0, 6, 0, 6], fontFace: "Calibri",
  });

  addKeyPrinciple(slide, "NASG is a bridge, not a cure. Remove only when definitive hemostasis is confirmed and patient is stable.", 5.22);
}

// ─── SLIDE 39: Stepwise Surgical Management ──────────────────────────────────
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  const slide = pres.addSlide();
  addSlideHeader(slide, "Stepwise Surgical Management of PPH", 39, C.crimson);

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    x: 0.35, y: 0.82, w: 9.3, h: 0.40,
    fill: { color: "3D1A18" }, line: { color: C.crimson, pt: 1 },
  });
  slide.addText("Indicated when conservative measures (uterotonics + tamponade) have failed to control hemorrhage.", {
    x: 0.35, y: 0.82, w: 9.3, h: 0.40,
    fontSize: 11, bold: true, color: C.crimson, align: "center", valign: "middle", margin: 0, fontFace: "Calibri",
  });

  // Escalation ladder (left panel)
  card(slide, 0.25, 1.32, 5.6, 3.60, C.slate);
  cardHeader(slide, 0.25, 1.32, 5.6, 0.42, "📶 Escalation Ladder (Least → Most Radical)", C.teal, "1C2E3E");

  const surgSteps = [
    { num: "1", label: "Examination Under Anaesthesia (EUA)", note: "Identify + repair any missed trauma" },
    { num: "2", label: "Uterine Compression Sutures", note: "B-Lynch, Hayman, Pereira sutures" },
    { num: "3", label: "Uterine Artery Ligation", note: "Reduces uterine blood flow ~90%" },
    { num: "4", label: "Utero-ovarian Artery Ligation", note: "O'Leary suture technique" },
    { num: "5", label: "Internal Iliac Artery Ligation", note: "Reduces pulse pressure; preserves uterus" },
    { num: "6", label: "Uterine Artery Embolization (UAE)", note: "Interventional radiology if available" },
    { num: "7", label: "Subtotal / Total Hysterectomy", note: "Definitive — last resort; life-saving" },
  ];

  surgSteps.forEach(function(s, i) {
    const ry = 1.77 + i * 0.445;
    const isLast = i === 6;
    const rowFill = isLast ? "3D1A18" : (i % 2 === 0 ? "1E2E3E" : "162530");
    slide.addShape(pres.ShapeType.rect, { x: 0.25, y: ry, w: 5.6, h: 0.42, fill: { color: rowFill }, line: { type: "none" } });
    // Step number badge
    slide.addShape(pres.ShapeType.rect, { x: 0.30, y: ry + 0.06, w: 0.28, h: 0.28, fill: { color: isLast ? C.crimson : C.teal }, line: { type: "none" } });
    slide.addText(s.num, { x: 0.30, y: ry + 0.06, w: 0.28, h: 0.28, fontSize: 9, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
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    slide.addText(s.note, { x: 3.48, y: ry, w: 2.28, h: 0.42, fontSize: 9, color: isLast ? C.gold : C.muted, valign: "middle", margin: 0, fontFace: "Calibri", italic: true });
  });

  // Right: Hysterectomy types + indications
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  cardHeader(slide, 6.05, 1.32, 3.7, 0.42, "🔪 Hysterectomy Types", C.crimson, "2A0A0A");
  slide.addText(bullets([
    "Subtotal (supracervical) — faster, less morbidity",
    "Total — if cervical pathology or cervical bleeding",
    "Both — permanently ends fertility",
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    x: 6.15, y: 1.77, w: 3.5, h: 1.28, valign: "top", margin: [2, 8, 2, 8], fontFace: "Calibri",
  });

  // Compression sutures diagram box
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    x: 6.05, y: 3.22, w: 3.7, h: 1.70,
    fill: { color: "0A1E2A" }, line: { color: C.teal, pt: 1, dashType: "dash" },
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    { text: "B-Lynch: longitudinal brace suture\n", options: { color: C.light, fontSize: 10, breakLine: true } },
    { text: "Hayman: 2 vertical compression sutures\n", options: { color: C.light, fontSize: 10, breakLine: true } },
    { text: "Pereira: transverse + longitudinal\n", options: { color: C.light, fontSize: 10, breakLine: true } },
    { text: "All preserve uterus + fertility", options: { color: C.gold, fontSize: 10, bold: true } },
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    x: 6.10, y: 3.25, w: 3.6, h: 1.64, valign: "middle", margin: [4, 8, 4, 8], fontFace: "Calibri",
  });

  addKeyPrinciple(slide, "Early surgical decision saves lives. Do NOT delay in a deteriorating patient — escalate promptly.", 4.98);
}

// ─── SLIDE 40: Summary & Key Takeaways ───────────────────────────────────────
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    x: 0, y: 0, w: 10, h: 0.80,
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    x: 0, y: 0.78, w: 10, h: 0.06,
    fill: { color: C.crimson }, line: { type: "none" },
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  slide.addText("PPH Management: Core Summary", {
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    { label: "TRAUMA", icon: "🔶", desc: "Inspect · Repair\nHematoma · Laparotomy", color: C.gold, bg: "3D2A00" },
    { label: "TISSUE", icon: "🟢", desc: "Remove placenta\nEvacuate fragments", color: C.green, bg: "103D10" },
    { label: "THROMBIN", icon: "🟣", desc: "FFP · Platelets\nCryo · Fibrinogen", color: C.purple, bg: "1A0A3D" },
  ];

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  const takeaways = [
    "Recognise PPH early: ≥ 500 mL vaginal / ≥ 1000 mL CS",
    "Resuscitate and treat the underlying cause simultaneously",
    "Follow the 4 Ts framework for every case of PPH",
    "Uterotonics are the cornerstone — use them early and in combination",
    "Balloon tamponade bridges to surgical intervention (~80–90% success)",
    "Escalate surgical steps without delay in deteriorating patients",
    "Tranexamic acid within 3 hours — always",
    "NASG stabilises in transport; does not replace definitive treatment",
  ];
  slide.addText(bullets(takeaways, { fontSize: 11, bulletColor: C.teal, char: "25B6" }), {
    x: 0.35, y: 2.82, w: 5.35, h: 2.20, valign: "top", margin: [2, 8, 2, 8], fontFace: "Calibri",
  });

  // "Remember" right panel
  card(slide, 6.0, 2.38, 3.75, 2.72, "1A0A0A");
  slide.addText("⚠️ Always Remember", { x: 6.1, y: 2.38, w: 3.55, h: 0.40, fontSize: 12.5, bold: true, color: C.crimson, valign: "middle", margin: [0,8,0,8], fontFace: "Calibri" });
  const remembers = [
    "Anticipate → Identify → Act",
    "Senior help early = better outcomes",
    "Document every step + timing",
    "Debrief the team after every PPH",
    "Simulation training saves lives",
  ];
  slide.addText(bullets(remembers, { fontSize: 11, bulletColor: C.crimson, char: "25CF" }), {
    x: 6.1, y: 2.82, w: 3.55, h: 1.55, valign: "top", margin: [2, 8, 2, 8], fontFace: "Calibri",
  });

  // Bottom motivational strip
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 5.18, w: 10, h: 0.445,
    fill: { color: C.crimson }, line: { type: "none" },
  });
  slide.addText('"Every drop of blood saved is a life preserved — know the 4 Ts, act without hesitation."', {
    x: 0.3, y: 5.18, w: 9.4, h: 0.445,
    fontSize: 11.5, bold: true, color: C.white, align: "center", valign: "middle",
    margin: 0, fontFace: "Calibri", italic: true,
  });
}

// ─── WRITE FILE ──────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/pph-slides/PPH_Emergency_Part4_Slides31-40.pptx" })
  .then(function() { console.log("SUCCESS: PPH_Emergency_Part4_Slides31-40.pptx created."); })
  .catch(function(err) { console.error("ERROR:", err); });

const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Diagnosis and Emergency Management of PPH - Part 5";
pres.author = "Clinical Education";

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  teal:    "1ABC9C",
  gold:    "F39C12",
  white:   "FFFFFF",
  light:   "ECF0F1",
  slate:   "2C3E50",
  muted:   "7F8C8D",
  green:   "27AE60",
  purple:  "8E44AD",
  orange:  "E67E22",
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// ── SLIDE 41: Uterine Compression Sutures ────────────────────────────────────
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    "Avoids hysterectomy in many patients",
    "Technically straightforward"
  ], {fs:10.8, bc:C.green, char:"2714"}), { x:0.35, y:3.54, w:2.82, h:1.26, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Middle: Three suture type cards
  const sutures = [
    { name:"B-Lynch Suture", desc:"Continuous brace suture loops over uterine fundus compressing anterior + posterior walls. Most widely used.", color:"0A1E2A", accent:C.teal },
    { name:"Hayman Suture", desc:"Two vertical compression sutures placed through the uterine cavity. Simpler; no need to open lower segment.", color:"1A0A2A", accent:C.purple },
    { name:"Cho Square Sutures", desc:"Multiple square sutures through all uterine layers. Best for segmental / lower segment bleeding.", color:"1A1A00", accent:C.gold },
  ];
  sutures.forEach(function(s, i) {
    const sy = 1.32 + i * 1.22;
    card(slide, 3.45, sy, 3.1, 1.15, s.color);
    slide.addShape(pres.ShapeType.rect, { x:3.45, y:sy, w:3.1, h:0.36, fill:{color:s.accent==="1ABC9C"?"0A2030":s.accent===C.purple?"1A0830":"2A2000"}, line:{type:"none"} });
    slide.addText(s.name, { x:3.55, y:sy, w:2.9, h:0.36, fontSize:11, bold:true, color:s.accent, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(s.desc, { x:3.55, y:sy+0.38, w:2.9, h:0.74, fontSize:9.8, color:C.light, valign:"top", margin:[2,4,2,4], fontFace:"Calibri" });
  });

  // Right: Diagram schematic
  card(slide, 6.75, 1.32, 3.0, 3.55, "0A1828");
  slide.addText("Compression Suture Comparison", { x:6.75, y:1.32, w:3.0, h:0.40, fontSize:11, bold:true, color:C.teal, align:"center", valign:"middle", margin:0, fontFace:"Calibri" });

  // B-Lynch schematic (uterus outline + loops)
  const bLynchSteps = ["B-Lynch", "- Enter below right CS incision", "- Loop over fundus", "- Compress ant+post walls", "- Exit below left incision", "- Tie to close"];
  slide.addText(bLynchSteps.map(function(t,i){ return { text:t, options:{color:i===0?C.teal:C.light, fontSize:i===0?11:9.5, bold:i===0, breakLine:i<bLynchSteps.length-1}}; }), {
    x:6.85, y:1.78, w:2.8, h:1.22, valign:"top", margin:[2,6,2,6], fontFace:"Calibri"
  });
  slide.addShape(pres.ShapeType.rect, { x:6.85, y:3.06, w:2.8, h:0.02, fill:{color:C.muted}, line:{type:"none"} });
  const haySteps = ["Hayman", "- 2 vertical sutures", "- Through all uterine layers", "- No need to open lower segment", "- Quicker technique"];
  slide.addText(haySteps.map(function(t,i){ return { text:t, options:{color:i===0?C.purple:C.light, fontSize:i===0?11:9.5, bold:i===0, breakLine:i<haySteps.length-1}}; }), {
    x:6.85, y:3.10, w:2.8, h:1.0, valign:"top", margin:[2,6,2,6], fontFace:"Calibri"
  });
  slide.addShape(pres.ShapeType.rect, { x:6.85, y:4.15, w:2.8, h:0.02, fill:{color:C.muted}, line:{type:"none"} });
  const choSteps = ["Cho Squares", "- Multiple squares through uterus", "- Best for lower segment bleeding"];
  slide.addText(choSteps.map(function(t,i){ return { text:t, options:{color:i===0?C.gold:C.light, fontSize:i===0?11:9.5, bold:i===0, breakLine:i<choSteps.length-1}}; }), {
    x:6.85, y:4.19, w:2.8, h:0.65, valign:"top", margin:[2,6,2,6], fontFace:"Calibri"
  });

  pearl(slide, "B-Lynch is the first-choice compression suture in most centers; Hayman is preferred when lower segment opening is not possible.", 4.98);
}

// ── SLIDE 42: B-Lynch Compression Suture ─────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "B-Lynch Compression Suture", 42, C.crimson);

  // Principle banner
  slide.addShape(pres.ShapeType.rect, { x:0.35, y:0.82, w:9.3, h:0.40, fill:{color:"1A0A00"}, line:{color:C.gold, pt:1} });
  slide.addText("Principle: A continuous brace suture compresses both uterine walls simultaneously to arrest hemorrhage.", {
    x:0.35, y:0.82, w:9.3, h:0.40, fontSize:11, bold:false, color:C.light, align:"center", valign:"middle", margin:0, fontFace:"Calibri", italic:true
  });

  // Left: Indications + Advantages
  card(slide, 0.25, 1.32, 4.55, 2.25, C.slate);
  cardHdr(slide, 0.25, 1.32, 4.55, 0.40, "Indications", C.teal, "1C2E3E");
  slide.addText(bul([
    "Uterine atony during or after caesarean section",
    "Failure of medical management (uterotonics)",
    "As part of stepwise surgical management",
    "Intraoperative decision to avoid hysterectomy"
  ], {fs:11, bc:C.teal}), { x:0.35, y:1.75, w:4.35, h:1.72, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  card(slide, 0.25, 3.65, 4.55, 1.22, "0A2A0A");
  cardHdr(slide, 0.25, 3.65, 4.55, 0.40, "Advantages", C.green, "0A2A0A");
  slide.addText(bul([
    "Controls hemorrhage rapidly - results seen within minutes",
    "Preserves uterus and fertility",
    "Technically simple for trained surgeons",
    "Success rate 75-90%"
  ], {fs:10.8, bc:C.green, char:"2714"}), { x:0.35, y:4.08, w:4.35, h:0.72, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });

  // Right: Steps + Complications
  card(slide, 5.0, 1.32, 4.75, 2.25, "1A0A2A");
  cardHdr(slide, 5.0, 1.32, 4.75, 0.40, "Surgical Steps", C.purple, "1A0A2A");
  const steps = [
    "Open lower uterine segment (if not already open)",
    "Enter 3 cm below & 3 cm medial to right corner",
    "Carry suture up over fundus to posterior wall",
    "Loop around uterus and return to anterior wall",
    "Enter 3 cm below & 3 cm medial to left corner",
    "Pull both ends and tie under tension",
    "Close uterine incision and check hemostasis"
  ];
  slide.addText(steps.map(function(s,i){ return { text:(i+1)+".  "+s, options:{color:C.light, fontSize:10, breakLine:i<steps.length-1}}; }), {
    x:5.1, y:1.75, w:4.55, h:1.72, valign:"top", margin:[4,8,4,8], fontFace:"Calibri"
  });

  card(slide, 5.0, 3.65, 4.75, 1.22, "2A0A0A");
  cardHdr(slide, 5.0, 3.65, 4.75, 0.40, "Possible Complications", C.crimson, "2A0A0A");
  slide.addText(bul([
    "Wound infection (rare with prophylactic antibiotics)",
    "Uterine ischemia - extremely rare",
    "Intrauterine adhesions (rare) - counsel pre-op"
  ], {fs:10.5, bc:C.crimson, char:"25CF"}), { x:5.1, y:4.08, w:4.55, h:0.72, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });

  pearl(slide, "B-Lynch suture is first-choice compression suture in most centers. Success is higher when placed before massive coagulopathy develops.", 4.98);
}

// ── SLIDE 43: Uterine Artery Ligation ────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Uterine Artery Ligation", 43, C.gold);

  // Mechanism highlight
  slide.addShape(pres.ShapeType.rect, { x:0.35, y:0.82, w:9.3, h:0.50, fill:{color:"2A1A00"}, line:{color:C.gold, pt:1.5} });
  slide.addText([
    { text:"Mechanism: ", options:{bold:true, color:C.gold} },
    { text:"Reduces uterine blood flow by approximately 90% - allows clot formation while collateral circulation maintains uterine viability.", options:{color:C.light} }
  ], { x:0.45, y:0.82, w:9.1, h:0.50, fontSize:11, valign:"middle", margin:[0,6,0,6], fontFace:"Calibri" });

  // Left column
  card(slide, 0.25, 1.42, 4.55, 1.82, C.slate);
  cardHdr(slide, 0.25, 1.42, 4.55, 0.40, "Indications", C.teal, "1C2E3E");
  slide.addText(bul([
    "Persistent bleeding despite uterotonics + compression sutures",
    "Desire to preserve the uterus",
    "PPH at caesarean section with accessible uterine vessels",
    "As part of stepwise devascularisation"
  ], {fs:11, bc:C.teal}), { x:0.35, y:1.85, w:4.35, h:1.28, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  card(slide, 0.25, 3.32, 4.55, 1.55, "0A2A0A");
  cardHdr(slide, 0.25, 3.32, 4.55, 0.40, "Advantages", C.green, "0A2A0A");
  slide.addText(bul([
    "Fertility-preserving",
    "Less radical than hysterectomy",
    "Fast to perform once abdomen is open",
    "Uterus remains viable via collaterals",
    "Can be combined with other techniques"
  ], {fs:10.8, bc:C.green, char:"2714"}), { x:0.35, y:3.75, w:4.35, h:1.04, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Right column
  card(slide, 5.0, 1.42, 4.75, 2.85, "1A1A2A");
  cardHdr(slide, 5.0, 1.42, 4.75, 0.40, "Technique (O'Leary Steps)", C.purple, "1A1A2A");
  const tech = [
    "Expose the lower uterine segment",
    "Identify the uterine vessels lateral to the uterus at the level of the lower segment",
    "Pass a suture medial to the vessels through the myometrium",
    "Tie the suture lateral to the vessels (avoid the ureter)",
    "Repeat on contralateral side",
    "Assess for hemostasis; if incomplete add utero-ovarian ligation"
  ];
  slide.addText(tech.map(function(s,i){ return { text:(i+1)+".  "+s, options:{color:C.light, fontSize:10.2, breakLine:i<tech.length-1}}; }), {
    x:5.1, y:1.85, w:4.55, h:2.30, valign:"top", margin:[4,8,4,8], fontFace:"Calibri"
  });

  card(slide, 5.0, 4.35, 4.75, 0.52, "2A0A0A");
  slide.addText(bul([
    "Injury to ureter or adjacent structures (rare if careful)",
    "Failure requiring further surgical escalation"
  ], {fs:10, bc:C.crimson, char:"25CF"}), { x:5.1, y:4.35, w:4.55, h:0.52, valign:"middle", margin:[2,8,2,8], fontFace:"Calibri" });
  slide.addText("Possible Complications", { x:5.0, y:4.35, w:1.6, h:0.52, fontSize:9, bold:true, color:C.crimson, valign:"middle", margin:[0,4,0,4], fontFace:"Calibri" });

  keyPrinciple(slide, "Stepwise devascularisation (uterine artery -> utero-ovarian -> internal iliac) preserves fertility at each step before proceeding to hysterectomy.", 4.96);
}

// ── SLIDE 44: Internal Iliac Artery Ligation & UAE ───────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Internal Iliac Artery Ligation  &  Uterine Artery Embolization", 44, C.purple);

  // Left: Internal Iliac
  card(slide, 0.25, 0.85, 4.6, 4.52, "1A0A2A");
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:0.85, w:4.6, h:0.42, fill:{color:C.purple}, line:{type:"none"} });
  slide.addText("Internal Iliac Artery Ligation (IIAL)", { x:0.35, y:0.85, w:4.4, h:0.42, fontSize:12.5, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });

  cardHdr(slide, 0.25, 1.30, 4.6, 0.36, "Indications", C.purple, "1A0A2A");
  slide.addText(bul([
    "Severe uncontrolled pelvic hemorrhage",
    "Experienced pelvic surgeon required",
    "When uterine artery ligation has failed",
    "Broad ligament hematoma or uterine rupture"
  ], {fs:10.5, bc:C.purple, char:"25B6"}), { x:0.35, y:1.68, w:4.4, h:1.08, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });

  cardHdr(slide, 0.25, 2.82, 4.6, 0.36, "Mechanism & Benefits", C.teal, "0A1E1E");
  slide.addText(bul([
    "Reduces mean arterial pressure in pelvis by 85%",
    "Converts pulsatile to collateral flow - aids clotting",
    "Does NOT cause ischemia - collateral circulation preserved",
    "Uterus remains viable; fertility potentially preserved"
  ], {fs:10.5, bc:C.teal}), { x:0.35, y:3.20, w:4.4, h:1.10, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });

  cardHdr(slide, 0.25, 4.36, 4.6, 0.36, "Technical Notes", C.gold, "1A1000");
  slide.addText("Identify common iliac bifurcation -> identify ureter -> ligate internal iliac 2.5 cm distal to bifurcation. Bilateral ligation preferred.", {
    x:0.35, y:4.74, w:4.4, h:0.60, fontSize:10, color:C.light, valign:"top", margin:[2,6,2,6], fontFace:"Calibri"
  });

  // Right: UAE
  card(slide, 5.05, 0.85, 4.7, 4.52, "0A1A2A");
  slide.addShape(pres.ShapeType.rect, { x:5.05, y:0.85, w:4.7, h:0.42, fill:{color:C.teal}, line:{type:"none"} });
  slide.addText("Uterine Artery Embolization (UAE)", { x:5.15, y:0.85, w:4.5, h:0.42, fontSize:12.5, bold:true, color:C.navy, valign:"middle", margin:0, fontFace:"Calibri" });

  cardHdr(slide, 5.05, 1.30, 4.7, 0.36, "Procedure", C.teal, "0A1A2A");
  const proc = [
    "Performed by interventional radiologist",
    "Catheter inserted via femoral or radial artery",
    "Selective catheterization of uterine arteries",
    "Embolic agents (gelfoam, coils) occlude vessels",
    "Bilateral embolization achieved in single session"
  ];
  slide.addText(proc.map(function(s,i){ return { text:(i+1)+".  "+s, options:{color:C.light, fontSize:10.5, breakLine:i<proc.length-1}}; }), {
    x:5.15, y:1.68, w:4.5, h:1.35, valign:"top", margin:[4,8,4,8], fontFace:"Calibri"
  });

  cardHdr(slide, 5.05, 3.08, 4.7, 0.36, "Advantages", C.green, "0A1A0A");
  slide.addText(bul([
    "Minimally invasive - no laparotomy",
    "Preserves fertility",
    "Success rate ~85-95% in stable patients",
    "Avoids general anaesthesia"
  ], {fs:10.5, bc:C.green, char:"2714"}), { x:5.15, y:3.46, w:4.5, h:0.85, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });

  cardHdr(slide, 5.05, 4.36, 4.7, 0.36, "Limitations", C.crimson, "2A0A0A");
  slide.addText(bul([
    "Requires specialized IR suite - not universally available",
    "NOT suitable for hemodynamically unstable patients"
  ], {fs:10.2, bc:C.crimson, char:"25CF"}), { x:5.15, y:4.74, w:4.5, h:0.60, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });
}

// ── SLIDE 45: Obstetric Hysterectomy ─────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Obstetric Hysterectomy  |  Definitive Management", 45, C.crimson);

  // Definition banner
  slide.addShape(pres.ShapeType.rect, { x:0.35, y:0.82, w:9.3, h:0.42, fill:{color:"2A0808"}, line:{color:C.crimson, pt:1} });
  slide.addText("Definition: Surgical removal of the uterus to control life-threatening haemorrhage when all other measures have failed.", {
    x:0.45, y:0.82, w:9.1, h:0.42, fontSize:11, color:C.light, align:"center", valign:"middle", margin:0, fontFace:"Calibri", italic:true
  });

  // Indications
  card(slide, 0.25, 1.34, 5.6, 2.0, C.slate);
  cardHdr(slide, 0.25, 1.34, 5.6, 0.40, "Indications", C.crimson, "1C2E3E");
  const inds = [
    "Uncontrolled PPH failing all conservative measures",
    "Placenta accreta spectrum (accreta / increta / percreta)",
    "Uterine rupture with irreparable damage",
    "Broad ligament hematoma with vessel damage",
    "Severe uterine infection with sepsis",
    "Uterine inversion not reducible"
  ];
  slide.addText(bul(inds, {fs:11, bc:C.crimson, char:"25CF"}), { x:0.35, y:1.77, w:5.4, h:1.50, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Types
  card(slide, 0.25, 3.42, 5.6, 1.45, "1A1A2A");
  cardHdr(slide, 0.25, 3.42, 5.6, 0.40, "Types", C.purple, "1A1A2A");
  slide.addText([
    { text:"Subtotal (Supracervical):  ", options:{bold:true, color:C.teal, fontSize:11} },
    { text:"Remove body, leave cervix. Faster, less morbidity. Preferred in emergencies.", options:{color:C.light, fontSize:11} },
    { text:"\n", options:{fontSize:6, breakLine:true} },
    { text:"Total Hysterectomy:  ", options:{bold:true, color:C.gold, fontSize:11} },
    { text:"Remove uterus + cervix. Indicated if cervical bleeding or pathology.", options:{color:C.light, fontSize:11} },
    { text:"\n", options:{fontSize:6, breakLine:true} },
    { text:"Both procedures:  ", options:{bold:true, color:C.crimson, fontSize:11} },
    { text:"Permanently end fertility - ensure informed consent when possible.", options:{color:C.muted, fontSize:11} }
  ], { x:0.35, y:3.85, w:5.4, h:0.96, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });

  // Right panel
  card(slide, 6.05, 1.34, 3.7, 2.0, "2A0A0A");
  cardHdr(slide, 6.05, 1.34, 3.7, 0.40, "When to Decide", C.gold, "2A0A0A");
  const when = [
    "Massive uncontrolled bleeding",
    "Deteriorating vitals despite resuscitation",
    "Failed uterotonic + tamponade + artery ligation",
    "DIC developing",
    "Do NOT delay - indecision kills"
  ];
  slide.addText(bul(when, {fs:11, bc:C.gold, char:"25B6"}), { x:6.15, y:1.77, w:3.5, h:1.50, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Principle box
  slide.addShape(pres.ShapeType.rect, { x:6.05, y:3.42, w:3.7, h:1.45, fill:{color:"1A0A00"}, line:{color:C.gold, pt:2} });
  slide.addText([
    { text:"Maternal Life > Fertility\n\n", options:{bold:true, color:C.gold, fontSize:14, breakLine:true} },
    { text:"Delayed hysterectomy increases morbidity and mortality. Consent if possible but never at the cost of delay.", options:{color:C.light, fontSize:10} }
  ], { x:6.15, y:3.44, w:3.5, h:1.40, valign:"middle", align:"center", margin:[4,8,4,8], fontFace:"Calibri" });

  pearl(slide, "Delayed hysterectomy in the face of uncontrolled haemorrhage significantly worsens maternal outcome. Decide early.", 4.98);
}

// ── SLIDE 46: Massive Obstetric Hemorrhage Protocol (MOHP) ───────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Massive Obstetric Haemorrhage Protocol (MOHP)", 46, C.teal);

  // Definition
  slide.addShape(pres.ShapeType.rect, { x:0.35, y:0.82, w:9.3, h:0.42, fill:{color:"0A1E1E"}, line:{color:C.teal, pt:1} });
  slide.addText("A standardized multidisciplinary protocol for rapid, coordinated management of severe obstetric bleeding.", {
    x:0.45, y:0.82, w:9.1, h:0.42, fontSize:11, color:C.light, align:"center", valign:"middle", margin:0, fontFace:"Calibri", italic:true
  });

  // 4 objectives across top
  const objs = [
    { label:"Early\nRecognition", icon:"1", color:C.teal, bg:"0A1E1E" },
    { label:"Rapid\nTransfusion", icon:"2", color:C.crimson, bg:"1E0A0A" },
    { label:"Correct\nCoagulopathy", icon:"3", color:C.gold, bg:"1E1A00" },
    { label:"Definitive\nHaemostasis", icon:"4", color:C.green, bg:"0A1E0A" }
  ];
  objs.forEach(function(o, i) {
    const ox = 0.25 + i * 2.42;
    card(slide, ox, 1.34, 2.3, 0.88, o.bg);
    slide.addShape(pres.ShapeType.rect, { x:ox, y:1.34, w:2.3, h:0.88, fill:{color:o.bg}, line:{color:o.color, pt:1.5} });
    slide.addShape(pres.ShapeType.rect, { x:ox+0.08, y:1.42, w:0.30, h:0.30, fill:{color:o.color}, line:{type:"none"} });
    slide.addText(o.icon, { x:ox+0.08, y:1.42, w:0.30, h:0.30, fontSize:11, bold:true, color:C.navy, align:"center", valign:"middle", margin:0 });
    slide.addText(o.label, { x:ox+0.44, y:1.34, w:1.78, h:0.88, fontSize:11.5, bold:true, color:o.color, valign:"middle", margin:[0,4,0,4], fontFace:"Calibri" });
  });

  // Team Members
  card(slide, 0.25, 2.32, 4.6, 2.55, C.slate);
  cardHdr(slide, 0.25, 2.32, 4.6, 0.40, "Multidisciplinary Team", C.teal, "1C2E3E");
  const team = [
    { role:"Lead Obstetrician", resp:"Directs clinical management" },
    { role:"Anaesthetist", resp:"Airway, analgesia, resuscitation" },
    { role:"Haematologist", resp:"Guides blood product use" },
    { role:"Blood Bank", resp:"Issue blood products rapidly" },
    { role:"Intensivist", resp:"ICU care if required" },
    { role:"Nursing Staff", resp:"Procedures, documentation" },
  ];
  team.forEach(function(t, i) {
    const ry = 2.75 + i * 0.35;
    const rc = i%2===0?"1E2E3E":"162530";
    slide.addShape(pres.ShapeType.rect, { x:0.25, y:ry, w:4.6, h:0.33, fill:{color:rc}, line:{type:"none"} });
    slide.addText(t.role, { x:0.35, y:ry, w:1.9, h:0.33, fontSize:10, bold:true, color:C.teal, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(t.resp, { x:2.28, y:ry, w:2.5, h:0.33, fontSize:10, color:C.light, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Benefits + Triggers
  card(slide, 5.05, 2.32, 4.7, 2.55, "0A1A0A");
  cardHdr(slide, 5.05, 2.32, 4.7, 0.40, "Benefits of MOHP", C.green, "0A1A0A");
  slide.addText(bul([
    "Reduces time to first blood product by 30-40%",
    "Improves maternal survival rates",
    "Enhances team communication and role clarity",
    "Reduces delays in decision-making",
    "Ensures blood products available proactively"
  ], {fs:11, bc:C.green, char:"2714"}), { x:5.15, y:2.75, w:4.5, h:1.08, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  cardHdr(slide, 5.05, 3.88, 4.7, 0.36, "Activation Triggers", C.crimson, "2A0A0A");
  slide.addText(bul([
    "Blood loss >1500 mL or ongoing rapid bleeding",
    "Hemodynamic instability despite initial resuscitation",
    "Clinical judgment of senior clinician"
  ], {fs:10.5, bc:C.crimson, char:"25CF"}), { x:5.15, y:4.26, w:4.5, h:0.58, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });

  keyPrinciple(slide, "Activate MOHP early - it is far better to activate and stand down than to delay and face uncontrolled haemorrhage.", 4.98);
}

// ── SLIDE 47: Intensive Care Management ──────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Intensive Care Management After Severe PPH", 47, C.purple);

  // Indications for ICU
  card(slide, 0.25, 0.85, 9.5, 1.12, "1A0A2A");
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:0.85, w:9.5, h:0.38, fill:{color:C.purple}, line:{type:"none"} });
  slide.addText("Indications for ICU Admission", { x:0.35, y:0.85, w:9.3, h:0.38, fontSize:13, bold:true, color:C.white, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });
  const icuInds = ["Massive blood loss (>2500 mL)", "Persistent haemodynamic shock", "Ventilatory support needed", "Coagulopathy / DIC", "Multi-organ dysfunction", "Unanticipated major surgery"];
  icuInds.forEach(function(s, i) {
    const ix = 0.35 + i * 1.57;
    slide.addShape(pres.ShapeType.rect, { x:ix, y:1.26, w:1.5, h:0.62, fill:{color:i%2===0?"1A0A2A":"130818"}, line:{color:C.purple, pt:0.5} });
    slide.addText(s, { x:ix, y:1.26, w:1.5, h:0.62, fontSize:9, color:C.light, align:"center", valign:"middle", margin:[2,4,2,4], fontFace:"Calibri" });
  });

  // Three columns: Monitoring, Goals, Parameters
  const cols3 = [
    {
      title:"Continuous Monitoring", color:"0A1E2A", accent:C.teal,
      items:["Continuous ECG", "SpO2 (target >95%)", "Non-invasive / arterial BP", "Central venous pressure (if indicated)", "Urine output (catheter - target >30 mL/h)", "Temperature monitoring", "End-tidal CO2 if ventilated"]
    },
    {
      title:"Laboratory Monitoring", color:"1A1A0A", accent:C.gold,
      items:["Haemoglobin / haematocrit (2-4 hourly)", "Platelet count", "PT / INR and aPTT", "Fibrinogen level", "Arterial blood gas (lactate)", "Renal function (urea, creatinine)", "Liver function tests"]
    },
    {
      title:"Management Goals", color:"0A2A0A", accent:C.green,
      items:["Restore tissue perfusion", "Correct metabolic acidosis", "Maintain Hb >8 g/dL", "Maintain platelets >50,000/uL", "Maintain fibrinogen >2 g/L", "Prevent / treat organ failure", "Early enteral nutrition when stable"]
    }
  ];
  cols3.forEach(function(col, i) {
    const cx = 0.25 + i * 3.25;
    card(slide, cx, 2.08, 3.1, 2.78, col.color);
    slide.addShape(pres.ShapeType.rect, { x:cx, y:2.08, w:3.1, h:0.40, fill:{color:col.color}, line:{type:"none"} });
    slide.addText(col.title, { x:cx+0.1, y:2.08, w:2.9, h:0.40, fontSize:11.5, bold:true, color:col.accent, valign:"middle", margin:[0,6,0,6], fontFace:"Calibri" });
    slide.addText(bul(col.items, {fs:10.2, bc:col.accent, char:"25B6"}), { x:cx+0.1, y:2.50, w:2.9, h:2.28, valign:"top", margin:[2,6,2,6], fontFace:"Calibri" });
  });

  keyPrinciple(slide, "Urine output >30 mL/hour is a reliable bedside marker of adequate end-organ perfusion. Target it actively.", 4.98);
}

// ── SLIDE 48: Monitoring After Haemorrhage Control ───────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Monitoring After Haemorrhage Control", 48, C.teal);

  // Two main columns
  card(slide, 0.25, 0.85, 4.55, 4.0, C.slate);
  cardHdr(slide, 0.25, 0.85, 4.55, 0.40, "Clinical Monitoring", C.teal, "1C2E3E");

  const clinRows = [
    { param:"Pulse", target:"60-100 bpm; tachycardia = ongoing loss / pain" },
    { param:"Blood Pressure", target:"SBP >90 mmHg; MAP >65 mmHg" },
    { param:"Respiratory Rate", target:"12-20 breaths/min" },
    { param:"Temperature", target:"Avoid hypothermia (<36 C worsens coagulopathy)" },
    { param:"SpO2", target:">95% on air or supplemental O2" },
    { param:"Mental Status", target:"GCS monitoring; confusion = poor perfusion" },
    { param:"Uterine Tone", target:"Firm on palpation every 15 min (first hour)" },
    { param:"Vaginal Bleeding", target:"Pad count + visual estimation, ongoing documentation" },
  ];
  clinRows.forEach(function(r, i) {
    const ry = 1.28 + i * 0.44;
    const rc = i%2===0?"1E2E3E":"162530";
    slide.addShape(pres.ShapeType.rect, { x:0.25, y:ry, w:4.55, h:0.42, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.param, { x:0.35, y:ry, w:1.35, h:0.42, fontSize:10, bold:true, color:C.teal, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.target, { x:1.72, y:ry, w:2.98, h:0.42, fontSize:9.5, color:C.light, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  card(slide, 5.0, 0.85, 4.75, 3.08, "0A1A2A");
  cardHdr(slide, 5.0, 0.85, 4.75, 0.40, "Laboratory Monitoring", C.gold, "0A1A2A");

  const labRows = [
    { test:"Haemoglobin", freq:"2-4 hourly", target:"Maintain >8 g/dL" },
    { test:"Platelet count", freq:"4 hourly", target:">50,000/uL (>75 if ongoing)" },
    { test:"PT / INR", freq:"4 hourly", target:"INR <1.5" },
    { test:"aPTT", freq:"4 hourly", target:"<1.5x normal" },
    { test:"Fibrinogen", freq:"4 hourly", target:">2 g/L" },
    { test:"Renal function", freq:"Daily", target:"Creatinine trend" },
    { test:"LFTs", freq:"Daily", target:"Exclude hepatic dysfunction" },
  ];
  labRows.forEach(function(r, i) {
    const ry = 1.28 + i * 0.38;
    const rc = i%2===0?"0E2030":"0A1828";
    slide.addShape(pres.ShapeType.rect, { x:5.0, y:ry, w:4.75, h:0.36, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.test, { x:5.1, y:ry, w:1.52, h:0.36, fontSize:9.5, bold:true, color:C.gold, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.freq, { x:6.65, y:ry, w:1.1, h:0.36, fontSize:9, color:C.muted, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.target, { x:7.78, y:ry, w:1.89, h:0.36, fontSize:9, color:C.light, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Urine output box
  slide.addShape(pres.ShapeType.rect, { x:5.0, y:3.98, w:4.75, h:0.78, fill:{color:"1A0A2A"}, line:{color:C.purple, pt:1.5} });
  slide.addText([
    { text:"Urine Output Target:  ", options:{bold:true, color:C.purple, fontSize:12} },
    { text:">30 mL/hour", options:{bold:true, color:C.white, fontSize:14} },
    { text:"\nMost reliable bedside marker of adequate renal perfusion after haemorrhage.", options:{color:C.light, fontSize:10, breakLine:false} }
  ], { x:5.1, y:3.98, w:4.55, h:0.78, valign:"middle", margin:[4,8,4,8], fontFace:"Calibri" });

  keyPrinciple(slide, "Document all parameters and timing meticulously. Trends matter more than single readings in the post-haemorrhage period.", 4.88);
}

// ── SLIDE 49: Complications of PPH ───────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Complications of Postpartum Haemorrhage", 49, C.crimson);

  // Immediate complications
  card(slide, 0.25, 0.85, 4.6, 3.42, "2A0A0A");
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:0.85, w:4.6, h:0.42, fill:{color:C.crimson}, line:{type:"none"} });
  slide.addText("Immediate Complications", { x:0.35, y:0.85, w:4.4, h:0.42, fontSize:13, bold:true, color:C.white, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  const immediate = [
    { comp:"Hypovolemic Shock", note:"Most common immediate complication; leads to organ hypoperfusion" },
    { comp:"DIC", note:"Disseminated intravascular coagulation - consumption of clotting factors" },
    { comp:"Acute Kidney Injury", note:"Renal cortical necrosis from prolonged hypoperfusion" },
    { comp:"ARDS", note:"Acute respiratory distress syndrome from massive transfusion / shock" },
    { comp:"Cardiac Arrest", note:"Secondary to severe shock; hypoxia; acidosis; coagulopathy" },
    { comp:"Death", note:"Leading cause of maternal mortality worldwide; preventable in most cases" },
  ];
  immediate.forEach(function(r, i) {
    const ry = 1.30 + i * 0.49;
    const rc = i%2===0?"1E0A0A":"180808";
    slide.addShape(pres.ShapeType.rect, { x:0.25, y:ry, w:4.6, h:0.46, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.comp, { x:0.35, y:ry, w:1.55, h:0.46, fontSize:10, bold:true, color:C.crimson, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.note, { x:1.93, y:ry, w:2.84, h:0.46, fontSize:9.5, color:C.light, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Late complications
  card(slide, 5.05, 0.85, 4.7, 3.42, "1A0A2A");
  slide.addShape(pres.ShapeType.rect, { x:5.05, y:0.85, w:4.7, h:0.42, fill:{color:C.purple}, line:{type:"none"} });
  slide.addText("Late / Long-term Complications", { x:5.15, y:0.85, w:4.5, h:0.42, fontSize:13, bold:true, color:C.white, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  const late = [
    { comp:"Severe Anaemia", note:"Persistent fatigue, reduced quality of life; requires iron + transfusion" },
    { comp:"Infection / Sepsis", note:"Wound infection, endometritis, pneumonia in ICU patients" },
    { comp:"Sheehan Syndrome", note:"Pituitary necrosis from hypoperfusion -> hypopituitarism" },
    { comp:"Infertility", note:"After hysterectomy or intrauterine adhesions (Asherman syndrome)" },
    { comp:"Psychological Trauma", note:"PTSD; fear of future pregnancy; postnatal depression" },
    { comp:"Postpartum Depression", note:"Compounded by anaemia, pain, prolonged hospitalisation" },
  ];
  late.forEach(function(r, i) {
    const ry = 1.30 + i * 0.49;
    const rc = i%2===0?"1A0A28":"130820";
    slide.addShape(pres.ShapeType.rect, { x:5.05, y:ry, w:4.7, h:0.46, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.comp, { x:5.15, y:ry, w:1.6, h:0.46, fontSize:10, bold:true, color:C.purple, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.note, { x:6.78, y:ry, w:2.88, h:0.46, fontSize:9.5, color:C.light, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Sheehan highlight
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:4.36, w:9.5, h:0.50, fill:{color:"1A1A00"}, line:{color:C.gold, pt:1} });
  slide.addText([
    { text:"Sheehan Syndrome: ", options:{bold:true, color:C.gold, fontSize:11} },
    { text:"Pituitary ischaemia due to hypotension -> failure of lactation, amenorrhoea, hypothyroidism, adrenal insufficiency. Screen all women with severe PPH.", options:{color:C.light, fontSize:10.5} }
  ], { x:0.35, y:4.36, w:9.3, h:0.50, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  pearl(slide, "Early, aggressive management of PPH prevents the vast majority of these complications. Every minute of delay increases risk.", 4.95);
}

// ── SLIDE 50: Maternal Outcome and Prognosis ──────────────────────────────────
{
  const slide = pres.addSlide();
  slide.background = { color: C.navy };

  // Header
  slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.80, fill:{color:"1E0A0A"}, line:{type:"none"} });
  slide.addShape(pres.ShapeType.rect, { x:0, y:0.78, w:10, h:0.06, fill:{color:C.crimson}, line:{type:"none"} });
  slide.addText("Maternal Outcome and Prognosis", { x:0.25, y:0, w:9.2, h:0.80, fontSize:22, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });
  slide.addText("50", { x:9.3, y:0.18, w:0.55, h:0.44, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });

  // Good prognosis
  card(slide, 0.25, 0.95, 4.6, 2.42, "0A2A0A");
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:0.95, w:4.6, h:0.42, fill:{color:C.green}, line:{type:"none"} });
  slide.addText("Good Prognosis When:", { x:0.35, y:0.95, w:4.4, h:0.42, fontSize:13, bold:true, color:C.white, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });
  slide.addText(bul([
    "PPH recognised early",
    "Prompt resuscitation initiated",
    "Cause identified and treated rapidly",
    "Multidisciplinary management available",
    "Adequate blood products on hand",
    "MOHP activated without delay"
  ], {fs:11, bc:C.green, char:"2714"}), { x:0.35, y:1.40, w:4.4, h:1.88, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Poor prognosis
  card(slide, 5.15, 0.95, 4.6, 2.42, "2A0A0A");
  slide.addShape(pres.ShapeType.rect, { x:5.15, y:0.95, w:4.6, h:0.42, fill:{color:C.crimson}, line:{type:"none"} });
  slide.addText("Poor Prognostic Factors:", { x:5.25, y:0.95, w:4.4, h:0.42, fontSize:13, bold:true, color:C.white, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });
  slide.addText(bul([
    "Delay in diagnosis",
    "Delay in referral to higher centre",
    "Inadequate blood transfusion",
    "Established coagulopathy (DIC)",
    "Massive blood loss (>3000 mL)",
    "Multi-organ dysfunction"
  ], {fs:11, bc:C.crimson, char:"25CF"}), { x:5.25, y:1.40, w:4.4, h:1.88, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Golden hour box
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:3.48, w:9.5, h:1.38, fill:{color:"1A0800"}, line:{color:C.gold, pt:2} });
  slide.addText([
    { text:"The Golden Hour\n", options:{bold:true, color:C.gold, fontSize:16, breakLine:true} },
    { text:"The first 60 minutes of PPH are decisive. Every 10 minutes of delay in resuscitation and cause-specific treatment exponentially increases the risk of death, DIC, organ failure, and hysterectomy.\n\n", options:{color:C.light, fontSize:11, breakLine:true} },
    { text:"Recognise early  ->  Resuscitate immediately  ->  Find the cause  ->  Treat specifically  ->  Escalate without hesitation.", options:{bold:true, color:C.gold, fontSize:11} }
  ], { x:0.40, y:3.50, w:9.2, h:1.34, valign:"middle", align:"center", margin:[4,10,4,10], fontFace:"Calibri" });

  // Bottom strip
  slide.addShape(pres.ShapeType.rect, { x:0, y:4.95, w:10, h:0.675, fill:{color:C.crimson}, line:{type:"none"} });
  slide.addText("\"Every drop of blood saved is a life preserved. Know the 4 Ts. Act without hesitation. PPH is survivable when teams are ready.\"", {
    x:0.3, y:4.95, w:9.4, h:0.675, fontSize:11.5, bold:true, color:C.white, align:"center", valign:"middle", margin:0, fontFace:"Calibri", italic:true
  });
}

// WRITE FILE
pres.writeFile({ fileName: "/home/daytona/workspace/pph-slides/PPH_Part5_Slides41-50.pptx" })
  .then(function() { console.log("SUCCESS"); })
  .catch(function(e) { console.error("ERROR:", e); });

const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Diagnosis and Emergency Management of PPH - Part 5";
pres.author = "Clinical Education";

// ── COLOR PALETTE (white background, dark text, vivid accents) ────────────────
const C = {
  white:   "FFFFFF",
  bg:      "F8F9FA",      // slide background
  navy:    "1A2F4A",      // header bar dark blue
  crimson: "C0392B",      // danger red
  teal:    "0E8C75",      // clinical green (darkened for legibility on white)
  gold:    "D68910",      // amber (darkened)
  green:   "1E8449",      // green (darkened)
  purple:  "7D3C98",      // purple (darkened)
  orange:  "CA6F1E",
  dark:    "1C2833",      // near-black text
  mid:     "2E4057",      // medium dark text
  muted:   "5D6D7E",      // secondary text
  cardBg:  "EBF5FB",      // light blue card bg
  cardBg2: "E9F7EF",      // light green card bg
  cardBg3: "FEF9E7",      // light gold card bg
  cardBg4: "F5EEF8",      // light purple card bg
  cardBg5: "FDEDEC",      // light red card bg
  headerLine: "2471A3",   // underline accent
};

// ── HELPERS ───────────────────────────────────────────────────────────────────
function hdr(slide, title, num, accentColor) {
  accentColor = accentColor || C.crimson;
  slide.background = { color: C.white };

  // Top header bar
  slide.addShape(pres.ShapeType.rect, {
    x:0, y:0, w:10, h:0.80,
    fill:{color:accentColor}, line:{type:"none"}
  });
  // Slide number badge
  slide.addShape(pres.ShapeType.rect, {
    x:9.25, y:0.14, w:0.60, h:0.50,
    fill:{color:"00000030"}, line:{type:"none"}
  });
  slide.addText(""+num, {
    x:9.25, y:0.14, w:0.60, h:0.50,
    fontSize:13, bold:true, color:C.white,
    align:"center", valign:"middle", margin:0, fontFace:"Calibri"
  });
  slide.addText(title, {
    x:0.25, y:0, w:8.85, h:0.80,
    fontSize:22, bold:true, color:C.white,
    valign:"middle", margin:0, fontFace:"Calibri"
  });
  // Thin accent line below header
  slide.addShape(pres.ShapeType.rect, {
    x:0, y:0.80, w:10, h:0.05,
    fill:{color:C.headerLine}, line:{type:"none"}
  });
}

function pearl(slide, text, y) {
  y = (y !== undefined) ? y : 4.78;
  slide.addShape(pres.ShapeType.rect, {
    x:0.25, y:y, w:9.5, h:0.65,
    fill:{color:C.cardBg3}, line:{color:C.gold, pt:1.5}
  });
  slide.addText([
    { text:"Clinical Pearl:  ", options:{bold:true, color:C.gold} },
    { text:text, options:{bold:false, color:C.dark} }
  ], { x:0.35, y:y, w:9.3, h:0.65, fontSize:13, valign:"middle", margin:[0,10,0,10], fontFace:"Calibri" });
}

function keyMsg(slide, text, y) {
  y = (y !== undefined) ? y : 4.78;
  slide.addShape(pres.ShapeType.rect, {
    x:0.25, y:y, w:9.5, h:0.65,
    fill:{color:C.cardBg}, line:{color:C.teal, pt:1.5}
  });
  slide.addText([
    { text:"Key Message:  ", options:{bold:true, color:C.teal} },
    { text:text, options:{bold:false, color:C.dark} }
  ], { x:0.35, y:y, w:9.3, h:0.65, fontSize:13, valign:"middle", margin:[0,10,0,10], fontFace:"Calibri" });
}

function box(slide, x, y, w, h, bg, border) {
  slide.addShape(pres.ShapeType.rect, {
    x:x, y:y, w:w, h:h,
    fill:{color:bg||C.cardBg},
    line: border ? {color:border, pt:1.5} : {type:"none"}
  });
}

function sectionHdr(slide, x, y, w, h, text, textColor, bg) {
  slide.addShape(pres.ShapeType.rect, { x:x, y:y, w:w, h:h, fill:{color:bg||C.cardBg}, line:{type:"none"} });
  slide.addText(text, {
    x:x+0.05, y:y, w:w-0.1, h:h,
    fontSize:14, bold:true, color:textColor||C.teal,
    valign:"middle", margin:[0,8,0,8], fontFace:"Calibri"
  });
}

function bul(items, opts) {
  opts = opts || {};
  return items.map(function(item, i) {
    return {
      text: item,
      options: {
        bullet: { type:"bullet", characterCode: opts.char||"25B6", color: opts.bc||C.teal },
        color: opts.color || C.dark,
        fontSize: opts.fs || 13,
        breakLine: i < items.length - 1,
        bold: opts.bold || false,
        indentLevel: opts.indent || 0
      }
    };
  });
}

// ── SLIDE 41: Uterine Compression Sutures ────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Uterine Compression Sutures", 41, C.crimson);

  // Purpose banner
  box(slide, 0.25, 0.92, 9.5, 0.50, C.cardBg5, C.crimson);
  slide.addText([
    { text:"Purpose: ", options:{bold:true, color:C.crimson} },
    { text:"Mechanically compress the uterus to control bleeding while preserving fertility.", options:{color:C.dark} }
  ], { x:0.45, y:0.92, w:9.1, h:0.50, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Left: Indications + Advantages
  box(slide, 0.25, 1.52, 2.95, 3.45, C.cardBg, C.teal);
  sectionHdr(slide, 0.25, 1.52, 2.95, 0.44, "Indications", C.teal, "D6EAF8");
  slide.addText(bul([
    "Persistent uterine atony despite uterotonics",
    "Failure of balloon tamponade",
    "Patient desires future fertility"
  ], {fs:12.5, bc:C.teal}), { x:0.35, y:2.00, w:2.75, h:1.30, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  sectionHdr(slide, 0.25, 3.36, 2.95, 0.44, "Advantages", C.green, "D5F5E3");
  slide.addText(bul([
    "Rapid and effective",
    "Uterus preserved",
    "Avoids hysterectomy",
    "Simple technique"
  ], {fs:12.5, bc:C.green, char:"2714", color:C.dark}), { x:0.35, y:3.83, w:2.75, h:1.08, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Middle: 3 suture type blocks
  const sutures = [
    { name:"B-Lynch Suture", desc:"Continuous brace suture loops over fundus, compresses ant+post walls. Most widely used. ~75-90% success.", color:C.teal, bg:C.cardBg },
    { name:"Hayman Suture", desc:"Two vertical compression sutures through uterine cavity. Simpler - no need to open lower segment.", color:C.purple, bg:C.cardBg4 },
    { name:"Cho Square Sutures", desc:"Multiple square sutures through all uterine layers. Best for lower segment / segmental bleeding.", color:C.gold, bg:C.cardBg3 },
  ];
  sutures.forEach(function(s, i) {
    const sy = 1.52 + i * 1.16;
    box(slide, 3.40, sy, 3.15, 1.10, s.bg, s.color);
    slide.addShape(pres.ShapeType.rect, { x:3.40, y:sy, w:3.15, h:0.40, fill:{color:s.color}, line:{type:"none"} });
    slide.addText(s.name, { x:3.50, y:sy, w:2.95, h:0.40, fontSize:13, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(s.desc, { x:3.50, y:sy+0.42, w:2.95, h:0.65, fontSize:12, color:C.dark, valign:"top", margin:[2,6,2,6], fontFace:"Calibri" });
  });

  // Right: Comparison guide
  box(slide, 6.75, 1.52, 3.0, 3.45, C.bg, C.muted);
  slide.addText("Suture Comparison", { x:6.75, y:1.52, w:3.0, h:0.42, fontSize:13, bold:true, color:C.navy, align:"center", valign:"middle", margin:0, fontFace:"Calibri" });
  const cmpRows = [
    {lbl:"B-Lynch",  cs:"CS needed", fert:"Yes", diff:"Moderate"},
    {lbl:"Hayman",   cs:"No CS needed", fert:"Yes", diff:"Easy"},
    {lbl:"Cho",      cs:"No CS needed", fert:"Yes", diff:"Moderate"},
  ];
  // mini table header
  ["Suture","Access","Fertility","Difficulty"].forEach(function(h,ci){
    const cx = [6.80, 7.55, 8.25, 8.83][ci];
    const cw = [0.7, 0.66, 0.56, 0.78][ci];
    slide.addShape(pres.ShapeType.rect, { x:cx, y:1.96, w:cw, h:0.34, fill:{color:C.navy}, line:{type:"none"} });
    slide.addText(h, { x:cx, y:1.96, w:cw, h:0.34, fontSize:10, bold:true, color:C.white, align:"center", valign:"middle", margin:0, fontFace:"Calibri" });
  });
  cmpRows.forEach(function(r,i){
    const ry = 2.32 + i * 0.46;
    const rc = i%2===0?"EBF5FB":"F8F9FA";
    slide.addShape(pres.ShapeType.rect, { x:6.80, y:ry, w:2.85, h:0.44, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.lbl,  { x:6.80, y:ry, w:0.70, h:0.44, fontSize:11, bold:true, color:C.navy, align:"center", valign:"middle", margin:0 });
    slide.addText(r.cs,   { x:7.52, y:ry, w:0.70, h:0.44, fontSize:10.5, color:C.mid, align:"center", valign:"middle", margin:0 });
    slide.addText(r.fert, { x:8.24, y:ry, w:0.58, h:0.44, fontSize:11, bold:true, color:C.green, align:"center", valign:"middle", margin:0 });
    slide.addText(r.diff, { x:8.84, y:ry, w:0.82, h:0.44, fontSize:10.5, color:C.mid, align:"center", valign:"middle", margin:0 });
  });

  pearl(slide, "B-Lynch is first-choice in most centres. Hayman is preferred when the lower segment is not open. Both preserve fertility.", 4.78);
}

// ── SLIDE 42: B-Lynch Compression Suture ──────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "B-Lynch Compression Suture", 42, C.crimson);

  // Principle
  box(slide, 0.25, 0.92, 9.5, 0.50, C.cardBg3, C.gold);
  slide.addText([
    { text:"Principle: ", options:{bold:true, color:C.gold} },
    { text:"A continuous brace suture compresses both uterine walls simultaneously to arrest haemorrhage.", options:{color:C.dark} }
  ], { x:0.45, y:0.92, w:9.1, h:0.50, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Left: Indications + advantages
  box(slide, 0.25, 1.52, 4.60, 2.30, C.cardBg, C.teal);
  sectionHdr(slide, 0.25, 1.52, 4.60, 0.44, "Indications", C.teal, "D6EAF8");
  slide.addText(bul([
    "Uterine atony during or after caesarean section",
    "Failure of medical management (uterotonics)",
    "Stepwise surgical management plan",
    "Intraoperative decision to avoid hysterectomy"
  ], {fs:13, bc:C.teal}), { x:0.35, y:1.99, w:4.40, h:1.74, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  box(slide, 0.25, 3.88, 4.60, 1.00, C.cardBg2, C.green);
  sectionHdr(slide, 0.25, 3.88, 4.60, 0.44, "Advantages", C.green, "D5F5E3");
  slide.addText(bul([
    "Rapid - results within minutes  |  Success rate ~75-90%",
    "Preserves uterus and fertility  |  Simple for trained surgeons"
  ], {fs:12.5, bc:C.green, char:"2714", color:C.dark}), { x:0.35, y:4.35, w:4.40, h:0.48, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });

  // Right: Surgical steps
  box(slide, 5.05, 1.52, 4.70, 2.30, C.cardBg4, C.purple);
  sectionHdr(slide, 5.05, 1.52, 4.70, 0.44, "Surgical Steps", C.purple, "F5EEF8");
  const steps = [
    "Open lower uterine segment (if not already open)",
    "Enter 3 cm below & 3 cm medial to right corner",
    "Carry suture up and over the uterine fundus",
    "Loop to posterior wall then return anteriorly",
    "Enter 3 cm below & 3 cm medial to left corner",
    "Pull both ends firmly together and tie under tension",
    "Close uterine incision and confirm haemostasis"
  ];
  slide.addText(steps.map(function(s,i){ return { text:(i+1)+".  "+s, options:{color:C.dark, fontSize:12.5, breakLine:i<steps.length-1}}; }), {
    x:5.15, y:1.99, w:4.50, h:1.74, valign:"top", margin:[4,8,4,8], fontFace:"Calibri"
  });

  // Complications
  box(slide, 5.05, 3.88, 4.70, 1.00, C.cardBg5, C.crimson);
  sectionHdr(slide, 5.05, 3.88, 4.70, 0.44, "Possible Complications", C.crimson, "FADBD8");
  slide.addText(bul([
    "Wound infection (rare with prophylactic antibiotics)",
    "Uterine ischaemia (extremely rare)  |  Intrauterine adhesions (rare)"
  ], {fs:12, bc:C.crimson, char:"25CF", color:C.dark}), { x:5.15, y:4.35, w:4.50, h:0.48, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });

  pearl(slide, "B-Lynch is first-choice compression suture. Success is higher when placed before massive coagulopathy develops.", 4.78);
}

// ── SLIDE 43: Uterine Artery Ligation ─────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Uterine Artery Ligation", 43, C.gold);

  // Mechanism
  box(slide, 0.25, 0.92, 9.5, 0.56, C.cardBg3, C.gold);
  slide.addText([
    { text:"Mechanism: ", options:{bold:true, color:C.gold} },
    { text:"Reduces uterine blood flow by ~90% - allows clot formation while collateral circulation maintains uterine viability.", options:{color:C.dark} }
  ], { x:0.45, y:0.92, w:9.1, h:0.56, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Left column
  box(slide, 0.25, 1.58, 4.60, 1.90, C.cardBg, C.teal);
  sectionHdr(slide, 0.25, 1.58, 4.60, 0.44, "Indications", C.teal, "D6EAF8");
  slide.addText(bul([
    "Persistent bleeding despite uterotonics + compression sutures",
    "Patient desires to preserve the uterus",
    "PPH at CS with accessible uterine vessels",
    "Part of stepwise surgical devascularisation"
  ], {fs:13, bc:C.teal}), { x:0.35, y:2.05, w:4.40, h:1.36, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  box(slide, 0.25, 3.55, 4.60, 1.33, C.cardBg2, C.green);
  sectionHdr(slide, 0.25, 3.55, 4.60, 0.44, "Advantages", C.green, "D5F5E3");
  slide.addText(bul([
    "Fertility-preserving",
    "Less radical than hysterectomy",
    "Fast to perform when abdomen is open",
    "Uterus remains viable via collaterals",
    "Can be combined with other techniques"
  ], {fs:12.5, bc:C.green, char:"2714", color:C.dark}), { x:0.35, y:4.02, w:4.40, h:0.82, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Right column: technique steps
  box(slide, 5.05, 1.58, 4.70, 3.30, C.cardBg4, C.purple);
  sectionHdr(slide, 5.05, 1.58, 4.70, 0.44, "Technique (O'Leary Steps)", C.purple, "F5EEF8");
  const tech = [
    "Expose the lower uterine segment",
    "Identify uterine vessels lateral to uterus at lower segment level",
    "Pass suture medial to vessels through the myometrium",
    "Tie suture lateral to vessels - stay medial to ureter",
    "Repeat on the contralateral side",
    "Assess haemostasis; add utero-ovarian ligation if incomplete"
  ];
  slide.addText(tech.map(function(s,i){ return { text:(i+1)+".  "+s, options:{color:C.dark, fontSize:13, breakLine:i<tech.length-1}}; }), {
    x:5.15, y:2.05, w:4.50, h:2.76, valign:"top", margin:[4,8,4,8], fontFace:"Calibri"
  });

  // Complications strip
  box(slide, 0.25, 4.92, 9.5, 0.46, C.cardBg5, C.crimson);
  slide.addText([
    { text:"Complications: ", options:{bold:true, color:C.crimson} },
    { text:"Ureteric injury (rare if careful) | Failure requiring further surgical escalation.", options:{color:C.dark} }
  ], { x:0.45, y:4.92, w:9.1, h:0.46, fontSize:12.5, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });
}

// ── SLIDE 44: Internal Iliac Artery Ligation & UAE ────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Internal Iliac Artery Ligation  &  Uterine Artery Embolization", 44, C.purple);

  // Left: IIAL
  box(slide, 0.25, 0.92, 4.65, 4.46, C.cardBg4, C.purple);
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:0.92, w:4.65, h:0.44, fill:{color:C.purple}, line:{type:"none"} });
  slide.addText("Internal Iliac Artery Ligation", { x:0.35, y:0.92, w:4.45, h:0.44, fontSize:14, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });

  sectionHdr(slide, 0.30, 1.40, 4.55, 0.40, "Indications", C.purple, "E8DAEF");
  slide.addText(bul([
    "Severe uncontrolled pelvic haemorrhage",
    "When uterine artery ligation has failed",
    "Broad ligament hematoma / uterine rupture",
    "Experienced pelvic surgeon required"
  ], {fs:13, bc:C.purple}), { x:0.40, y:1.84, w:4.40, h:1.06, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  sectionHdr(slide, 0.30, 2.96, 4.55, 0.40, "Mechanism & Benefits", C.teal, "D6EAF8");
  slide.addText(bul([
    "Reduces mean pelvic arterial pressure by ~85%",
    "Converts pulsatile to collateral flow - aids clotting",
    "Does NOT cause ischaemia - collaterals preserved",
    "Uterus remains viable; fertility potentially preserved"
  ], {fs:13, bc:C.teal}), { x:0.40, y:3.40, w:4.40, h:1.06, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  sectionHdr(slide, 0.30, 4.50, 4.55, 0.38, "Technical Note", C.gold, "FEF9E7");
  slide.addText("Identify common iliac bifurcation, identify ureter, ligate internal iliac 2.5 cm distal to bifurcation. Bilateral preferred.", {
    x:0.40, y:4.90, w:4.40, h:0.45, fontSize:12, color:C.dark, valign:"top", margin:[2,6,2,6], fontFace:"Calibri"
  });

  // Right: UAE
  box(slide, 5.10, 0.92, 4.65, 4.46, C.cardBg, C.teal);
  slide.addShape(pres.ShapeType.rect, { x:5.10, y:0.92, w:4.65, h:0.44, fill:{color:C.teal}, line:{type:"none"} });
  slide.addText("Uterine Artery Embolization (UAE)", { x:5.20, y:0.92, w:4.45, h:0.44, fontSize:14, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });

  sectionHdr(slide, 5.15, 1.40, 4.55, 0.40, "Procedure", C.teal, "D6EAF8");
  const proc = [
    "Performed by an interventional radiologist",
    "Catheter inserted via femoral or radial artery",
    "Selective catheterization of uterine arteries",
    "Embolic agents (gelfoam, coils) occlude vessels",
    "Bilateral embolization in single session"
  ];
  slide.addText(proc.map(function(s,i){ return { text:(i+1)+".  "+s, options:{color:C.dark, fontSize:13, breakLine:i<proc.length-1}}; }), {
    x:5.25, y:1.84, w:4.40, h:1.34, valign:"top", margin:[4,8,4,8], fontFace:"Calibri"
  });

  sectionHdr(slide, 5.15, 3.24, 4.55, 0.40, "Advantages", C.green, "D5F5E3");
  slide.addText(bul([
    "Minimally invasive - no laparotomy",
    "Preserves fertility",
    "Success rate ~85-95% in stable patients",
    "Avoids general anaesthesia"
  ], {fs:13, bc:C.green, char:"2714", color:C.dark}), { x:5.25, y:3.68, w:4.40, h:0.80, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  sectionHdr(slide, 5.15, 4.52, 4.55, 0.38, "Limitations", C.crimson, "FADBD8");
  slide.addText(bul([
    "Requires specialist IR suite - not universally available",
    "NOT suitable for haemodynamically unstable patients"
  ], {fs:12.5, bc:C.crimson, char:"25CF", color:C.dark}), { x:5.25, y:4.93, w:4.40, h:0.42, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });
}

// ── SLIDE 45: Obstetric Hysterectomy ──────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Obstetric Hysterectomy  |  Definitive Management", 45, C.crimson);

  // Definition
  box(slide, 0.25, 0.92, 9.5, 0.52, C.cardBg5, C.crimson);
  slide.addText([
    { text:"Definition: ", options:{bold:true, color:C.crimson} },
    { text:"Surgical removal of the uterus to control life-threatening haemorrhage when all other measures have failed.", options:{color:C.dark, italic:true} }
  ], { x:0.45, y:0.92, w:9.1, h:0.52, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Left: Indications
  box(slide, 0.25, 1.54, 5.65, 2.05, C.cardBg5, C.crimson);
  sectionHdr(slide, 0.25, 1.54, 5.65, 0.44, "Indications", C.crimson, "FADBD8");
  slide.addText(bul([
    "Uncontrolled PPH failing all conservative measures",
    "Placenta accreta spectrum (accreta / increta / percreta)",
    "Uterine rupture with irreparable damage",
    "Severe uterine infection with sepsis",
    "Uterine inversion not reducible by other means"
  ], {fs:13, bc:C.crimson, char:"25CF"}), { x:0.35, y:2.01, w:5.45, h:1.52, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Left: Types
  box(slide, 0.25, 3.65, 5.65, 1.20, C.cardBg4, C.purple);
  sectionHdr(slide, 0.25, 3.65, 5.65, 0.44, "Types", C.purple, "F5EEF8");
  slide.addText([
    { text:"Subtotal (Supracervical):  ", options:{bold:true, color:C.purple, fontSize:13} },
    { text:"Remove body, leave cervix. Faster, less morbidity. Preferred in emergencies.\n", options:{color:C.dark, fontSize:13, breakLine:true} },
    { text:"Total Hysterectomy:  ", options:{bold:true, color:C.navy, fontSize:13} },
    { text:"Remove uterus + cervix. Indicated if cervical bleeding or pathology.", options:{color:C.dark, fontSize:13} }
  ], { x:0.35, y:4.12, w:5.45, h:0.68, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });

  // Right: When to decide + principle
  box(slide, 6.10, 1.54, 3.65, 2.05, C.cardBg3, C.gold);
  sectionHdr(slide, 6.10, 1.54, 3.65, 0.44, "When to Decide", C.gold, "FEF9E7");
  slide.addText(bul([
    "Massive uncontrolled bleeding",
    "Deteriorating vitals despite full resuscitation",
    "Failed uterotonics + tamponade + artery ligation",
    "DIC developing",
    "Do NOT delay - indecision costs lives"
  ], {fs:13, bc:C.gold, char:"25B6"}), { x:6.20, y:2.01, w:3.45, h:1.52, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Principle box
  box(slide, 6.10, 3.65, 3.65, 1.20, C.cardBg5, C.crimson);
  slide.addText([
    { text:"Maternal Life > Fertility\n", options:{bold:true, color:C.crimson, fontSize:15, breakLine:true} },
    { text:"Delayed hysterectomy increases morbidity and mortality.", options:{color:C.dark, fontSize:12.5} }
  ], { x:6.20, y:3.68, w:3.45, h:1.14, valign:"middle", align:"center", margin:[4,8,4,8], fontFace:"Calibri" });

  pearl(slide, "Delayed hysterectomy in uncontrolled haemorrhage significantly worsens maternal outcome. Decide early and act decisively.", 4.90);
}

// ── SLIDE 46: MOHP ────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Massive Obstetric Haemorrhage Protocol (MOHP)", 46, C.teal);

  // Definition
  box(slide, 0.25, 0.92, 9.5, 0.48, C.cardBg, C.teal);
  slide.addText([
    { text:"Definition: ", options:{bold:true, color:C.teal} },
    { text:"A standardized multidisciplinary protocol for rapid, coordinated management of severe obstetric bleeding.", options:{color:C.dark, italic:true} }
  ], { x:0.45, y:0.92, w:9.1, h:0.48, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // 4 Objectives strip
  const objs = [
    { n:"1", label:"Early Recognition",   color:C.teal,    bg:"D6EAF8" },
    { n:"2", label:"Rapid Transfusion",    color:C.crimson, bg:"FADBD8" },
    { n:"3", label:"Correct Coagulopathy", color:C.gold,    bg:"FEF9E7" },
    { n:"4", label:"Definitive Haemostasis",color:C.green,  bg:"D5F5E3" },
  ];
  objs.forEach(function(o, i) {
    const ox = 0.25 + i * 2.42;
    box(slide, ox, 1.50, 2.30, 0.90, o.bg, o.color);
    slide.addShape(pres.ShapeType.rect, { x:ox+0.08, y:1.58, w:0.32, h:0.32, fill:{color:o.color}, line:{type:"none"} });
    slide.addText(o.n, { x:ox+0.08, y:1.58, w:0.32, h:0.32, fontSize:12, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });
    slide.addText(o.label, { x:ox+0.46, y:1.50, w:1.76, h:0.90, fontSize:13, bold:true, color:o.color, valign:"middle", margin:[0,4,0,4], fontFace:"Calibri" });
  });

  // Team Members
  box(slide, 0.25, 2.52, 4.65, 2.58, C.cardBg, C.teal);
  sectionHdr(slide, 0.25, 2.52, 4.65, 0.44, "Multidisciplinary Team", C.teal, "D6EAF8");
  const team = [
    { role:"Lead Obstetrician",  resp:"Directs all clinical management" },
    { role:"Anaesthetist",       resp:"Airway, analgesia, resuscitation" },
    { role:"Haematologist",      resp:"Guides blood product use" },
    { role:"Blood Bank",         resp:"Issues blood products rapidly" },
    { role:"Intensivist",        resp:"ICU care when required" },
    { role:"Nursing Staff",      resp:"Procedures and documentation" },
  ];
  team.forEach(function(t, i) {
    const ry = 2.99 + i * 0.35;
    const rc = i%2===0?"EBF5FB":"F8F9FA";
    slide.addShape(pres.ShapeType.rect, { x:0.25, y:ry, w:4.65, h:0.34, fill:{color:rc}, line:{type:"none"} });
    slide.addText(t.role, { x:0.35, y:ry, w:1.90, h:0.34, fontSize:12, bold:true, color:C.teal, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(t.resp, { x:2.28, y:ry, w:2.55, h:0.34, fontSize:12, color:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Benefits + Triggers
  box(slide, 5.10, 2.52, 4.65, 2.58, C.cardBg2, C.green);
  sectionHdr(slide, 5.10, 2.52, 4.65, 0.44, "Benefits of MOHP", C.green, "D5F5E3");
  slide.addText(bul([
    "Reduces time to first blood product by 30-40%",
    "Improves maternal survival rates",
    "Enhances team communication and role clarity",
    "Ensures blood products available proactively"
  ], {fs:13, bc:C.green, char:"2714", color:C.dark}), { x:5.20, y:2.99, w:4.45, h:0.92, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  sectionHdr(slide, 5.10, 3.96, 4.65, 0.40, "Activation Triggers", C.crimson, "FADBD8");
  slide.addText(bul([
    "Blood loss >1500 mL or ongoing rapid bleeding",
    "Haemodynamic instability despite resuscitation",
    "Clinical judgement of senior clinician"
  ], {fs:13, bc:C.crimson, char:"25CF", color:C.dark}), { x:5.20, y:4.39, w:4.45, h:0.65, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });

  keyMsg(slide, "Activate MOHP early - far better to activate and stand down than to delay and face uncontrolled haemorrhage.", 4.90);
}

// ── SLIDE 47: Intensive Care Management ───────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Intensive Care Management After Severe PPH", 47, C.purple);

  // ICU Indications strip
  box(slide, 0.25, 0.92, 9.5, 0.92, C.cardBg4, C.purple);
  slide.addText("Indications for ICU Admission:", { x:0.40, y:0.92, w:2.80, h:0.44, fontSize:13, bold:true, color:C.purple, valign:"middle", margin:0, fontFace:"Calibri" });
  const icuInds = ["Massive blood loss (>2500 mL)", "Persistent haemodynamic shock", "Ventilatory support needed", "Coagulopathy / DIC", "Multi-organ dysfunction", "Major unanticipated surgery"];
  icuInds.forEach(function(s, i) {
    const ix = 0.40 + i * 1.56;
    box(slide, ix, 1.38, 1.48, 0.44, i%2===0?"EAD4F5":"D7BDE2", C.purple);
    slide.addText(s, { x:ix, y:1.38, w:1.48, h:0.44, fontSize:10.5, color:C.dark, align:"center", valign:"middle", margin:[2,4,2,4], fontFace:"Calibri" });
  });

  // Three columns
  const cols = [
    {
      title:"Continuous Monitoring", color:C.teal, bg:"D6EAF8",
      items:["Continuous ECG", "SpO2 (target >95%)", "Non-invasive / arterial BP", "Central venous pressure", "Urine output - target >30 mL/h", "Temperature monitoring", "End-tidal CO2 if ventilated"]
    },
    {
      title:"Laboratory Monitoring", color:C.gold, bg:"FEF9E7",
      items:["Haemoglobin every 2-4 hours", "Platelet count every 4 hours", "PT / INR and aPTT", "Fibrinogen level", "Arterial blood gas (lactate)", "Renal function (urea, creatinine)", "Liver function tests"]
    },
    {
      title:"Management Goals", color:C.green, bg:"D5F5E3",
      items:["Restore tissue perfusion", "Correct metabolic acidosis", "Maintain Hb >8 g/dL", "Maintain platelets >50,000/uL", "Maintain fibrinogen >2 g/L", "Prevent / treat organ failure", "Early enteral nutrition when stable"]
    }
  ];
  cols.forEach(function(col, i) {
    const cx = 0.25 + i * 3.25;
    box(slide, cx, 1.92, 3.10, 2.88, col.bg, col.color);
    sectionHdr(slide, cx, 1.92, 3.10, 0.44, col.title, col.color, col.bg);
    slide.addText(bul(col.items, {fs:12.5, bc:col.color, char:"25B6", color:C.dark}), {
      x:cx+0.10, y:2.39, w:2.90, h:2.36, valign:"top", margin:[2,6,2,6], fontFace:"Calibri"
    });
  });

  keyMsg(slide, "Urine output >30 mL/hour is a reliable bedside marker of adequate organ perfusion. Target it actively.", 4.90);
}

// ── SLIDE 48: Monitoring After Haemorrhage Control ────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Monitoring After Haemorrhage Control", 48, C.teal);

  // Clinical Monitoring table
  box(slide, 0.25, 0.90, 4.60, 4.00, C.cardBg, C.teal);
  sectionHdr(slide, 0.25, 0.90, 4.60, 0.44, "Clinical Monitoring", C.teal, "D6EAF8");
  const clinRows = [
    { param:"Pulse",           target:"60-100 bpm; tachycardia = ongoing loss" },
    { param:"Blood Pressure",  target:"SBP >90; MAP >65 mmHg" },
    { param:"Resp. Rate",      target:"12-20 breaths/min" },
    { param:"Temperature",     target:"Avoid hypothermia (<36C worsens coagulopathy)" },
    { param:"SpO2",            target:">95% on air or supplemental O2" },
    { param:"Mental Status",   target:"Confusion = poor perfusion (monitor GCS)" },
    { param:"Uterine Tone",    target:"Firm on palpation every 15 min (first hour)" },
    { param:"Vaginal Bleeding",target:"Pad count + visual estimation, documented" },
  ];
  clinRows.forEach(function(r, i) {
    const ry = 1.37 + i * 0.43;
    const rc = i%2===0?"EBF5FB":"F8F9FA";
    slide.addShape(pres.ShapeType.rect, { x:0.25, y:ry, w:4.60, h:0.41, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.param,  { x:0.35, y:ry, w:1.38, h:0.41, fontSize:11.5, bold:true, color:C.teal, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.target, { x:1.76, y:ry, w:3.00, h:0.41, fontSize:11,   color:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Lab Monitoring table
  box(slide, 5.05, 0.90, 4.70, 3.12, C.cardBg3, C.gold);
  sectionHdr(slide, 5.05, 0.90, 4.70, 0.44, "Laboratory Monitoring", C.gold, "FEF9E7");
  // column headers
  ["Test","Frequency","Target"].forEach(function(h,ci){
    const cx=[5.15,6.85,7.95][ci]; const cw=[1.62,1.06,1.70][ci];
    slide.addShape(pres.ShapeType.rect, { x:cx, y:1.37, w:cw, h:0.36, fill:{color:C.gold}, line:{type:"none"} });
    slide.addText(h, { x:cx, y:1.37, w:cw, h:0.36, fontSize:12, bold:true, color:C.white, align:"center", valign:"middle", margin:0, fontFace:"Calibri" });
  });
  const labRows = [
    { test:"Haemoglobin",   freq:"2-4 hourly",  target:"Maintain >8 g/dL" },
    { test:"Platelets",     freq:"4 hourly",     target:">50,000/uL" },
    { test:"PT / INR",      freq:"4 hourly",     target:"INR <1.5" },
    { test:"aPTT",          freq:"4 hourly",     target:"<1.5x normal" },
    { test:"Fibrinogen",    freq:"4 hourly",     target:">2 g/L" },
    { test:"Renal function",freq:"Daily",        target:"Creatinine trend" },
    { test:"LFTs",          freq:"Daily",        target:"Hepatic dysfunction" },
  ];
  labRows.forEach(function(r, i) {
    const ry = 1.76 + i * 0.37;
    const rc = i%2===0?"FEF9E7":"FFFBF0";
    slide.addShape(pres.ShapeType.rect, { x:5.05, y:ry, w:4.70, h:0.35, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.test, { x:5.15, y:ry, w:1.62, h:0.35, fontSize:11.5, bold:true, color:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.freq, { x:6.80, y:ry, w:1.08, h:0.35, fontSize:11,   color:C.muted, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.target,{ x:7.91, y:ry, w:1.76, h:0.35, fontSize:11,   color:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Urine output highlight
  box(slide, 5.05, 4.07, 4.70, 0.72, C.cardBg4, C.purple);
  slide.addText([
    { text:"Urine Output Target: ", options:{bold:true, color:C.purple, fontSize:14} },
    { text:">30 mL/hour\n", options:{bold:true, color:C.crimson, fontSize:15, breakLine:true} },
    { text:"Most reliable bedside marker of renal perfusion.", options:{color:C.dark, fontSize:12} }
  ], { x:5.15, y:4.07, w:4.50, h:0.72, valign:"middle", margin:[4,8,4,8], fontFace:"Calibri" });

  keyMsg(slide, "Document all parameters and timing meticulously. Trends matter more than single readings after haemorrhage.", 4.88);
}

// ── SLIDE 49: Complications of PPH ────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Complications of Postpartum Haemorrhage", 49, C.crimson);

  // Immediate
  box(slide, 0.25, 0.92, 4.65, 3.50, C.cardBg5, C.crimson);
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:0.92, w:4.65, h:0.44, fill:{color:C.crimson}, line:{type:"none"} });
  slide.addText("Immediate Complications", { x:0.35, y:0.92, w:4.45, h:0.44, fontSize:14, bold:true, color:C.white, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });
  const imm = [
    { comp:"Hypovolemic Shock",  note:"Most common; leads to organ hypoperfusion" },
    { comp:"DIC",                note:"Consumption of clotting factors; self-perpetuating" },
    { comp:"Acute Kidney Injury",note:"Renal cortical necrosis from hypoperfusion" },
    { comp:"ARDS",               note:"From massive transfusion and shock" },
    { comp:"Cardiac Arrest",     note:"From severe shock; hypoxia; acidosis" },
    { comp:"Death",              note:"Leading cause of maternal mortality - preventable" },
  ];
  imm.forEach(function(r, i) {
    const ry = 1.40 + i * 0.50;
    const rc = i%2===0?"FADBD8":"FBE8E7";
    slide.addShape(pres.ShapeType.rect, { x:0.25, y:ry, w:4.65, h:0.48, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.comp, { x:0.35, y:ry, w:1.68, h:0.48, fontSize:12, bold:true, color:C.crimson, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.note, { x:2.06, y:ry, w:2.75, h:0.48, fontSize:12, color:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Late
  box(slide, 5.10, 0.92, 4.65, 3.50, C.cardBg4, C.purple);
  slide.addShape(pres.ShapeType.rect, { x:5.10, y:0.92, w:4.65, h:0.44, fill:{color:C.purple}, line:{type:"none"} });
  slide.addText("Late / Long-term Complications", { x:5.20, y:0.92, w:4.45, h:0.44, fontSize:14, bold:true, color:C.white, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });
  const late = [
    { comp:"Severe Anaemia",      note:"Persistent fatigue; needs iron + transfusion" },
    { comp:"Infection / Sepsis",  note:"Wound, endometritis, pneumonia in ICU" },
    { comp:"Sheehan Syndrome",    note:"Pituitary necrosis -> hypopituitarism" },
    { comp:"Infertility",         note:"After hysterectomy or Asherman syndrome" },
    { comp:"Psychological Trauma",note:"PTSD; fear of future pregnancy" },
    { comp:"Postpartum Depression",note:"Compounded by anaemia and prolonged admission" },
  ];
  late.forEach(function(r, i) {
    const ry = 1.40 + i * 0.50;
    const rc = i%2===0?"F5EEF8":"EDE0F5";
    slide.addShape(pres.ShapeType.rect, { x:5.10, y:ry, w:4.65, h:0.48, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.comp, { x:5.20, y:ry, w:1.70, h:0.48, fontSize:12, bold:true, color:C.purple, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.note, { x:6.93, y:ry, w:2.74, h:0.48, fontSize:12, color:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Sheehan callout
  box(slide, 0.25, 4.50, 9.5, 0.55, C.cardBg3, C.gold);
  slide.addText([
    { text:"Sheehan Syndrome: ", options:{bold:true, color:C.gold, fontSize:13} },
    { text:"Pituitary ischaemia from hypotension causes failure of lactation, amenorrhoea, hypothyroidism, adrenal insufficiency. Screen all women with severe PPH.", options:{color:C.dark, fontSize:12.5} }
  ], { x:0.40, y:4.50, w:9.2, h:0.55, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  pearl(slide, "Early aggressive management prevents the vast majority of these complications. Every minute of delay increases risk.", 5.12);
}

// ── SLIDE 50: Maternal Outcome and Prognosis ──────────────────────────────────
{
  const slide = pres.addSlide();
  slide.background = { color: C.white };

  // Header
  slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.82, fill:{color:C.navy}, line:{type:"none"} });
  slide.addShape(pres.ShapeType.rect, { x:0, y:0.82, w:10, h:0.06, fill:{color:C.crimson}, line:{type:"none"} });
  slide.addText("Maternal Outcome and Prognosis", { x:0.25, y:0, w:9.20, h:0.82, fontSize:24, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });
  slide.addText("50", { x:9.25, y:0.16, w:0.60, h:0.50, fontSize:13, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });

  // Good prognosis
  box(slide, 0.25, 0.98, 4.65, 2.42, C.cardBg2, C.green);
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:0.98, w:4.65, h:0.44, fill:{color:C.green}, line:{type:"none"} });
  slide.addText("Good Prognosis When:", { x:0.35, y:0.98, w:4.45, h:0.44, fontSize:14, bold:true, color:C.white, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });
  slide.addText(bul([
    "PPH recognised early",
    "Prompt resuscitation initiated",
    "Cause identified and treated rapidly",
    "Multidisciplinary management available",
    "Adequate blood products on hand",
    "MOHP activated without delay"
  ], {fs:13, bc:C.green, char:"2714", color:C.dark}), { x:0.35, y:1.45, w:4.45, h:1.88, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Poor prognosis
  box(slide, 5.10, 0.98, 4.65, 2.42, C.cardBg5, C.crimson);
  slide.addShape(pres.ShapeType.rect, { x:5.10, y:0.98, w:4.65, h:0.44, fill:{color:C.crimson}, line:{type:"none"} });
  slide.addText("Poor Prognostic Factors:", { x:5.20, y:0.98, w:4.45, h:0.44, fontSize:14, bold:true, color:C.white, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });
  slide.addText(bul([
    "Delay in diagnosis",
    "Delay in referral to higher centre",
    "Inadequate blood transfusion",
    "Established coagulopathy (DIC)",
    "Massive blood loss (>3000 mL)",
    "Multi-organ dysfunction"
  ], {fs:13, bc:C.crimson, char:"25CF", color:C.dark}), { x:5.20, y:1.45, w:4.45, h:1.88, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Golden Hour box
  box(slide, 0.25, 3.50, 9.5, 1.40, C.cardBg3, C.gold);
  slide.addText([
    { text:"The Golden Hour\n", options:{bold:true, color:C.gold, fontSize:18, breakLine:true} },
    { text:"The first 60 minutes are decisive. Every 10 minutes of delay exponentially increases the risk of death, DIC, organ failure, and hysterectomy.\n\n", options:{color:C.dark, fontSize:13, breakLine:true} },
    { text:"Recognise -> Resuscitate -> Find the cause -> Treat specifically -> Escalate without hesitation.", options:{bold:true, color:C.navy, fontSize:13} }
  ], { x:0.40, y:3.52, w:9.2, h:1.36, valign:"middle", align:"center", margin:[4,10,4,10], fontFace:"Calibri" });

  // Bottom strip
  slide.addShape(pres.ShapeType.rect, { x:0, y:5.00, w:10, h:0.625, fill:{color:C.crimson}, line:{type:"none"} });
  slide.addText("\"Every drop of blood saved is a life preserved. Know the 4 Ts. Act without hesitation.\"", {
    x:0.3, y:5.00, w:9.4, h:0.625, fontSize:13, bold:true, color:C.white, align:"center", valign:"middle", margin:0, fontFace:"Calibri", italic:true
  });
}

// WRITE FILE
pres.writeFile({ fileName: "/home/daytona/workspace/pph-slides/PPH_Part5_White_Slides41-50.pptx" })
  .then(function() { console.log("SUCCESS"); })
  .catch(function(e) { console.error("ERROR:", e); });

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/pph-slides/pph_part5_white.js'

const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Diagnosis and Emergency Management of PPH - Part 6";
pres.author = "Clinical Education";

// ── COLOR PALETTE (white background, dark readable text) ─────────────────────
const C = {
  white:   "FFFFFF",
  navy:    "1A2F4A",
  crimson: "C0392B",
  teal:    "0E8C75",
  gold:    "D68910",
  green:   "1E8449",
  purple:  "7D3C98",
  dark:    "1C2833",
  mid:     "2E4057",
  muted:   "5D6D7E",
  // light card backgrounds
  cBlu:    "D6EAF8",
  cGrn:    "D5F5E3",
  cGld:    "FEF9E7",
  cPrp:    "F5EEF8",
  cRed:    "FADBD8",
  cGry:    "F2F3F4",
  // header bg
  hBlu:    "2471A3",
};

// ── HELPERS ───────────────────────────────────────────────────────────────────
function hdr(slide, title, num, accent) {
  accent = accent || C.crimson;
  slide.background = { color: C.white };
  slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.80, fill:{color:accent}, line:{type:"none"} });
  slide.addShape(pres.ShapeType.rect, { x:0, y:0.80, w:10, h:0.05, fill:{color:C.hBlu}, line:{type:"none"} });
  slide.addShape(pres.ShapeType.rect, { x:9.22, y:0.14, w:0.62, h:0.50, fill:{color:"1A1A1A"}, line:{type:"none"} });
  slide.addText(""+num, { x:9.22, y:0.14, w:0.62, h:0.50, fontSize:13, bold:true, color:C.white, align:"center", valign:"middle", margin:0, fontFace:"Calibri" });
  slide.addText(title, { x:0.25, y:0, w:8.85, h:0.80, fontSize:21, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });
}

function pearl(slide, text, y) {
  y = (y !== undefined) ? y : 4.80;
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:y, w:9.50, h:0.65, fill:{color:C.cGld}, line:{color:C.gold, pt:1.5} });
  slide.addText([
    { text:"Clinical Pearl:  ", options:{bold:true, color:C.gold} },
    { text:text, options:{bold:false, color:C.dark} }
  ], { x:0.38, y:y, w:9.26, h:0.65, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });
}

function keyMsg(slide, text, y) {
  y = (y !== undefined) ? y : 4.80;
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:y, w:9.50, h:0.65, fill:{color:C.cBlu}, line:{color:C.teal, pt:1.5} });
  slide.addText([
    { text:"Key Message:  ", options:{bold:true, color:C.teal} },
    { text:text, options:{bold:false, color:C.dark} }
  ], { x:0.38, y:y, w:9.26, h:0.65, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });
}

function box(slide, x, y, w, h, bg, border) {
  slide.addShape(pres.ShapeType.rect, { x:x, y:y, w:w, h:h, fill:{color:bg||C.cBlu}, line:border?{color:border,pt:1.5}:{type:"none"} });
}

function secHdr(slide, x, y, w, h, text, tc, bg) {
  slide.addShape(pres.ShapeType.rect, { x:x, y:y, w:w, h:h, fill:{color:bg||C.cBlu}, line:{type:"none"} });
  slide.addText(text, { x:x+0.06, y:y, w:w-0.1, h:h, fontSize:14, bold:true, color:tc||C.teal, valign:"middle", margin:[0,6,0,6], fontFace:"Calibri" });
}

function bul(items, opts) {
  opts = opts || {};
  return items.map(function(item, i) {
    return {
      text: item,
      options: {
        bullet: { type:"bullet", characterCode:opts.char||"25B6", color:opts.bc||C.teal },
        color: opts.color||C.dark,
        fontSize: opts.fs||13,
        breakLine: i < items.length - 1,
        bold: opts.bold||false,
        indentLevel: opts.indent||0
      }
    };
  });
}

// ── SLIDE 51: Prevention of PPH ───────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Prevention of Postpartum Haemorrhage", 51, C.green);

  // Top banner
  box(slide, 0.25, 0.93, 9.50, 0.46, C.cGrn, C.green);
  slide.addText([
    { text:"Prevention is Better Than Cure:  ", options:{bold:true, color:C.green} },
    { text:"Most cases of PPH can be prevented with timely antenatal, intrapartum, and postpartum interventions.", options:{color:C.dark} }
  ], { x:0.40, y:0.93, w:9.20, h:0.46, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Three columns
  const cols = [
    {
      title:"Antenatal Measures", color:C.teal, bg:C.cBlu,
      items:[
        "Identify high-risk pregnancies early",
        "Correct maternal anaemia (target Hb >11 g/dL)",
        "Screen for placenta praevia / accreta",
        "Manage hypertensive disorders",
        "Ensure institutional delivery for all high-risk women",
        "Counsel on risks and birth plan"
      ]
    },
    {
      title:"Intrapartum Measures", color:C.gold, bg:C.cGld,
      items:[
        "Skilled birth attendance at all deliveries",
        "Avoid prolonged or obstructed labour",
        "Use oxytocin judiciously (not for augmentation alone)",
        "Follow AMTSL at every delivery",
        "Avoid unnecessary episiotomy",
        "Identify and repair all genital tract trauma early"
      ]
    },
    {
      title:"Postpartum Measures", color:C.purple, bg:C.cPrp,
      items:[
        "Monitor uterine tone every 15 min (first hour)",
        "Assess vaginal bleeding regularly - quantify",
        "Monitor maternal vital signs closely",
        "Inspect placenta for completeness after delivery",
        "Keep IV access patent for at least 2 hours",
        "Ensure woman does not leave unmonitored"
      ]
    },
  ];

  cols.forEach(function(col, i) {
    const cx = 0.25 + i * 3.25;
    box(slide, cx, 1.49, 3.10, 3.42, col.bg, col.color);
    slide.addShape(pres.ShapeType.rect, { x:cx, y:1.49, w:3.10, h:0.44, fill:{color:col.color}, line:{type:"none"} });
    slide.addText(col.title, { x:cx+0.06, y:1.49, w:2.98, h:0.44, fontSize:14, bold:true, color:C.white, valign:"middle", margin:[0,6,0,6], fontFace:"Calibri" });
    slide.addText(bul(col.items, {fs:12.5, bc:col.color, char:"25B6", color:C.dark}), {
      x:cx+0.10, y:1.96, w:2.88, h:2.88, valign:"top", margin:[4,6,4,6], fontFace:"Calibri"
    });
  });

  keyMsg(slide, "Most cases of PPH can be prevented or managed effectively with timely interventions at every stage of care.", 4.80);
}

// ── SLIDE 52: AMTSL ───────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Active Management of the Third Stage of Labour (AMTSL)", 52, C.teal);

  // Definition
  box(slide, 0.25, 0.93, 9.50, 0.50, C.cBlu, C.teal);
  slide.addText([
    { text:"Definition:  ", options:{bold:true, color:C.teal} },
    { text:"AMTSL is a package of evidence-based interventions performed immediately after birth to reduce the risk and severity of PPH.", options:{color:C.dark} }
  ], { x:0.40, y:0.93, w:9.20, h:0.50, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Components - numbered flow
  box(slide, 0.25, 1.53, 5.65, 3.38, C.cBlu, C.teal);
  secHdr(slide, 0.25, 1.53, 5.65, 0.44, "Components of AMTSL", C.teal, "D0E8F5");

  const steps = [
    { n:"1", title:"Uterotonic Administration", desc:"Give oxytocin 10 IU IM / IV slow bolus within 1 minute of baby delivery. First and most important step." },
    { n:"2", title:"Delayed Cord Clamping", desc:"Clamp and cut cord 1-3 minutes after birth (or when cord stops pulsating) if baby does not need resuscitation." },
    { n:"3", title:"Controlled Cord Traction (CCT)", desc:"Apply gentle downward traction on cord while providing counter-traction on uterus. Only when uterus is contracted." },
    { n:"4", title:"Uterine Massage", desc:"After placental delivery, massage fundus to stimulate contraction. Check tone every 15 min for 1 hour." },
  ];

  steps.forEach(function(s, i) {
    const sy = 2.01 + i * 0.72;
    const rc = i%2===0?"EBF5FB":"F0F7FC";
    slide.addShape(pres.ShapeType.rect, { x:0.30, y:sy, w:5.55, h:0.68, fill:{color:rc}, line:{type:"none"} });
    slide.addShape(pres.ShapeType.rect, { x:0.30, y:sy+0.08, w:0.36, h:0.36, fill:{color:C.teal}, line:{type:"none"} });
    slide.addText(s.n, { x:0.30, y:sy+0.08, w:0.36, h:0.36, fontSize:12, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });
    slide.addText(s.title, { x:0.72, y:sy, w:1.80, h:0.68, fontSize:12.5, bold:true, color:C.teal, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(s.desc, { x:2.55, y:sy, w:3.25, h:0.68, fontSize:12, color:C.dark, valign:"middle", margin:[2,4,2,4], fontFace:"Calibri" });
  });

  // Right: Benefits + WHO note
  box(slide, 6.10, 1.53, 3.65, 2.10, C.cGrn, C.green);
  secHdr(slide, 6.10, 1.53, 3.65, 0.44, "Benefits of AMTSL", C.green, "C8F0D8");
  slide.addText(bul([
    "Reduces incidence of PPH by 60%",
    "Decreases mean blood loss significantly",
    "Lowers need for blood transfusion",
    "Reduces maternal morbidity and mortality",
    "Evidence-based: WHO & FIGO endorsed"
  ], {fs:13, bc:C.green, char:"2714", color:C.dark}), { x:6.20, y:2.00, w:3.45, h:1.56, valign:"top", margin:[4,6,4,6], fontFace:"Calibri" });

  // WHO recommendation box
  box(slide, 6.10, 3.70, 3.65, 1.22, C.cGld, C.gold);
  secHdr(slide, 6.10, 3.70, 3.65, 0.44, "WHO Recommendation", C.gold, "FAF0D0");
  slide.addText("Oxytocin is the preferred uterotonic for AMTSL. It should be offered to all women in the third stage of labour.", {
    x:6.20, y:4.17, w:3.45, h:0.70, fontSize:12.5, color:C.dark, valign:"top", margin:[2,6,2,6], fontFace:"Calibri"
  });

  pearl(slide, "AMTSL reduces PPH risk by ~60%. Oxytocin administration is the single most important step - do it within 1 minute of delivery.", 4.80);
}

// ── SLIDE 53: Uterotonics for Prevention ──────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Uterotonics for Prevention of PPH", 53, C.teal);

  // First-line drug hero card
  box(slide, 0.25, 0.93, 9.50, 1.20, C.cBlu, C.teal);
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:0.93, w:2.30, h:1.20, fill:{color:C.teal}, line:{type:"none"} });
  slide.addText("FIRST-LINE\nDRUG", { x:0.25, y:0.93, w:2.30, h:1.20, fontSize:15, bold:true, color:C.white, align:"center", valign:"middle", margin:0, fontFace:"Calibri" });
  slide.addText([
    { text:"OXYTOCIN\n", options:{bold:true, color:C.teal, fontSize:18, breakLine:true} },
    { text:"Dose: 10 IU IM or IV slow bolus after delivery of the baby\n", options:{color:C.dark, fontSize:13, breakLine:true} },
    { text:"Onset: 2-3 min (IM) | 1 min (IV)  |  Duration: 30-60 min\n", options:{color:C.muted, fontSize:12, breakLine:true} },
    { text:"WHO endorsed as preferred uterotonic whenever available and quality-assured.", options:{color:C.dark, fontSize:12.5, bold:true} }
  ], { x:2.65, y:0.93, w:6.95, h:1.20, valign:"middle", margin:[4,10,4,10], fontFace:"Calibri" });

  // Alternatives table
  box(slide, 0.25, 2.25, 9.50, 2.68, C.cGry, C.muted);
  secHdr(slide, 0.25, 2.25, 9.50, 0.44, "Alternative Uterotonics (when Oxytocin is unavailable or insufficient)", C.navy, "E8ECF0");

  // Table header
  ["Drug","Dose & Route","Onset","Contraindications","Notes"].forEach(function(h,i) {
    const cx = [0.30, 1.68, 4.10, 5.30, 7.40][i];
    const cw = [1.34, 2.38, 1.16, 2.06, 2.28][i];
    slide.addShape(pres.ShapeType.rect, { x:cx, y:2.72, w:cw, h:0.38, fill:{color:C.navy}, line:{type:"none"} });
    slide.addText(h, { x:cx, y:2.72, w:cw, h:0.38, fontSize:12, bold:true, color:C.white, align:"center", valign:"middle", margin:0, fontFace:"Calibri" });
  });

  const drugs = [
    { drug:"Misoprostol",   dose:"600-800 mcg SL / oral / rectal", onset:"3-5 min", ci:"None absolute", note:"Best for low-resource settings; heat-stable" },
    { drug:"Ergometrine",   dose:"0.2 mg IM or slow IV",            onset:"2-5 min", ci:"Hypertension, eclampsia, cardiac disease", note:"Avoid in HTN; causes sustained contraction" },
    { drug:"Oxytocin +\nErgometrine", dose:"1 ampoule IM (Syntometrine)", onset:"2-3 min", ci:"Hypertension",  note:"More effective than either alone" },
    { drug:"Carboprost",    dose:"250 mcg IM q15 min (max 8 doses)", onset:"~5 min", ci:"Asthma, severe hepatic/renal disease", note:"Use for treatment, not primary prevention" },
  ];
  drugs.forEach(function(r, i) {
    const ry = 3.13 + i * 0.44;
    const rc = i%2===0?"EAECEE":"F2F3F4";
    const vals = [r.drug, r.dose, r.onset, r.ci, r.note];
    const cxs = [0.30, 1.68, 4.10, 5.30, 7.40];
    const cws = [1.34, 2.38, 1.16, 2.06, 2.28];
    vals.forEach(function(v, ci) {
      slide.addShape(pres.ShapeType.rect, { x:cxs[ci], y:ry, w:cws[ci], h:0.42, fill:{color:rc}, line:{type:"none"} });
      slide.addText(v, { x:cxs[ci]+0.04, y:ry, w:cws[ci]-0.08, h:0.42, fontSize:ci===0?12.5:11.5, bold:ci===0, color:ci===0?C.teal:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
    });
  });

  pearl(slide, "Oxytocin within 1 minute after birth significantly reduces PPH risk. In resource-limited settings, misoprostol is a safe and effective alternative.", 4.80);
}

// ── SLIDE 54: WHO Recommendations ────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "WHO Recommendations for PPH Management", 54, C.navy);

  // Left: Key recommendations numbered
  box(slide, 0.25, 0.93, 5.65, 3.98, C.cBlu, C.teal);
  secHdr(slide, 0.25, 0.93, 5.65, 0.44, "Key WHO Recommendations", C.teal, "D0E8F5");

  const recs = [
    "Early recognition of excessive bleeding (quantitative assessment where feasible)",
    "Immediate administration of oxytocin (first-line uterotonic)",
    "Early use of tranexamic acid within 3 hours of PPH onset",
    "Rapid IV fluid resuscitation to maintain organ perfusion",
    "Timely blood transfusion - do not delay for lab confirmation in emergencies",
    "Stepwise approach to uterine atony - massage, uterotonics, tamponade, surgery",
    "Escalation to surgical management when conservative measures fail",
    "Team-based multidisciplinary approach - MOHP activation"
  ];
  slide.addText(recs.map(function(s,i){ return { text:(i+1)+".  "+s, options:{color:C.dark, fontSize:13, breakLine:i<recs.length-1, bold:false}}; }), {
    x:0.38, y:1.40, w:5.42, h:3.44, valign:"top", margin:[4,8,4,8], fontFace:"Calibri"
  });

  // Right: Goals
  box(slide, 6.10, 0.93, 3.65, 1.88, C.cGrn, C.green);
  secHdr(slide, 6.10, 0.93, 3.65, 0.44, "Goals of Management", C.green, "C8F0D8");
  slide.addText(bul([
    "Save maternal life - first priority",
    "Prevent complications (DIC, organ failure)",
    "Preserve fertility whenever possible",
    "Minimise blood product use",
    "Support psychological recovery"
  ], {fs:13, bc:C.green, char:"2714", color:C.dark}), { x:6.20, y:1.40, w:3.45, h:1.34, valign:"top", margin:[4,6,4,6], fontFace:"Calibri" });

  // TXA highlight box
  box(slide, 6.10, 2.91, 3.65, 1.06, C.cGld, C.gold);
  secHdr(slide, 6.10, 2.91, 3.65, 0.44, "Tranexamic Acid - Key Points", C.gold, "FAF0D0");
  slide.addText(bul([
    "Give within 3 hours of PPH onset (1 g IV over 10 min)",
    "Repeat dose if bleeding continues at 30 min",
    "Reduces PPH mortality by ~30% (WOMAN trial)"
  ], {fs:12.5, bc:C.gold, char:"25CF", color:C.dark}), { x:6.20, y:3.38, w:3.45, h:0.55, valign:"top", margin:[2,6,2,6], fontFace:"Calibri" });

  // Quantification box
  box(slide, 6.10, 4.05, 3.65, 0.86, C.cPrp, C.purple);
  secHdr(slide, 6.10, 4.05, 3.65, 0.40, "Quantitative Blood Loss (QBL)", C.purple, "EAD4F5");
  slide.addText("Use calibrated drapes, weighing pads, and suction canisters. QBL identifies PPH earlier than visual estimation alone.", {
    x:6.20, y:4.48, w:3.45, h:0.40, fontSize:12, color:C.dark, valign:"top", margin:[2,6,2,6], fontFace:"Calibri"
  });

  keyMsg(slide, "WHO recommendations are evidence-based. Implement every step in sequence without delay - each step improves survival.", 4.98);
}

// ── SLIDE 55: Simulation-Based Training ───────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Simulation-Based Training for PPH", 55, C.purple);

  // Why simulation banner
  box(slide, 0.25, 0.93, 9.50, 0.50, C.cPrp, C.purple);
  slide.addText([
    { text:"Why Simulation?  ", options:{bold:true, color:C.purple} },
    { text:"Allows healthcare workers to practise emergency management in a safe environment, without risk to patients.", options:{color:C.dark} }
  ], { x:0.40, y:0.93, w:9.20, h:0.50, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Three columns
  const cols = [
    {
      title:"Learning Objectives", color:C.teal, bg:C.cBlu,
      items:[
        "Early recognition of PPH",
        "Structured ABCDE assessment",
        "Team communication (SBAR)",
        "Correct use of uterotonics",
        "Bimanual uterine compression",
        "Effective IV access and resuscitation",
        "Crisis resource management"
      ]
    },
    {
      title:"Advantages of Simulation", color:C.green, bg:C.cGrn,
      items:[
        "Improves clinical confidence",
        "Strengthens teamwork and roles",
        "Reduces medical errors",
        "Improves patient outcomes",
        "Immediate feedback and debrief",
        "Repeatable without patient risk",
        "Builds muscle memory for emergencies"
      ]
    },
    {
      title:"Types of Simulation", color:C.gold, bg:C.cGld,
      items:[
        "Low-fidelity: task trainers, models",
        "High-fidelity: computerised manikins",
        "Standardised patient scenarios",
        "Team-based in-situ simulation",
        "Virtual reality (emerging)",
        "Debriefing and video review",
        "Regular drills and refreshers"
      ]
    }
  ];

  cols.forEach(function(col, i) {
    const cx = 0.25 + i * 3.25;
    box(slide, cx, 1.53, 3.10, 3.38, col.bg, col.color);
    slide.addShape(pres.ShapeType.rect, { x:cx, y:1.53, w:3.10, h:0.44, fill:{color:col.color}, line:{type:"none"} });
    slide.addText(col.title, { x:cx+0.06, y:1.53, w:2.98, h:0.44, fontSize:14, bold:true, color:C.white, valign:"middle", margin:[0,6,0,6], fontFace:"Calibri" });
    slide.addText(bul(col.items, {fs:12.5, bc:col.color, char:"25B6", color:C.dark}), {
      x:cx+0.10, y:2.00, w:2.88, h:2.84, valign:"top", margin:[4,6,4,6], fontFace:"Calibri"
    });
  });

  keyMsg(slide, "Regular simulation training converts theoretical knowledge into practical skills and improves team readiness for real obstetric emergencies.", 4.98);
}

// ── SLIDE 56: Equipment Required for PPH Simulation ───────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Equipment Required for PPH Simulation", 56, C.navy);

  // 4 equipment cards (2x2)
  const cards = [
    {
      title:"Airway Equipment", color:C.teal, bg:C.cBlu,
      items:["Oxygen source and flow meter","Face masks (various sizes)","Suction apparatus","Laryngoscope with blades","Endotracheal tubes (6.0-8.0)","Bag-valve-mask (Ambu bag)"]
    },
    {
      title:"Circulation Equipment", color:C.crimson, bg:C.cRed,
      items:["IV cannulas (14G and 16G)", "IV fluids (Normal saline, Hartmann's)", "Blood administration sets","Blood collection tubes (FBC, coag, X-match)","Tourniquet","Pressure bag for rapid infusion"]
    },
    {
      title:"Obstetric Equipment", color:C.purple, bg:C.cPrp,
      items:["Delivery tray / PPH trolley","Foley catheter set","Uterine balloon tamponade kit","Suturing instruments and absorbable sutures","Sterile gloves","Weighing scales / calibrated drape"]
    },
    {
      title:"Drugs Tray", color:C.gold, bg:C.cGld,
      items:["Oxytocin 10 IU ampoules","Methylergometrine 0.2 mg","Carboprost 250 mcg","Misoprostol 200 mcg tablets","Tranexamic acid 1 g/10 mL","Normal saline for dilution"]
    },
  ];

  const pos = [{x:0.25,y:0.95},{x:5.10,y:0.95},{x:0.25,y:3.22},{x:5.10,y:3.22}];
  cards.forEach(function(c, i) {
    const p = pos[i];
    box(slide, p.x, p.y, 4.65, 2.18, c.bg, c.color);
    slide.addShape(pres.ShapeType.rect, { x:p.x, y:p.y, w:4.65, h:0.44, fill:{color:c.color}, line:{type:"none"} });
    slide.addText(c.title, { x:p.x+0.06, y:p.y, w:4.53, h:0.44, fontSize:14, bold:true, color:C.white, valign:"middle", margin:[0,6,0,6], fontFace:"Calibri" });
    slide.addText(bul(c.items, {fs:12.5, bc:c.color, char:"25B6", color:C.dark}), {
      x:p.x+0.10, y:p.y+0.47, w:4.45, h:1.66, valign:"top", margin:[2,6,2,6], fontFace:"Calibri"
    });
  });
}

// ── SLIDE 57: PPH Emergency Trolley ───────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "PPH Emergency Trolley", 57, C.crimson);

  // Banner
  box(slide, 0.25, 0.93, 9.50, 0.46, C.cRed, C.crimson);
  slide.addText([
    { text:"Importance:  ", options:{bold:true, color:C.crimson} },
    { text:"A well-stocked, readily accessible emergency trolley saves critical minutes during obstetric emergencies.", options:{color:C.dark} }
  ], { x:0.40, y:0.93, w:9.20, h:0.46, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Drugs column
  box(slide, 0.25, 1.49, 4.65, 3.42, C.cGld, C.gold);
  secHdr(slide, 0.25, 1.49, 4.65, 0.44, "Drugs", C.gold, "FAF0D0");
  const drugRows = [
    { drug:"Oxytocin",           dose:"10 IU/mL ampoule",   use:"First-line uterotonic" },
    { drug:"Tranexamic Acid",    dose:"1 g/10 mL vial",      use:"Antifibrinolytic - within 3 h" },
    { drug:"Carboprost",         dose:"250 mcg/mL ampoule",  use:"Second-line uterotonic" },
    { drug:"Methylergometrine",  dose:"0.2 mg/mL ampoule",   use:"Avoid in hypertension" },
    { drug:"Misoprostol",        dose:"200 mcg tablet",       use:"Low-resource / sublingual" },
    { drug:"Adrenaline",         dose:"1 mg/mL",              use:"For anaphylaxis / cardiac arrest" },
  ];
  drugRows.forEach(function(r, i) {
    const ry = 1.96 + i * 0.46;
    const rc = i%2===0?"FEF9E7":"FFFBF2";
    slide.addShape(pres.ShapeType.rect, { x:0.25, y:ry, w:4.65, h:0.44, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.drug,  { x:0.35, y:ry, w:1.55, h:0.44, fontSize:12.5, bold:true, color:C.gold, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.dose,  { x:1.93, y:ry, w:1.40, h:0.44, fontSize:12,   color:C.muted, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.use,   { x:3.36, y:ry, w:1.45, h:0.44, fontSize:12,   color:C.dark,  valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Equipment column
  box(slide, 5.10, 1.49, 4.65, 3.42, C.cBlu, C.teal);
  secHdr(slide, 5.10, 1.49, 4.65, 0.44, "Equipment", C.teal, "D0E8F5");
  const equip = [
    "Syringes (2 mL, 5 mL, 10 mL, 20 mL)",
    "IV cannulas (14G and 16G)",
    "IV fluids (Normal saline, Ringer's lactate)",
    "Blood transfusion administration set",
    "Foley catheter set (with urine bag)",
    "Sterile surgical gloves (various sizes)",
    "Suture material (Vicryl 0 and 1)",
    "Balloon tamponade device (Bakri / condom)",
  ];
  slide.addText(bul(equip, {fs:12.5, bc:C.teal, char:"25B6", color:C.dark}), {
    x:5.20, y:1.96, w:4.45, h:2.88, valign:"top", margin:[4,6,4,6], fontFace:"Calibri"
  });

  keyMsg(slide, "Check and restock the PPH trolley after every use and at the start of every shift. A missing drug or item in an emergency can be fatal.", 4.98);
}

// ── SLIDE 58: Team Communication During PPH ───────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Team Communication During PPH", 58, C.teal);

  // Closed-loop intro
  box(slide, 0.25, 0.93, 9.50, 0.48, C.cBlu, C.teal);
  slide.addText([
    { text:"Closed-Loop Communication:  ", options:{bold:true, color:C.teal} },
    { text:"A structured communication technique that eliminates ambiguity, confirms task completion, and prevents errors during emergencies.", options:{color:C.dark} }
  ], { x:0.40, y:0.93, w:9.20, h:0.48, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Left: Principles
  box(slide, 0.25, 1.51, 4.60, 2.05, C.cBlu, C.teal);
  secHdr(slide, 0.25, 1.51, 4.60, 0.44, "Principles of Closed-Loop Communication", C.teal, "D0E8F5");
  const principles = [
    "Give clear, direct instructions (name + task + dose)",
    "Receiver repeats back the instruction verbatim",
    "Sender confirms the repeat is correct",
    "Task is completed and verbally confirmed",
    "Document all interventions with timing"
  ];
  slide.addText(principles.map(function(s,i){ return { text:(i+1)+".  "+s, options:{color:C.dark, fontSize:13, breakLine:i<principles.length-1}}; }), {
    x:0.38, y:1.98, w:4.38, h:1.52, valign:"top", margin:[4,8,4,8], fontFace:"Calibri"
  });

  // Left: Benefits
  box(slide, 0.25, 3.64, 4.60, 1.28, C.cGrn, C.green);
  secHdr(slide, 0.25, 3.64, 4.60, 0.44, "Benefits", C.green, "C8F0D8");
  slide.addText(bul(["Prevents medication errors","Improves team coordination","Enhances patient safety","Maintains situational awareness"], {fs:13, bc:C.green, char:"2714", color:C.dark}), {
    x:0.38, y:4.11, w:4.38, h:0.75, valign:"top", margin:[2,8,2,8], fontFace:"Calibri"
  });

  // Right: Example scenario
  box(slide, 5.05, 1.51, 4.70, 3.42, C.cGld, C.gold);
  secHdr(slide, 5.05, 1.51, 4.70, 0.44, "Example: PPH Communication Scenario", C.gold, "FAF0D0");

  const dialog = [
    { speaker:"Team Leader", role:"leader", line:"\"Nurse Ahmed - administer Oxytocin 10 IU IV now.\"" },
    { speaker:"Nurse Ahmed", role:"nurse",  line:"\"Understood - Oxytocin 10 IU IV. Administering now.\"" },
    { speaker:"Team Leader", role:"leader", line:"\"Confirmed - thank you.\"" },
    { speaker:"Nurse Ahmed", role:"nurse",  line:"\"Oxytocin 10 IU IV given at 14:32. Task complete.\"" },
    { speaker:"Team Leader", role:"leader", line:"\"Dr Khan - insert two large-bore IV cannulas, 14G bilateral.\"" },
    { speaker:"Dr Khan",     role:"nurse",  line:"\"Two 14G IV cannulas bilaterally - doing it now.\"" },
  ];
  dialog.forEach(function(d, i) {
    const dy = 2.00 + i * 0.50;
    const isLeader = d.role === "leader";
    const rc = isLeader?"EBF5FB":"FEF9E7";
    const tc = isLeader?C.teal:C.gold;
    slide.addShape(pres.ShapeType.rect, { x:5.10, y:dy, w:4.60, h:0.46, fill:{color:rc}, line:{type:"none"} });
    slide.addText(d.speaker+":", { x:5.18, y:dy, w:1.22, h:0.46, fontSize:12, bold:true, color:tc, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(d.line, { x:6.43, y:dy, w:3.20, h:0.46, fontSize:11.5, color:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  keyMsg(slide, "In emergencies, poor communication kills. Use structured, closed-loop communication for every instruction - no assumptions.", 4.98);
}

// ── SLIDE 59: Simulation Scenario ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Simulation Scenario  |  Clinical Case", 59, C.crimson);

  // Clinical case
  box(slide, 0.25, 0.93, 9.50, 1.52, C.cRed, C.crimson);
  secHdr(slide, 0.25, 0.93, 9.50, 0.44, "Clinical Case", C.crimson, "FADBD8");
  slide.addText([
    { text:"A 26-year-old G2P2 delivers vaginally at term. Ten minutes after delivery she develops heavy vaginal bleeding.\n", options:{color:C.dark, fontSize:13.5, bold:false, breakLine:true} },
    { text:"Vital Signs:  ", options:{bold:true, color:C.crimson, fontSize:13.5} },
    { text:"Pulse 120/min   |   BP 80/50 mmHg   |   SpO2 94%   |   GCS 14   |   Uterus: soft and boggy", options:{color:C.dark, fontSize:13.5, bold:false} }
  ], { x:0.38, y:1.40, w:9.24, h:1.02, valign:"middle", margin:[4,8,4,8], fontFace:"Calibri" });

  // Questions column
  box(slide, 0.25, 2.56, 4.60, 2.36, C.cPrp, C.purple);
  secHdr(slide, 0.25, 2.56, 4.60, 0.44, "Questions", C.purple, "EAD4F5");
  const qs = [
    "What is your primary diagnosis?",
    "What is the most likely underlying cause?",
    "What are your FIRST FIVE immediate actions?",
    "Which investigations will you send urgently?",
    "When would you escalate to surgical management?"
  ];
  slide.addText(qs.map(function(s,i){ return { text:"Q"+(i+1)+".  "+s, options:{color:C.dark, fontSize:13, breakLine:i<qs.length-1, bold:false}}; }), {
    x:0.38, y:3.04, w:4.38, h:1.82, valign:"top", margin:[4,8,4,8], fontFace:"Calibri"
  });

  // Expected answers column
  box(slide, 5.05, 2.56, 4.70, 2.36, C.cGrn, C.green);
  secHdr(slide, 5.05, 2.56, 4.70, 0.44, "Expected Answers", C.green, "C8F0D8");
  slide.addText([
    { text:"Diagnosis: ", options:{bold:true, color:C.green, fontSize:13} },
    { text:"Primary PPH (EBL >500 mL within 24 h of vaginal delivery)\n", options:{color:C.dark, fontSize:13, breakLine:true} },
    { text:"Cause: ", options:{bold:true, color:C.green, fontSize:13} },
    { text:"Uterine atony (Tone - the most common cause, ~80%)\n", options:{color:C.dark, fontSize:13, breakLine:true} },
    { text:"First 5 Actions: ", options:{bold:true, color:C.green, fontSize:13} },
    { text:"(1) Call for help & activate PPH protocol | (2) ABCDE assessment | (3) Oxygen 15 L/min | (4) Two large-bore IVs (14G) | (5) Bimanual uterine massage + oxytocin 10 IU IV", options:{color:C.dark, fontSize:12.5} }
  ], { x:5.15, y:3.04, w:4.50, h:1.82, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  keyMsg(slide, "This scenario should be practised until the first 5 actions are automatic. Speed and sequence both matter in real PPH.", 4.98);
}

// ── SLIDE 60: Simulation Debriefing ───────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Simulation Debriefing", 60, C.purple);

  // Why debrief
  box(slide, 0.25, 0.93, 9.50, 0.46, C.cPrp, C.purple);
  slide.addText([
    { text:"Purpose:  ", options:{bold:true, color:C.purple} },
    { text:"Debriefing converts the simulation experience into durable learning by reflecting on performance in a safe, structured conversation.", options:{color:C.dark} }
  ], { x:0.40, y:0.93, w:9.20, h:0.46, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // What went well
  box(slide, 0.25, 1.49, 4.60, 2.18, C.cGrn, C.green);
  secHdr(slide, 0.25, 1.49, 4.60, 0.44, "What Went Well?", C.green, "C8F0D8");
  slide.addText(bul([
    "Early diagnosis of PPH made promptly",
    "Good team communication and role assignment",
    "Correct sequence of management followed",
    "Uterotonics administered in time",
    "IV access established quickly",
    "Senior called early"
  ], {fs:13, bc:C.green, char:"2714", color:C.dark}), { x:0.38, y:1.96, w:4.38, h:1.64, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // What could improve
  box(slide, 5.05, 1.49, 4.70, 2.18, C.cRed, C.crimson);
  secHdr(slide, 5.05, 1.49, 4.70, 0.44, "What Could Be Improved?", C.crimson, "FADBD8");
  slide.addText(bul([
    "Faster activation of the PPH protocol",
    "Earlier blood product request to blood bank",
    "Better verbal documentation during emergency",
    "More effective closed-loop communication",
    "Earlier escalation to balloon tamponade",
    "Clearer team leader identification"
  ], {fs:13, bc:C.crimson, char:"25CF", color:C.dark}), { x:5.15, y:1.96, w:4.50, h:1.64, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  // Debrief structure
  box(slide, 0.25, 3.75, 4.60, 1.18, C.cBlu, C.teal);
  secHdr(slide, 0.25, 3.75, 4.60, 0.44, "Debrief Structure (Gather-Analyse-Summarise)", C.teal, "D0E8F5");
  slide.addText([
    { text:"Gather: ", options:{bold:true, color:C.teal, fontSize:13} },
    { text:"What happened? Describe events.\n", options:{color:C.dark, fontSize:13, breakLine:true} },
    { text:"Analyse: ", options:{bold:true, color:C.teal, fontSize:13} },
    { text:"Why? What went well and what did not?\n", options:{color:C.dark, fontSize:13, breakLine:true} },
    { text:"Summarise: ", options:{bold:true, color:C.teal, fontSize:13} },
    { text:"Key learning points for next time.", options:{color:C.dark, fontSize:13} }
  ], { x:0.38, y:4.22, w:4.38, h:0.66, valign:"top", margin:[2,8,2,8], fontFace:"Calibri" });

  // Learning outcome
  box(slide, 5.05, 3.75, 4.70, 1.18, C.cGld, C.gold);
  secHdr(slide, 5.05, 3.75, 4.70, 0.44, "Learning Outcome", C.gold, "FAF0D0");
  slide.addText("Simulation builds the reflex responses, teamwork, and decision-making speed that are essential when managing a real PPH. The debrief is where learning happens.", {
    x:5.15, y:4.22, w:4.50, h:0.66, fontSize:12.5, color:C.dark, valign:"top", margin:[2,8,2,8], fontFace:"Calibri"
  });

  // Bottom banner
  slide.addShape(pres.ShapeType.rect, { x:0, y:5.00, w:10, h:0.625, fill:{color:C.navy}, line:{type:"none"} });
  slide.addText("\"Train hard so you perform well. Every simulation drill is a life saved in advance.\"", {
    x:0.3, y:5.00, w:9.4, h:0.625, fontSize:13, bold:true, color:C.white, align:"center", valign:"middle", margin:0, fontFace:"Calibri", italic:true
  });
}

// WRITE FILE
pres.writeFile({ fileName: "/home/daytona/workspace/pph-slides/PPH_Part6_White_Slides51-60.pptx" })
  .then(function() { console.log("SUCCESS"); })
  .catch(function(e) { console.error("ERROR:", e); });

const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Shock in PPH – Emergency Management";
pres.author = "Clinical Education";

// ── COLOR PALETTE (white background) ─────────────────────────────────────────
const C = {
  white:  "FFFFFF",
  navy:   "1A2F4A",
  crimson:"C0392B",
  teal:   "0E8C75",
  gold:   "D68910",
  green:  "1E8449",
  purple: "7D3C98",
  orange: "CA6F1E",
  dark:   "1C2833",
  mid:    "2E4057",
  muted:  "5D6D7E",
  cBlu:   "D6EAF8",
  cGrn:   "D5F5E3",
  cGld:   "FEF9E7",
  cPrp:   "F5EEF8",
  cRed:   "FADBD8",
  cGry:   "F2F3F4",
  cOrg:   "FDEBD0",
  hBlu:   "2471A3",
};

// ── HELPERS ───────────────────────────────────────────────────────────────────
function hdr(slide, title, num, accent) {
  accent = accent || C.crimson;
  slide.background = { color: C.white };
  slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.80, fill:{color:accent}, line:{type:"none"} });
  slide.addShape(pres.ShapeType.rect, { x:0, y:0.80, w:10, h:0.05, fill:{color:C.hBlu}, line:{type:"none"} });
  slide.addShape(pres.ShapeType.rect, { x:9.22, y:0.14, w:0.62, h:0.50, fill:{color:"1A1A1A"}, line:{type:"none"} });
  slide.addText(""+num, { x:9.22, y:0.14, w:0.62, h:0.50, fontSize:13, bold:true, color:C.white, align:"center", valign:"middle", margin:0, fontFace:"Calibri" });
  slide.addText(title, { x:0.25, y:0, w:8.85, h:0.80, fontSize:21, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });
}

function pearl(slide, text, y) {
  y = (y !== undefined) ? y : 4.80;
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:y, w:9.50, h:0.65, fill:{color:C.cGld}, line:{color:C.gold, pt:1.5} });
  slide.addText([
    { text:"Clinical Pearl:  ", options:{bold:true, color:C.gold} },
    { text:text, options:{color:C.dark} }
  ], { x:0.38, y:y, w:9.26, h:0.65, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });
}

function keyMsg(slide, text, y) {
  y = (y !== undefined) ? y : 4.80;
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:y, w:9.50, h:0.65, fill:{color:C.cBlu}, line:{color:C.teal, pt:1.5} });
  slide.addText([
    { text:"Key Message:  ", options:{bold:true, color:C.teal} },
    { text:text, options:{color:C.dark} }
  ], { x:0.38, y:y, w:9.26, h:0.65, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });
}

function box(slide, x, y, w, h, bg, border) {
  slide.addShape(pres.ShapeType.rect, { x:x, y:y, w:w, h:h, fill:{color:bg||C.cBlu}, line:border?{color:border,pt:1.5}:{type:"none"} });
}

function secHdr(slide, x, y, w, h, text, tc, bg) {
  slide.addShape(pres.ShapeType.rect, { x:x, y:y, w:w, h:h, fill:{color:bg||C.cBlu}, line:{type:"none"} });
  slide.addText(text, { x:x+0.06, y:y, w:w-0.10, h:h, fontSize:14, bold:true, color:tc||C.teal, valign:"middle", margin:[0,6,0,6], fontFace:"Calibri" });
}

function bul(items, opts) {
  opts = opts || {};
  return items.map(function(item, i) {
    return {
      text: item,
      options: {
        bullet: { type:"bullet", characterCode:opts.char||"25B6", color:opts.bc||C.teal },
        color: opts.color || C.dark,
        fontSize: opts.fs || 13,
        breakLine: i < items.length - 1,
        bold: opts.bold || false,
        indentLevel: opts.indent || 0
      }
    };
  });
}

// ── SLIDE 1: Shock in PPH ─────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Shock in Postpartum Haemorrhage (PPH)", 1, C.crimson);

  // Definition banner
  box(slide, 0.25, 0.93, 9.50, 0.56, C.cRed, C.crimson);
  slide.addText([
    { text:"Definition:  ", options:{bold:true, color:C.crimson} },
    { text:"Haemorrhagic shock due to excessive postpartum blood loss causing inadequate tissue perfusion and oxygen delivery to vital organs.", options:{color:C.dark} }
  ], { x:0.40, y:0.93, w:9.20, h:0.56, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Left: Clinical Features
  box(slide, 0.25, 1.59, 5.65, 3.30, C.cRed, C.crimson);
  secHdr(slide, 0.25, 1.59, 5.65, 0.44, "Clinical Features", C.crimson, "FADBD8");

  const features = [
    { sign:"Tachycardia",         detail:">100 bpm — earliest sign; compensatory response to blood loss" },
    { sign:"Hypotension",         detail:"SBP <90 mmHg — late sign; appears after >30% blood volume lost" },
    { sign:"Cold, clammy skin",   detail:"Peripheral vasoconstriction; shunting blood to vital organs" },
    { sign:"Pallor",              detail:"Reduced peripheral perfusion; anaemia from acute blood loss" },
    { sign:"Restlessness",        detail:"Cerebral hypoperfusion; early sign of reduced cardiac output" },
    { sign:"Oliguria",            detail:"<30 mL/hour; renal hypoperfusion — monitor with Foley catheter" },
    { sign:"Altered sensorium",   detail:"Confusion, loss of consciousness — severe cerebral hypoperfusion" },
  ];
  features.forEach(function(r, i) {
    const ry = 2.06 + i * 0.41;
    const rc = i%2===0?"FADBD8":"FBE8E7";
    slide.addShape(pres.ShapeType.rect, { x:0.25, y:ry, w:5.65, h:0.39, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.sign,   { x:0.35, y:ry, w:1.62, h:0.39, fontSize:12.5, bold:true, color:C.crimson, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.detail, { x:2.00, y:ry, w:3.82, h:0.39, fontSize:12,   color:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Right: Shock classes + management priorities
  box(slide, 6.10, 1.59, 3.65, 1.88, C.cGld, C.gold);
  secHdr(slide, 6.10, 1.59, 3.65, 0.44, "Classes of Haemorrhagic Shock", C.gold, "FAF0D0");
  const classes = [
    { cls:"Class I",  loss:"<750 mL (<15%)",   pr:"Normal",    note:"Mild" },
    { cls:"Class II", loss:"750-1500 mL (15-30%)", pr:"Normal", note:"Compensated" },
    { cls:"Class III",loss:"1500-2000 mL (30-40%)", pr:"Low",   note:"Moderate" },
    { cls:"Class IV", loss:">2000 mL (>40%)",   pr:"Very low",  note:"Severe/Life-threatening" },
  ];
  classes.forEach(function(r, i) {
    const ry = 2.06 + i * 0.35;
    const rc = i%2===0?"FEF9E7":"FFFBF2";
    slide.addShape(pres.ShapeType.rect, { x:6.10, y:ry, w:3.65, h:0.33, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.cls,  { x:6.16, y:ry, w:0.70, h:0.33, fontSize:11, bold:true, color:C.gold, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.loss, { x:6.88, y:ry, w:1.60, h:0.33, fontSize:10.5, color:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.note, { x:8.50, y:ry, w:1.18, h:0.33, fontSize:10.5, bold:i>1, color:i>1?C.crimson:C.muted, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  box(slide, 6.10, 3.52, 3.65, 1.38, C.cBlu, C.teal);
  secHdr(slide, 6.10, 3.52, 3.65, 0.44, "Management Priorities", C.teal, "D0E8F5");
  slide.addText(bul([
    "Early recognition (do not wait for hypotension)",
    "Simultaneous resuscitation + control of bleeding",
    "Call for help immediately",
    "Activate MOHP if available"
  ], {fs:13, bc:C.teal, color:C.dark}), { x:6.20, y:3.99, w:3.45, h:0.84, valign:"top", margin:[4,6,4,6], fontFace:"Calibri" });

  pearl(slide, "Hypotension is a LATE sign of haemorrhagic shock. Tachycardia and oliguria appear earlier — act on these, do not wait.", 4.98);
}

// ── SLIDE 2: Emergency Management – Initial Resuscitation ─────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Emergency Management of PPH  |  Initial Resuscitation", 2, C.crimson);

  // Call for help strip
  box(slide, 0.25, 0.93, 9.50, 0.48, C.cRed, C.crimson);
  slide.addText([
    { text:"Step 1 — Call for Help:  ", options:{bold:true, color:C.crimson} },
    { text:"Senior obstetrician  |  Anaesthetist  |  Blood bank  |  Nursing staff  |  Activate PPH protocol immediately", options:{color:C.dark} }
  ], { x:0.40, y:0.93, w:9.20, h:0.48, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Left: ABC approach
  box(slide, 0.25, 1.51, 5.65, 3.40, C.cBlu, C.teal);
  secHdr(slide, 0.25, 1.51, 5.65, 0.44, "ABC Resuscitation Approach", C.teal, "D0E8F5");

  // Airway
  slide.addShape(pres.ShapeType.rect, { x:0.30, y:1.98, w:5.55, h:0.40, fill:{color:C.teal}, line:{type:"none"} });
  slide.addText("A — Airway", { x:0.38, y:1.98, w:5.39, h:0.40, fontSize:13.5, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });
  slide.addText("Maintain a clear airway. Position patient flat with legs elevated (Trendelenburg). Call anaesthetist early.", {
    x:0.38, y:2.40, w:5.39, h:0.38, fontSize:13, color:C.dark, valign:"middle", margin:0, fontFace:"Calibri"
  });

  // Breathing
  slide.addShape(pres.ShapeType.rect, { x:0.30, y:2.80, w:5.55, h:0.40, fill:{color:"1A6B5A"}, line:{type:"none"} });
  slide.addText("B — Breathing", { x:0.38, y:2.80, w:5.39, h:0.40, fontSize:13.5, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });
  slide.addText("High-flow oxygen 10-15 L/min via non-rebreather mask. Target SpO2 >95%. Prepare for intubation if GCS falls.", {
    x:0.38, y:3.22, w:5.39, h:0.38, fontSize:13, color:C.dark, valign:"middle", margin:0, fontFace:"Calibri"
  });

  // Circulation
  slide.addShape(pres.ShapeType.rect, { x:0.30, y:3.62, w:5.55, h:0.40, fill:{color:C.crimson}, line:{type:"none"} });
  slide.addText("C — Circulation", { x:0.38, y:3.62, w:5.39, h:0.40, fontSize:13.5, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });
  const circItems = ["Two wide-bore IV cannulas (14-16G) immediately","Send blood: CBC, coagulation, blood group + cross-match","Warm IV crystalloids (Normal saline / Hartmann's 1-2 L fast)","Blood transfusion as required (O-negative in emergency)"];
  slide.addText(bul(circItems, {fs:12.5, bc:C.crimson, char:"25CF", color:C.dark}), {
    x:0.38, y:4.04, w:5.39, h:0.82, valign:"top", margin:[2,6,2,6], fontFace:"Calibri"
  });

  // Right: Monitoring
  box(slide, 6.10, 1.51, 3.65, 3.40, C.cGld, C.gold);
  secHdr(slide, 6.10, 1.51, 3.65, 0.44, "Monitoring", C.gold, "FAF0D0");
  const monRows = [
    { param:"Pulse",             target:"Every 5 min; target <100 bpm" },
    { param:"Blood Pressure",    target:"Every 5 min; target SBP >90" },
    { param:"Respiratory Rate",  target:"Every 15 min" },
    { param:"SpO2",              target:"Continuous; target >95%" },
    { param:"Urine Output",      target:"Insert Foley; target >30 mL/h" },
    { param:"Blood Loss",        target:"Quantify with calibrated drape" },
    { param:"Mental Status",     target:"GCS every 15 min" },
  ];
  monRows.forEach(function(r, i) {
    const ry = 1.98 + i * 0.42;
    const rc = i%2===0?"FEF9E7":"FFFBF2";
    slide.addShape(pres.ShapeType.rect, { x:6.10, y:ry, w:3.65, h:0.40, fill:{color:rc}, line:{type:"none"} });
    slide.addText(r.param,  { x:6.18, y:ry, w:1.35, h:0.40, fontSize:12, bold:true, color:C.gold, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(r.target, { x:7.56, y:ry, w:2.12, h:0.40, fontSize:11.5, color:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  keyMsg(slide, "Do not wait for a definitive diagnosis before starting resuscitation. Treat shock and find the cause simultaneously.", 4.98);
}

// ── SLIDE 3: Identify Cause – 4 Ts ───────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Emergency Management of PPH  |  Identify the Cause  —  4 Ts", 3, C.navy);

  // Banner
  box(slide, 0.25, 0.93, 9.50, 0.44, C.cBlu, C.teal);
  slide.addText("Management must target the underlying cause while resuscitation continues simultaneously.", {
    x:0.40, y:0.93, w:9.20, h:0.44, fontSize:13, bold:false, color:C.dark, italic:true, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri"
  });

  // 4 Ts — one card per T
  const Ts = [
    {
      t:"TONE", icon:"1", color:C.crimson, bg:C.cRed, border:C.crimson,
      causes:["Uterine atony — most common cause (80% of PPH)","Overdistended uterus (twins, polyhydramnios)","Prolonged or precipitate labour","Uterine fatigue after prolonged oxytocin use"],
      mgmt:["Uterine massage + bimanual compression","Oxytocin, ergometrine, carboprost, misoprostol","Balloon tamponade","Compression sutures / hysterectomy"]
    },
    {
      t:"TISSUE", icon:"2", color:C.purple, bg:C.cPrp, border:C.purple,
      causes:["Retained placenta (failure to deliver within 30 min)","Retained placental fragments","Placenta accreta spectrum (accreta/increta/percreta)","Placental polyp"],
      mgmt:["Controlled cord traction","Manual removal under anaesthesia","Uterine evacuation","Avoid forceful removal in PAS — plan for hysterectomy"]
    },
    {
      t:"TRAUMA", icon:"3", color:C.gold, bg:C.cGld, border:C.gold,
      causes:["Cervical / vaginal / perineal tears","Episiotomy extension","Uterine rupture","Broad ligament / vulval haematoma","Uterine inversion"],
      mgmt:["Inspect under adequate analgesia/anaesthesia","Repair lacerations with absorbable sutures","Drain expanding haematomas","Laparotomy for uterine rupture"]
    },
    {
      t:"THROMBIN", icon:"4", color:C.teal, bg:C.cBlu, border:C.teal,
      causes:["Pre-existing coagulopathy (ITP, vWD)","DIC secondary to PPH or abruption","HELLP syndrome","Dilutional coagulopathy from massive transfusion"],
      mgmt:["FFP for prolonged PT/aPTT","Platelets if <50,000/uL with bleeding","Cryoprecipitate if fibrinogen <2 g/L","Tranexamic acid 1 g IV within 3 hours"]
    },
  ];

  Ts.forEach(function(t, i) {
    const tx = 0.25 + i * 2.42;
    box(slide, tx, 1.47, 2.30, 3.42, t.bg, t.border);
    // T label bar
    slide.addShape(pres.ShapeType.rect, { x:tx, y:1.47, w:2.30, h:0.50, fill:{color:t.color}, line:{type:"none"} });
    slide.addShape(pres.ShapeType.rect, { x:tx+0.06, y:1.54, w:0.34, h:0.34, fill:{color:"1A1A1A"}, line:{type:"none"} });
    slide.addText(t.icon, { x:tx+0.06, y:1.54, w:0.34, h:0.34, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });
    slide.addText(t.t, { x:tx+0.46, y:1.47, w:1.76, h:0.50, fontSize:14, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });

    // Causes
    slide.addText("Causes", { x:tx+0.08, y:2.00, w:2.14, h:0.30, fontSize:12, bold:true, color:t.color, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(bul(t.causes, {fs:11, bc:t.color, char:"25CF", color:C.dark}), {
      x:tx+0.08, y:2.32, w:2.14, h:1.10, valign:"top", margin:[2,4,2,4], fontFace:"Calibri"
    });
    // Management
    slide.addText("Management", { x:tx+0.08, y:3.46, w:2.14, h:0.30, fontSize:12, bold:true, color:t.color, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(bul(t.mgmt, {fs:11, bc:t.color, char:"25B6", color:C.dark}), {
      x:tx+0.08, y:3.78, w:2.14, h:1.00, valign:"top", margin:[2,4,2,4], fontFace:"Calibri"
    });
  });

  keyMsg(slide, "All four Ts can coexist in the same patient. Systematically check each one while continuing resuscitation.", 4.98);
}

// ── SLIDE 4: Uterotonics in PPH ───────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Uterotonics in PPH", 4, C.teal);

  // Oxytocin hero
  box(slide, 0.25, 0.93, 9.50, 0.80, C.cBlu, C.teal);
  slide.addShape(pres.ShapeType.rect, { x:0.25, y:0.93, w:2.20, h:0.80, fill:{color:C.teal}, line:{type:"none"} });
  slide.addText("FIRST LINE", { x:0.25, y:0.93, w:2.20, h:0.80, fontSize:14, bold:true, color:C.white, align:"center", valign:"middle", margin:0, fontFace:"Calibri" });
  slide.addText([
    { text:"Oxytocin  ", options:{bold:true, color:C.teal, fontSize:16} },
    { text:"10 IU IM or slow IV; infusion 20-40 IU/L  |  ", options:{color:C.dark, fontSize:13} },
    { text:"Onset 1-3 min  |  First-line drug for PPH prevention and treatment", options:{color:C.dark, fontSize:13} }
  ], { x:2.55, y:0.93, w:7.10, h:0.80, valign:"middle", margin:[4,8,4,8], fontFace:"Calibri" });

  // Drug table header
  const colX = [0.25, 2.62, 4.95, 7.00];
  const colW = [2.33, 2.29, 2.01, 2.75];
  const colHdrs = ["Drug", "Dose & Route", "Important Notes", "Contraindications / Cautions"];
  colHdrs.forEach(function(h, i) {
    slide.addShape(pres.ShapeType.rect, { x:colX[i], y:1.82, w:colW[i], h:0.40, fill:{color:C.navy}, line:{type:"none"} });
    slide.addText(h, { x:colX[i]+0.04, y:1.82, w:colW[i]-0.08, h:0.40, fontSize:12.5, bold:true, color:C.white, align:"center", valign:"middle", margin:0, fontFace:"Calibri" });
  });

  const drugs = [
    { drug:"Oxytocin",         dose:"10 IU IM / IV\nInfusion: 20-40 IU/L NS",  note:"First-line; use immediately", ci:"None. Use cautiously IV (hypotension with fast bolus)" },
    { drug:"Methylergometrine",dose:"0.2 mg IM or slow IV",                     note:"Second-line uterotonic",      ci:"Hypertension, eclampsia, cardiac disease, Raynaud's" },
    { drug:"Carboprost",       dose:"250 mcg IM every 15-90 min\n(max 8 doses)", note:"Potent; use if others fail",  ci:"Asthma, severe hepatic / renal disease" },
    { drug:"Misoprostol",      dose:"800-1000 mcg PR or SL",                    note:"Heat-stable; low-resource",   ci:"No absolute CI; relative: allergy to prostaglandins" },
    { drug:"Tranexamic Acid",  dose:"1 g IV over 10 min\nRepeat once if bleeding", note:"Give within 3 hours of PPH", ci:"Thromboembolic disease; known clot in urinary tract" },
  ];

  drugs.forEach(function(r, i) {
    const ry = 2.25 + i * 0.52;
    const rc = i%2===0?"EBF5FB":"F8F9FA";
    colX.forEach(function(cx, ci) {
      slide.addShape(pres.ShapeType.rect, { x:cx, y:ry, w:colW[ci], h:0.50, fill:{color:rc}, line:{type:"none"} });
    });
    const vals = [r.drug, r.dose, r.note, r.ci];
    vals.forEach(function(v, ci) {
      slide.addText(v, { x:colX[ci]+0.06, y:ry, w:colW[ci]-0.12, h:0.50, fontSize:ci===0?12.5:12, bold:ci===0, color:ci===0?C.teal:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
    });
  });

  pearl(slide, "Oxytocin within 1 minute of delivery prevents PPH. Tranexamic acid within 3 hours of PPH reduces mortality by ~30% (WOMAN trial).", 4.90);
}

// ── SLIDE 5: Non-Surgical Measures ────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Non-Surgical Measures for PPH", 5, C.purple);

  // Three columns
  const cols = [
    {
      title:"Mechanical Measures", color:C.crimson, bg:C.cRed,
      items:[
        "Uterine massage - sustained fundal massage until firm",
        "Bimanual uterine compression - internal fist + external hand",
        "Aortic compression - press aorta against spine to reduce pelvic flow",
        "Empty bladder - full bladder prevents uterine contraction",
        "Correct patient positioning - legs elevated if in shock"
      ]
    },
    {
      title:"Balloon Tamponade", color:C.purple, bg:C.cPrp,
      items:[
        "Bakri balloon - purpose-built for PPH, up to 500 mL saline",
        "Condom catheter balloon - effective in low-resource settings",
        "Sengstaken-Blakemore tube - modified use in uterine cavity",
        "Success rate ~80-90% in uterine atony",
        "Minimally invasive - preserves fertility",
        "Tamponade test: if controls bleeding, avoids surgery"
      ]
    },
    {
      title:"Supportive Measures", color:C.teal, bg:C.cBlu,
      items:[
        "IV crystalloids - 1-2 L Hartmann's or Normal saline",
        "Blood transfusion - packed RBCs (target Hb >8 g/dL)",
        "Fresh Frozen Plasma - 1:1:1 ratio with pRBC in massive PPH",
        "Platelets - if <50,000/uL with active bleeding",
        "Cryoprecipitate - if fibrinogen <2 g/L",
        "NASG - non-pneumatic anti-shock garment for transport"
      ]
    }
  ];

  cols.forEach(function(col, i) {
    const cx = 0.25 + i * 3.25;
    box(slide, cx, 0.93, 3.10, 4.00, col.bg, col.color);
    slide.addShape(pres.ShapeType.rect, { x:cx, y:0.93, w:3.10, h:0.44, fill:{color:col.color}, line:{type:"none"} });
    slide.addText(col.title, { x:cx+0.06, y:0.93, w:2.98, h:0.44, fontSize:14, bold:true, color:C.white, valign:"middle", margin:[0,6,0,6], fontFace:"Calibri" });
    slide.addText(bul(col.items, {fs:12.5, bc:col.color, char:"25B6", color:C.dark}), {
      x:cx+0.10, y:1.40, w:2.88, h:3.46, valign:"top", margin:[4,6,4,6], fontFace:"Calibri"
    });
  });

  keyMsg(slide, "Non-surgical measures should be exhausted in a stepwise manner before proceeding to surgery, except in catastrophic haemorrhage.", 4.98);
}

// ── SLIDE 6: Surgical Management ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Surgical Management of PPH", 6, C.crimson);

  // Banner
  box(slide, 0.25, 0.93, 9.50, 0.44, C.cRed, C.crimson);
  slide.addText("Indicated when conservative measures (uterotonics + tamponade) fail to control haemorrhage. Escalate promptly — delay worsens outcomes.", {
    x:0.40, y:0.93, w:9.20, h:0.44, fontSize:13, bold:false, color:C.dark, italic:true, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri"
  });

  // Left: Conservative
  box(slide, 0.25, 1.47, 5.65, 3.42, C.cBlu, C.teal);
  secHdr(slide, 0.25, 1.47, 5.65, 0.44, "Conservative Surgical Options (Fertility-Preserving)", C.teal, "D0E8F5");

  const consSurg = [
    { step:"1", name:"Examination Under Anaesthesia", note:"Identify and repair any missed trauma" },
    { step:"2", name:"Compression Sutures", note:"B-Lynch / Hayman / Cho — compress uterus without hysterectomy" },
    { step:"3", name:"Uterine Artery Ligation", note:"Reduces blood flow ~90%; O'Leary sutures" },
    { step:"4", name:"Utero-ovarian Artery Ligation", note:"Combined with uterine artery ligation" },
    { step:"5", name:"Internal Iliac Artery Ligation", note:"Reduces pelvic pulse pressure ~85%; experienced surgeon" },
    { step:"6", name:"Uterine Artery Embolization", note:"Interventional radiology; stable patients only" },
  ];
  consSurg.forEach(function(s, i) {
    const sy = 1.94 + i * 0.46;
    const rc = i%2===0?"EBF5FB":"F0F7FC";
    slide.addShape(pres.ShapeType.rect, { x:0.30, y:sy, w:5.55, h:0.44, fill:{color:rc}, line:{type:"none"} });
    slide.addShape(pres.ShapeType.rect, { x:0.34, y:sy+0.06, w:0.30, h:0.30, fill:{color:C.teal}, line:{type:"none"} });
    slide.addText(s.step, { x:0.34, y:sy+0.06, w:0.30, h:0.30, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });
    slide.addText(s.name, { x:0.70, y:sy, w:2.60, h:0.44, fontSize:12.5, bold:true, color:C.teal, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(s.note, { x:3.33, y:sy, w:2.44, h:0.44, fontSize:12, color:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Right: Definitive + Indications
  box(slide, 6.10, 1.47, 3.65, 1.82, C.cRed, C.crimson);
  secHdr(slide, 6.10, 1.47, 3.65, 0.44, "Definitive Surgery", C.crimson, "FADBD8");
  slide.addText([
    { text:"Subtotal Hysterectomy:\n", options:{bold:true, color:C.crimson, fontSize:13, breakLine:true} },
    { text:"Faster; preferred in emergencies; lower morbidity\n\n", options:{color:C.dark, fontSize:12.5, breakLine:true} },
    { text:"Total Hysterectomy:\n", options:{bold:true, color:C.navy, fontSize:13, breakLine:true} },
    { text:"When cervical pathology or bleeding from cervix", options:{color:C.dark, fontSize:12.5} }
  ], { x:6.20, y:1.94, w:3.45, h:1.28, valign:"top", margin:[4,8,4,8], fontFace:"Calibri" });

  box(slide, 6.10, 3.35, 3.65, 1.55, C.cGld, C.gold);
  secHdr(slide, 6.10, 3.35, 3.65, 0.44, "Indications for Surgery", C.gold, "FAF0D0");
  slide.addText(bul([
    "Persistent haemorrhage despite conservative measures",
    "Placenta accreta spectrum",
    "Uterine rupture with irreparable damage",
    "Broad ligament haematoma with vessel injury"
  ], {fs:12.5, bc:C.gold, char:"25CF", color:C.dark}), { x:6.20, y:3.82, w:3.45, h:1.00, valign:"top", margin:[4,6,4,6], fontFace:"Calibri" });

  pearl(slide, "Early surgery saves lives. Do NOT delay hysterectomy in a deteriorating patient — maternal life always takes priority over fertility.", 4.98);
}

// ── SLIDE 7: Retained Placenta ────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Retained Placenta", 7, C.gold);

  // Definition
  box(slide, 0.25, 0.93, 9.50, 0.50, C.cGld, C.gold);
  slide.addText([
    { text:"Definition:  ", options:{bold:true, color:C.gold} },
    { text:"Failure to deliver the placenta within 30 minutes of birth after active management of the third stage of labour.", options:{color:C.dark} }
  ], { x:0.40, y:0.93, w:9.20, h:0.50, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Three columns
  box(slide, 0.25, 1.53, 2.92, 3.38, C.cGld, C.gold);
  secHdr(slide, 0.25, 1.53, 2.92, 0.44, "Causes / Types", C.gold, "FAF0D0");
  const causes = [
    { t:"Placenta Adherens",  d:"Morbidly adherent due to uterine scarring; plane of separation present but difficult" },
    { t:"Trapped Placenta",   d:"Placenta separated but caught behind closed cervical os" },
    { t:"Placenta Accreta",   d:"Abnormal invasion into myometrium; no cleavage plane" },
    { t:"Increta / Percreta", d:"Deep/through myometrium; risk of catastrophic haemorrhage" },
  ];
  causes.forEach(function(c, i) {
    const cy = 2.00 + i * 0.72;
    const rc = i%2===0?"FEF9E7":"FFFBF2";
    slide.addShape(pres.ShapeType.rect, { x:0.30, y:cy, w:2.82, h:0.68, fill:{color:rc}, line:{type:"none"} });
    slide.addText(c.t, { x:0.38, y:cy, w:2.66, h:0.30, fontSize:12, bold:true, color:C.gold, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(c.d, { x:0.38, y:cy+0.30, w:2.66, h:0.36, fontSize:11, color:C.dark, valign:"top", margin:0, fontFace:"Calibri" });
  });

  box(slide, 3.37, 1.53, 2.92, 3.38, C.cRed, C.crimson);
  secHdr(slide, 3.37, 1.53, 2.92, 0.44, "Clinical Features", C.crimson, "FADBD8");
  slide.addText(bul([
    "Failure of placental delivery after 30 min",
    "Persistent or heavy vaginal bleeding",
    "Soft, enlarged uterus that does not contract well",
    "Signs of haemorrhagic shock if severe",
    "Fundal height not decreasing as expected"
  ], {fs:13, bc:C.crimson, char:"25CF", color:C.dark}), { x:3.47, y:2.00, w:2.72, h:2.84, valign:"top", margin:[4,6,4,6], fontFace:"Calibri" });

  box(slide, 6.49, 1.53, 3.26, 3.38, C.cGrn, C.green);
  secHdr(slide, 6.49, 1.53, 3.26, 0.44, "Management", C.green, "C8F0D8");
  const mgmtSteps = [
    "Give oxytocin if not already done",
    "Controlled cord traction (Brandt-Andrews)",
    "Maintain IV access; correct hypovolaemia",
    "If not delivered in 30 min - prepare for manual removal",
    "Manual removal under spinal / general anaesthesia",
    "Administer prophylactic antibiotics",
    "In PAS: do NOT force removal; plan hysterectomy",
    "Send products for histology"
  ];
  slide.addText(mgmtSteps.map(function(s,i){ return { text:(i+1)+".  "+s, options:{color:C.dark, fontSize:12.5, breakLine:i<mgmtSteps.length-1}}; }), {
    x:6.59, y:2.00, w:3.06, h:2.84, valign:"top", margin:[4,6,4,6], fontFace:"Calibri"
  });

  pearl(slide, "Always inspect the placenta after delivery. A missing cotyledon or ragged membrane edge mandates immediate uterine exploration.", 4.98);
}

// ── SLIDE 8: Genital Tract Trauma ─────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Genital Tract Trauma", 8, C.orange);

  // Banner
  box(slide, 0.25, 0.93, 9.50, 0.44, C.cOrg, C.orange);
  slide.addText([
    { text:"Key Clinical Clue:  ", options:{bold:true, color:C.orange} },
    { text:"Persistent bright-red bleeding with a FIRM, well-contracted uterus almost always indicates a traumatic source.", options:{color:C.dark} }
  ], { x:0.40, y:0.93, w:9.20, h:0.44, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Left: Causes
  box(slide, 0.25, 1.47, 4.60, 3.44, C.cOrg, C.orange);
  secHdr(slide, 0.25, 1.47, 4.60, 0.44, "Causes / Types of Trauma", C.orange, "FDEBD0");
  const types = [
    { name:"Cervical Tears",       note:"Often at 3 and 9 o'clock; may extend to lower uterus" },
    { name:"Vaginal Lacerations",  note:"Particularly in precipitate or instrumental delivery" },
    { name:"Perineal Tears",       note:"Grade I-IV; Grade III/IV involve anal sphincter" },
    { name:"Episiotomy Extension", note:"Inadequate or malpositioned episiotomy" },
    { name:"Vulval Haematoma",     note:"Expanding; can conceal large blood loss" },
    { name:"Uterine Rupture",      note:"Scar or unscarred; life-threatening; requires laparotomy" },
    { name:"Uterine Inversion",    note:"Rare; presents with shock + no fundus palpable" },
  ];
  types.forEach(function(t, i) {
    const ty = 1.94 + i * 0.43;
    const rc = i%2===0?"FDEBD0":"FEF3E8";
    slide.addShape(pres.ShapeType.rect, { x:0.30, y:ty, w:4.50, h:0.41, fill:{color:rc}, line:{type:"none"} });
    slide.addText(t.name, { x:0.38, y:ty, w:1.65, h:0.41, fontSize:12, bold:true, color:C.orange, valign:"middle", margin:0, fontFace:"Calibri" });
    slide.addText(t.note, { x:2.06, y:ty, w:2.66, h:0.41, fontSize:11.5, color:C.dark, valign:"middle", margin:0, fontFace:"Calibri" });
  });

  // Right: Clinical Features + Management
  box(slide, 5.05, 1.47, 4.70, 1.56, C.cRed, C.crimson);
  secHdr(slide, 5.05, 1.47, 4.70, 0.44, "Clinical Features", C.crimson, "FADBD8");
  slide.addText(bul([
    "Continuous bright-red vaginal bleeding",
    "Well-contracted, firm uterus (distinguishes from atony)",
    "Visible laceration or haematoma on examination",
    "Haemodynamic instability in severe cases"
  ], {fs:12.5, bc:C.crimson, char:"25CF", color:C.dark}), { x:5.15, y:1.94, w:4.50, h:1.02, valign:"top", margin:[4,6,4,6], fontFace:"Calibri" });

  box(slide, 5.05, 3.09, 4.70, 1.82, C.cGrn, C.green);
  secHdr(slide, 5.05, 3.09, 4.70, 0.44, "Management", C.green, "C8F0D8");
  const mgmt = [
    "Ensure adequate lighting, analgesia / anaesthesia",
    "Systematic inspection: cervix -> vagina -> perineum",
    "Repair all lacerations with absorbable sutures (Vicryl)",
    "Drain large / expanding haematomas; pack if needed",
    "Laparotomy for uterine rupture",
    "Johnson's manoeuvre for uterine inversion"
  ];
  slide.addText(mgmt.map(function(s,i){ return { text:(i+1)+".  "+s, options:{color:C.dark, fontSize:12.5, breakLine:i<mgmt.length-1}}; }), {
    x:5.15, y:3.56, w:4.50, h:1.28, valign:"top", margin:[4,6,4,6], fontFace:"Calibri"
  });

  pearl(slide, "Never assume bleeding is from atony without a thorough systematic examination of the lower genital tract.", 4.98);
}

// ── SLIDE 9: Secondary PPH ────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Secondary Postpartum Haemorrhage", 9, C.purple);

  // Definition
  box(slide, 0.25, 0.93, 9.50, 0.50, C.cPrp, C.purple);
  slide.addText([
    { text:"Definition:  ", options:{bold:true, color:C.purple} },
    { text:"Excessive vaginal bleeding occurring between 24 hours and 12 weeks after delivery (most commonly at 1-2 weeks postpartum).", options:{color:C.dark} }
  ], { x:0.40, y:0.93, w:9.20, h:0.50, fontSize:13, valign:"middle", margin:[0,8,0,8], fontFace:"Calibri" });

  // Three columns
  box(slide, 0.25, 1.53, 2.92, 3.38, C.cPrp, C.purple);
  secHdr(slide, 0.25, 1.53, 2.92, 0.44, "Causes", C.purple, "EAD4F5");
  slide.addText(bul([
    "Retained products of conception (most common)",
    "Endometritis - uterine infection",
    "Subinvolution of placental site",
    "Placental polyp",
    "Coagulation disorders",
    "Arteriovenous malformation (rare)"
  ], {fs:13, bc:C.purple, char:"25B6", color:C.dark}), { x:0.35, y:2.00, w:2.72, h:2.84, valign:"top", margin:[4,6,4,6], fontFace:"Calibri" });

  box(slide, 3.37, 1.53, 2.92, 3.38, C.cRed, C.crimson);
  secHdr(slide, 3.37, 1.53, 2.92, 0.44, "Clinical Features", C.crimson, "FADBD8");
  slide.addText(bul([
    "Heavy vaginal bleeding (may be sudden or gradual)",
    "Fever and chills (if infective cause)",
    "Foul-smelling lochia or vaginal discharge",
    "Pelvic / lower abdominal pain",
    "Enlarged, tender, soft uterus",
    "Signs of anaemia (pallor, tachycardia)"
  ], {fs:13, bc:C.crimson, char:"25CF", color:C.dark}), { x:3.47, y:2.00, w:2.72, h:2.84, valign:"top", margin:[4,6,4,6], fontFace:"Calibri" });

  box(slide, 6.49, 1.53, 3.26, 3.38, C.cBlu, C.teal);
  secHdr(slide, 6.49, 1.53, 3.26, 0.44, "Investigations", C.teal, "D0E8F5");
  slide.addText(bul([
    "CBC (haemoglobin, WBC, platelets)",
    "Coagulation profile (PT, aPTT, fibrinogen)",
    "Blood group + cross-match",
    "Pelvic ultrasound - retained products?",
    "High vaginal swab / endometrial culture",
    "Serum beta-hCG (exclude trophoblastic disease)",
    "Renal and liver function tests"
  ], {fs:12.5, bc:C.teal, char:"25B6", color:C.dark}), { x:6.59, y:2.00, w:3.06, h:2.84, valign:"top", margin:[4,6,4,6], fontFace:"Calibri" });

  pearl(slide, "Retained products of conception and endometritis often coexist. Treat infection before surgical evacuation to reduce perforation risk.", 4.98);
}

// ── SLIDE 10: Management of Secondary PPH ─────────────────────────────────────
{
  const slide = pres.addSlide();
  hdr(slide, "Management of Secondary PPH", 10, C.purple);

  // Three management columns
  const cols = [
    {
      title:"Initial Stabilization", color:C.crimson, bg:C.cRed,
      items:[
        "ABC approach - assess airway, breathing, circulation",
        "IV access (two wide-bore cannulas)",
        "IV fluids to restore volume",
        "Blood transfusion if haemodynamically unstable",
        "Oxygen therapy if SpO2 <95%",
        "Monitor pulse, BP, urine output"
      ]
    },
    {
      title:"Medical Management", color:C.teal, bg:C.cBlu,
      items:[
        "Broad-spectrum antibiotics (cover gram-negative + anaerobes)",
        "Example: Co-amoxiclav + Metronidazole",
        "Uterotonics: oxytocin / misoprostol to promote involution",
        "Tranexamic acid if coagulopathy suspected",
        "Oral iron therapy once haemodynamically stable",
        "Analgesia for pelvic pain"
      ]
    },
    {
      title:"Surgical Management", color:C.purple, bg:C.cPrp,
      items:[
        "Evacuation of retained products - under ultrasound guidance",
        "Use suction curettage (safer than sharp curettage)",
        "Give antibiotics before procedure",
        "Balloon tamponade if bleeding persists after evacuation",
        "Uterine artery embolization in stable patients",
        "Hysterectomy - rare; life-saving last resort"
      ]
    }
  ];

  cols.forEach(function(col, i) {
    const cx = 0.25 + i * 3.25;
    box(slide, cx, 0.93, 3.10, 3.98, col.bg, col.color);
    slide.addShape(pres.ShapeType.rect, { x:cx, y:0.93, w:3.10, h:0.44, fill:{color:col.color}, line:{type:"none"} });
    slide.addText(col.title, { x:cx+0.06, y:0.93, w:2.98, h:0.44, fontSize:14, bold:true, color:C.white, valign:"middle", margin:[0,6,0,6], fontFace:"Calibri" });
    slide.addText(bul(col.items, {fs:12.5, bc:col.color, char:"25B6", color:C.dark}), {
      x:cx+0.10, y:1.40, w:2.88, h:3.44, valign:"top", margin:[4,6,4,6], fontFace:"Calibri"
    });
  });

  pearl(slide, "Secondary PPH warrants urgent ultrasound to identify retained products. Medical treatment alone is insufficient if products are confirmed - evacuate.", 4.98);
}

// ── SLIDE 11: Summary ─────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  slide.background = { color: C.white };

  // Header
  slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.82, fill:{color:C.navy}, line:{type:"none"} });
  slide.addShape(pres.ShapeType.rect, { x:0, y:0.82, w:10, h:0.05, fill:{color:C.crimson}, line:{type:"none"} });
  slide.addText("Summary", { x:0.25, y:0, w:9.10, h:0.82, fontSize:26, bold:true, color:C.white, valign:"middle", margin:0, fontFace:"Calibri" });
  slide.addText("11", { x:9.22, y:0.16, w:0.62, h:0.50, fontSize:13, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });

  // Summary points
  const points = [
    { icon:"1", color:C.crimson, bg:C.cRed, text:"PPH is a leading cause of maternal mortality. Rapid recognition and simultaneous resuscitation are the cornerstones of management." },
    { icon:"2", color:C.teal,    bg:C.cBlu, text:"Follow the 4 Ts (Tone, Tissue, Trauma, Thrombin) systematically to identify and treat the underlying cause while resuscitation continues." },
    { icon:"3", color:C.gold,    bg:C.cGld, text:"Oxytocin is the first-line uterotonic for both prevention (AMTSL) and treatment. Tranexamic acid must be given within 3 hours of PPH onset." },
    { icon:"4", color:C.purple,  bg:C.cPrp, text:"Use non-surgical measures first (massage, compression, balloon tamponade) in a stepwise manner before escalating to surgery." },
    { icon:"5", color:C.green,   bg:C.cGrn, text:"Surgical options include compression sutures, arterial ligation, UAE, and hysterectomy. Early surgery saves lives — do not delay in deteriorating patients." },
    { icon:"6", color:C.orange,  bg:C.cOrg, text:"Prompt diagnosis of retained placenta, genital tract trauma, and secondary PPH is essential to prevent severe morbidity and maternal death." },
  ];

  points.forEach(function(p, i) {
    const py = 0.97 + i * 0.74;
    box(slide, 0.25, py, 9.50, 0.70, p.bg, p.color);
    slide.addShape(pres.ShapeType.rect, { x:0.30, y:py+0.10, w:0.42, h:0.42, fill:{color:p.color}, line:{type:"none"} });
    slide.addText(p.icon, { x:0.30, y:py+0.10, w:0.42, h:0.42, fontSize:14, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });
    slide.addText(p.text, { x:0.82, y:py, w:8.84, h:0.70, fontSize:13, color:C.dark, valign:"middle", margin:[4,8,4,8], fontFace:"Calibri" });
  });

  // Bottom strip
  slide.addShape(pres.ShapeType.rect, { x:0, y:5.38, w:10, h:0.24, fill:{color:C.crimson}, line:{type:"none"} });
  slide.addText("Recognise. Resuscitate. Identify the cause. Treat. Escalate without hesitation.", {
    x:0.3, y:5.38, w:9.4, h:0.24, fontSize:12, bold:true, color:C.white, align:"center", valign:"middle", margin:0, fontFace:"Calibri"
  });
}

// WRITE FILE
pres.writeFile({ fileName: "/home/daytona/workspace/pph-slides/PPH_Shock_Slides1-11.pptx" })
  .then(function() { console.log("SUCCESS"); })
  .catch(function(e) { console.error("ERROR:", e); });