cd /home/daytona/workspace/attachments/d3842864-c2f8-452d-9d70-5dba2b419212/ && …

obstetrics medical diagrams flowcharts preeclampsia PPH APH gestational diabetes free images

mkdir -p /home/daytona/workspace/obstetrics-ppt && ls /home/daytona/workspace/ob…

~/obstetrics-ppt/create_ppt.js

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

let pres = new pptxgen();
pres.layout = "LAYOUT_WIDE";
pres.title = "Obstetrics 2019-2024 Complete Guide";
pres.author = "Medical Education";

// ─── COLOR PALETTE ───────────────────────────────────────────────
const DARK_BG   = "0D1B2A";   // Deep navy
const MID_BG    = "1B2A3B";   // Slate navy
const ACCENT1   = "00B4D8";   // Cyan
const ACCENT2   = "E63946";   // Red
const ACCENT3   = "2DC653";   // Green
const ACCENT4   = "FFB703";   // Amber
const ACCENT5   = "A8DADC";   // Soft teal
const WHITE     = "FFFFFF";
const LIGHT_GRAY= "C8D6E5";
const DARK_TEXT = "1A1A2E";

// ─── HELPER FUNCTIONS ─────────────────────────────────────────────

function addSlide(bg = DARK_BG) {
  let s = pres.addSlide();
  s.background = { color: bg };
  return s;
}

function addTitle(slide, text, y = 0.18, color = ACCENT1, size = 28) {
  slide.addText(text, {
    x: 0.4, y: y, w: 12.5, h: 0.55,
    fontSize: size, bold: true, color: color, fontFace: "Calibri",
    align: "left", margin: 0
  });
  // underline bar
  slide.addShape(pres.ShapeType.rect, {
    x: 0.4, y: y + 0.58, w: 12.5, h: 0.04,
    fill: { color: ACCENT1 }, line: { color: ACCENT1 }
  });
}

function addSubtitle(slide, text, y, color = ACCENT4) {
  slide.addText(text, {
    x: 0.4, y: y, w: 12.5, h: 0.4,
    fontSize: 17, bold: true, color: color, fontFace: "Calibri",
    align: "left", margin: 0
  });
}

function bulletList(slide, items, x, y, w, h, opts = {}) {
  const textArr = items.map((item, i) => ({
    text: item,
    options: { bullet: { type: "bullet" }, breakLine: i < items.length - 1, ...opts }
  }));
  slide.addText(textArr, {
    x, y, w, h,
    fontSize: opts.fontSize || 13, color: opts.color || WHITE,
    fontFace: "Calibri", valign: "top"
  });
}

function addBox(slide, x, y, w, h, fillColor, text, textColor = WHITE, fontSize = 13, bold = false) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h,
    fill: { color: fillColor },
    line: { color: fillColor },
    rectRadius: 0.08
  });
  slide.addText(text, {
    x, y, w, h,
    fontSize, bold, color: textColor,
    fontFace: "Calibri", align: "center", valign: "middle", margin: 4
  });
}

function addArrow(slide, x, y, w = 0.0, h = 0.35) {
  // vertical arrow
  slide.addShape(pres.ShapeType.line, {
    x: x, y: y, w: w, h: h,
    line: { color: ACCENT1, width: 2, endArrowType: "triangle" }
  });
}

function addHArrow(slide, x, y, w = 0.4) {
  slide.addShape(pres.ShapeType.line, {
    x, y, w, h: 0,
    line: { color: ACCENT1, width: 2, endArrowType: "triangle" }
  });
}

function sectionHeader(slide, title, subtitle, color = ACCENT1) {
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 13.3, h: 7.5,
    fill: { color: DARK_BG }, line: { color: DARK_BG }
  });
  // accent stripe left
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 0.25, h: 7.5,
    fill: { color: color }, line: { color: color }
  });
  slide.addText(title, {
    x: 1, y: 2.5, w: 11, h: 1.2,
    fontSize: 42, bold: true, color: WHITE, fontFace: "Calibri", align: "center"
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 1, y: 3.9, w: 11, h: 0.6,
      fontSize: 20, color: color, fontFace: "Calibri", align: "center"
    });
  }
}

// Fetch images safely
function fetchImages(urls) {
  try {
    const result = execSync(
      `node /home/daytona/skills/shared/scripts/fetch_images.js ${urls.map(u => `"${u}"`).join(" ")}`,
      { timeout: 30000 }
    ).toString();
    return JSON.parse(result);
  } catch (e) {
    return urls.map(u => ({ url: u, base64: null, error: e.message }));
  }
}

// ─── SLIDE 1: TITLE SLIDE ─────────────────────────────────────────
let s = addSlide(DARK_BG);
// big gradient-like rect
s.addShape(pres.ShapeType.rect, {
  x: 0, y: 0, w: 13.3, h: 7.5,
  fill: { type: "solid", color: DARK_BG }, line: { color: DARK_BG }
});
s.addShape(pres.ShapeType.rect, {
  x: 0, y: 4.8, w: 13.3, h: 2.7,
  fill: { color: MID_BG }, line: { color: MID_BG }
});
// Accent shapes
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.18, fill: { color: ACCENT1 }, line: { color: ACCENT1 } });
s.addShape(pres.ShapeType.rect, { x: 0, y: 7.32, w: 13.3, h: 0.18, fill: { color: ACCENT2 }, line: { color: ACCENT2 } });
// Cross symbol (medical)
s.addShape(pres.ShapeType.rect, { x: 0.7, y: 1.5, w: 0.15, h: 0.6, fill: { color: ACCENT2 }, line: { color: ACCENT2 } });
s.addShape(pres.ShapeType.rect, { x: 0.55, y: 1.65, w: 0.45, h: 0.15, fill: { color: ACCENT2 }, line: { color: ACCENT2 } });
s.addText("OBSTETRICS", {
  x: 1, y: 1.3, w: 11, h: 1.4,
  fontSize: 58, bold: true, color: WHITE, fontFace: "Calibri", align: "center",
  charSpacing: 8
});
s.addText("Complete Question Bank & Study Guide", {
  x: 1, y: 2.85, w: 11, h: 0.6,
  fontSize: 22, color: ACCENT1, fontFace: "Calibri", align: "center"
});
s.addText("2019 – 2024  |  Essay & Short Notes  |  All Major Topics", {
  x: 1, y: 3.5, w: 11, h: 0.45,
  fontSize: 15, color: LIGHT_GRAY, fontFace: "Calibri", align: "center"
});
s.addText("Topics Covered: Prolonged Pregnancy • Multiple Pregnancy • Hypertensive Disorders • Anemia • PPH • APH\nPreterm Labour • GDM • Cesarean Section • Rh-Negative Pregnancy • Labour & Delivery & MORE", {
  x: 0.6, y: 5.0, w: 12.1, h: 1.0,
  fontSize: 11.5, color: ACCENT5, fontFace: "Calibri", align: "center"
});
s.addText("42 Essay Topics  |  42 Short Note Topics  |  Exam Years Mapped", {
  x: 1, y: 6.3, w: 11, h: 0.4,
  fontSize: 13, color: ACCENT4, fontFace: "Calibri", align: "center", bold: true
});

// ─── SLIDE 2: INDEX / TABLE OF CONTENTS ──────────────────────────
s = addSlide(MID_BG);
addTitle(s, "📋  TABLE OF CONTENTS", 0.18, ACCENT1, 24);
const topics = [
  ["1. Prolonged Pregnancy","2. Multiple/Twin Pregnancy","3. Hypertensive Disorders"],
  ["4. Anemia in Pregnancy","5. Post-Partum Haemorrhage","6. Ante-Partum Haemorrhage"],
  ["7. Preterm Labour","8. Gestational Diabetes","9. Cesarean Section"],
  ["10. Rh-Negative Pregnancy","11. Labour","12. HELLP Syndrome"],
  ["13. Perinatal Mortality","14. Puerperium","15. Fetus & Newborn"],
  ["16. Maternal Adaptations","17. Aneuploidy Screening","18. Labour & Delivery"],
];
topics.forEach((row, ri) => {
  row.forEach((cell, ci) => {
    const colors = [ACCENT1, ACCENT2, ACCENT3, ACCENT4, "7B2FBE", "E76F51"];
    addBox(s, 0.3 + ci * 4.3, 1.1 + ri * 0.93, 4.0, 0.75, colors[ci % 6], cell, WHITE, 11.5, true);
  });
});
s.addText("* All topics mapped to exam years (2019–2024)", {
  x: 0.4, y: 7.05, w: 12.5, h: 0.3, fontSize: 10, color: LIGHT_GRAY, fontFace: "Calibri", italic: true
});

// ─── SLIDE 3: SECTION HEADER – ESSAY TOPICS ──────────────────────
s = addSlide(DARK_BG);
sectionHeader(s, "ESSAY TOPICS", "Detailed Study Cards for All 13 Major Topics", ACCENT1);

// ─── SLIDE 4: PROLONGED PREGNANCY ────────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "1.  PROLONGED PREGNANCY  |  Feb 2024", 0.18, ACCENT1, 24);
// Definition box
addBox(s, 0.3, 0.9, 5.8, 0.65, ACCENT2, "DEFINITION: Pregnancy ≥ 42 completed weeks (294 days) from LMP", WHITE, 12, true);
// Two columns
addSubtitle(s, "🔬 Complications", 1.75, ACCENT4);
bulletList(s, [
  "Uteroplacental insufficiency",
  "Meconium aspiration syndrome",
  "Macrosomia → CPD, shoulder dystocia",
  "Oligohydramnios",
  "Fetal distress / Intrauterine death",
  "Post-maturity syndrome",
  "Increased C-section rate",
], 0.3, 2.15, 5.8, 3.2, { fontSize: 12 });

addSubtitle(s, "🩺 Management", 1.75, ACCENT3);
bulletList(s, [
  "Confirm dating – USG, LMP",
  "Antepartum fetal surveillance from 41 wks",
  "Biophysical profile (BPP), NST, AFI",
  "Cervical assessment – Bishop score",
  "Induction of labour at 41–42 weeks",
  "C-section if induction fails / fetal distress",
  "Monitor for meconium-stained liquor",
], 6.5, 2.15, 6.0, 3.2, { fontSize: 12 });

addSubtitle(s, "🔍 Investigations", 1.75, ACCENT1);
bulletList(s, ["USG for BPP", "NST / CTG", "Amniotic Fluid Index", "Doppler studies"], 0.3, 1.78, 5.8, 0.85, { fontSize: 11 });

// Flowchart: Management
addSubtitle(s, "▶ Management Flowchart", 5.5, ACCENT4);
addBox(s, 0.3, 5.95, 3.5, 0.5, "1B3A6B", "41 Weeks: ANC Surveillance", ACCENT1, 11, true);
addHArrow(s, 3.85, 6.2, 0.4);
addBox(s, 4.3, 5.95, 3.0, 0.5, "1B3A6B", "42 Weeks: Induce Labour", ACCENT4, 11, true);
addHArrow(s, 7.35, 6.2, 0.4);
addBox(s, 7.8, 5.95, 2.5, 0.5, ACCENT2, "Fetal Distress → C-Section", WHITE, 11, true);
addHArrow(s, 10.35, 6.2, 0.4);
addBox(s, 10.8, 5.95, 2.1, 0.5, ACCENT3, "Normal → SVD", WHITE, 11, true);

// ─── SLIDE 5: MULTIPLE PREGNANCY ─────────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "2.  MULTIPLE / TWIN PREGNANCY  |  Feb 24, Jan 20, Apr 21", 0.18, ACCENT1, 22);
// Etiology + Classification boxes
addBox(s, 0.3, 0.88, 3.8, 0.5, "7B2FBE", "ETIOLOGY", WHITE, 13, true);
bulletList(s, ["Ovulation induction / ART", "Race (African > Asian)", "Advanced maternal age", "Hereditary (maternal side)", "High parity"], 0.3, 1.42, 3.8, 1.8, { fontSize: 11.5 });

addBox(s, 4.3, 0.88, 4.5, 0.5, ACCENT2, "DIAGNOSIS", WHITE, 13, true);
bulletList(s, [
  "Clinical: uterus large for dates, multiple FHR sites",
  "USG: gold standard – chorionicity, amnionicity",
  "Twin peak sign (Lambda) → DCDA",
  "T-sign → MCDA",
  "Elevated AFP / hCG",
], 4.3, 1.42, 4.5, 1.8, { fontSize: 11 });

addBox(s, 9.0, 0.88, 4.0, 0.5, ACCENT3, "ZYGOSITY", WHITE, 13, true);
const zyg = [
  ["DZ (70%)", "MZ (30%)"],
  ["2 ova + 2 sperms", "1 ovum + 1 sperm"],
  ["Always DCDA", "DCDA/MCDA/MCMA"],
  ["No shared placenta", "May share placenta"],
];
zyg.forEach((row, ri) => {
  row.forEach((cell, ci) => {
    addBox(s, 9.05 + ci * 1.95, 1.42 + ri * 0.48, 1.85, 0.42,
      ri === 0 ? ACCENT1 : (ci === 0 ? "1B3A6B" : "1B2A4B"), cell, WHITE, 10);
  });
});

addSubtitle(s, "⚠ Complications of Multifetal Gestation", 3.4, ACCENT4);
const comps = [
  ["Maternal", ["Hyperemesis", "Anaemia", "Preterm Labour", "PIH/PET", "Polyhydramnios", "PPH"]],
  ["Fetal", ["IUGR", "Malpresentation", "TTTS", "Cord entanglement", "IUD", "Prematurity"]],
  ["Neonatal", ["RDS", "IVH", "NEC", "Hypoglycaemia", "Hyperbilirubinaemia"]],
];
comps.forEach(([hdr, items], ci) => {
  const cx = 0.3 + ci * 4.35;
  addBox(s, cx, 3.88, 4.0, 0.42, ACCENT2, hdr, WHITE, 13, true);
  bulletList(s, items, cx, 4.35, 4.0, 2.8, { fontSize: 10.5 });
});

// TTTS note
addBox(s, 0.3, 7.05, 12.5, 0.35, "1B3A6B",
  "TTTS: Twin-to-Twin Transfusion Syndrome | Quintero staging | Tx: Fetoscopic laser coagulation (preferred)", ACCENT1, 11, true);

// ─── SLIDE 6: HYPERTENSIVE DISORDERS ─────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "3.  HYPERTENSIVE DISORDERS OF PREGNANCY", 0.18, ACCENT1, 24);
// Classification table
const hdpClasses = [
  ["Classification", "Definition", "Key Features"],
  ["Gestational HTN", "BP ≥140/90 after 20 wks\nNo proteinuria", "Resolves by 12 wks postpartum"],
  ["Pre-Eclampsia", "HTN + Proteinuria (≥300mg/24h)\nafter 20 wks", "Multi-system disorder"],
  ["Severe PET", "SBP ≥160 or DBP ≥110\nor end-organ damage", "HELLP, pulmonary edema, seizures"],
  ["Eclampsia", "PET + Convulsions\n(not due to other cause)", "Emergency – MgSO4 + Deliver"],
  ["Chronic HTN", "Pre-existing or before 20 wks", "May superimpose PET"],
  ["Superimposed PET", "Chronic HTN + new proteinuria", "Higher risk of complications"],
];
hdpClasses.forEach((row, ri) => {
  row.forEach((cell, ci) => {
    const isHeader = ri === 0;
    addBox(s, 0.25 + ci * 4.35, 0.9 + ri * 0.82, 4.15, 0.75,
      isHeader ? ACCENT1 : (ri % 2 === 0 ? "1B2A4B" : "0D1B2A"),
      cell, isHeader ? DARK_TEXT : WHITE, isHeader ? 12 : 10.5, isHeader);
  });
});

// Treatment flowchart
addSubtitle(s, "▶ Eclampsia Management Flowchart", 5.9, ACCENT4);
const ecl = [
  { label: "Eclampsia Seizure", color: ACCENT2 },
  { label: "Airway / Lateral decubitus", color: "7B2FBE" },
  { label: "MgSO4 (Pritchard/Zuspan)", color: ACCENT1 },
  { label: "Antihypertensives (Labetalol/Hydralazine)", color: ACCENT3 },
  { label: "Fetal Monitoring + Delivery", color: ACCENT4 },
  { label: "ICU / HDU Monitoring", color: "E76F51" },
];
ecl.forEach((step, i) => {
  addBox(s, 0.25 + i * 2.2, 6.3, 2.0, 0.65, step.color, step.label, WHITE, 10, true);
  if (i < ecl.length - 1) addHArrow(s, 2.28 + i * 2.2, 6.63, 0.18);
});

// ─── SLIDE 7: HELLP & MgSO4 REGIMENS ─────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "3a.  HELLP SYNDROME  &  MgSO4 REGIMENS", 0.18, ACCENT2, 24);

addSubtitle(s, "HELLP Syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)", 0.88, ACCENT4);
const hellpCols = [
  ["Criteria", ["LDH >600 U/L", "AST/ALT >70 U/L", "Platelets <100,000/µL"]],
  ["Tennessee Classification", ["Class I: Plt <50k", "Class II: Plt 50–100k", "Class III: Plt 100–150k"]],
  ["Management", ["Stabilise BP", "MgSO4 prophylaxis", "Steroids if <34 wks", "Deliver ≥34 wks", "Platelets if <20k or surgery"]],
];
hellpCols.forEach(([hdr, items], ci) => {
  addBox(s, 0.3 + ci * 4.35, 1.35, 4.0, 0.45, ACCENT2, hdr, WHITE, 12, true);
  bulletList(s, items, 0.3 + ci * 4.35, 1.85, 4.0, 1.7, { fontSize: 12 });
});

addSubtitle(s, "MgSO4 Regimens", 3.8, ACCENT1);
const mgRegs = [
  ["Pritchard Regimen", ["Loading: 4g IV (slow) + 10g IM (5g each buttock)", "Maintenance: 5g IM every 4h", "Continue 24h after last fit / delivery", "Monitor: RR >12/min, urine >25ml/h, patellar reflex present"]],
  ["Zuspan Regimen", ["Loading: 4g IV over 20 min", "Maintenance: 1–2g/hr IV infusion", "Easier to titrate, preferred in ICU setting", "Same monitoring parameters"]],
  ["Antidote", ["Calcium gluconate 1g IV slowly", "Given if toxicity signs appear", "Respiratory depression, loss of DTRs"]],
];
mgRegs.forEach(([hdr, items], ci) => {
  addBox(s, 0.3 + ci * 4.35, 4.3, 4.0, 0.48, ACCENT1, hdr, DARK_TEXT, 12, true);
  bulletList(s, items, 0.3 + ci * 4.35, 4.85, 4.0, 2.3, { fontSize: 11 });
});

addBox(s, 0.3, 7.1, 12.5, 0.32, ACCENT2,
  "⚠ Toxicity: Loss of patellar reflex (first sign) → Respiratory arrest → Cardiac arrest  |  Antidote: Ca Gluconate 1g IV", WHITE, 11, true);

// ─── SLIDE 8: ANEMIA IN PREGNANCY ────────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "4.  ANEMIA IN PREGNANCY  |  Feb 24, Apr 24, Jul 24, Aug 22, Jul 19", 0.18, ACCENT1, 20);
// Definition
addBox(s, 0.3, 0.88, 12.5, 0.48, ACCENT2,
  "WHO Definition: Hb <11 g/dL in pregnancy  |  Severe: Hb <7 g/dL  |  Very Severe: Hb <4 g/dL", WHITE, 12, true);

// Classification
addSubtitle(s, "Classification (WHO)", 1.52, ACCENT4);
const aneClass = [
  ["Mild", "Hb 10–10.9 g/dL", ACCENT3],
  ["Moderate", "Hb 7–9.9 g/dL", ACCENT4],
  ["Severe", "Hb 4–6.9 g/dL", ACCENT2],
  ["Very Severe", "Hb <4 g/dL", "8B1A1A"],
];
aneClass.forEach(([grade, range, clr], i) => {
  addBox(s, 0.3 + i * 3.15, 1.97, 2.9, 0.55, clr, `${grade}\n${range}`, WHITE, 11, true);
});

// IDA
addSubtitle(s, "Iron Deficiency Anemia (IDA) – Most Common", 2.75, ACCENT3);
bulletList(s, [
  "Causes: Poor intake, multiple pregnancies, malabsorption, hookworm infestation",
  "Complications: IUGR, preterm birth, PPH, maternal mortality",
  "Management: Oral iron (FeSO4 200mg TDS) for mild-moderate; IV iron (Ferric carboxymaltose) for severe",
  "Prevention: IFA supplementation from 12 wks; 100–150mg elemental iron + folic acid 500µg daily",
], 0.3, 3.2, 12.5, 1.8, { fontSize: 11.5 });

// Severe anemia management
addSubtitle(s, "Severe Anemia (Hb <7 g/dL) at 28 Weeks – Management", 5.15, ACCENT2);
const sevAneSteps = ["Admit + Bedrest", "High protein diet", "Oral/IV iron therapy", "Treat cause (deworm etc.)", "Target Hb ≥10 by term", "Transfuse if Hb <6 or symptomatic"];
sevAneSteps.forEach((step, i) => {
  addBox(s, 0.3 + i * 2.18, 5.6, 2.0, 0.65, i === 5 ? ACCENT2 : "1B3A6B", step, i === 5 ? WHITE : ACCENT1, 10.5, true);
  if (i < sevAneSteps.length - 1) addHArrow(s, 2.33 + i * 2.18, 5.93, 0.15);
});

addSubtitle(s, "Intrapartum Management", 6.45, ACCENT1);
bulletList(s, [
  "Active management of 3rd stage (Oxytocin 10IU IM)",
  "Minimize blood loss",
  "Transfuse if Hb <8 g/dL before delivery",
  "Paediatric presence at delivery for neonatal care",
], 0.3, 6.88, 12.5, 0.65, { fontSize: 11 });

// ─── SLIDE 9: PPH ─────────────────────────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "5.  POST-PARTUM HAEMORRHAGE (PPH)  |  Jul 23, Aug 21, Aug 22, Jan 20, Jan 19", 0.18, ACCENT1, 19);
addBox(s, 0.3, 0.88, 12.5, 0.48, ACCENT2,
  "Definition: Blood loss ≥500mL after vaginal delivery or ≥1000mL after C-section within 24 hrs (Primary) | After 24hrs–6wks (Secondary)", WHITE, 11.5, true);

// 4 T's of PPH
addSubtitle(s, "Etiological Factors – The 4 T's", 1.52, ACCENT4);
const fourTs = [
  ["TONE (70–80%)", ACCENT2, ["Uterine atony", "Grand multiparity", "Macrosomia", "Polyhydramnios", "Prolonged labour"]],
  ["TRAUMA (20%)", ACCENT4, ["Cervical/vaginal tears", "Uterine rupture", "Episiotomy", "Broad ligament hematoma"]],
  ["TISSUE (10%)", ACCENT3, ["Retained placenta", "Retained products", "Morbidly adherent placenta", "Placenta accreta"]],
  ["THROMBIN (<1%)", ACCENT1, ["Coagulation defects", "DIC", "ITP", "Von Willebrand disease"]],
];
fourTs.forEach(([hdr, clr, items], ci) => {
  addBox(s, 0.3 + ci * 3.2, 2.0, 3.0, 0.48, clr, hdr, ci === 0 ? WHITE : DARK_TEXT, 12, true);
  bulletList(s, items, 0.3 + ci * 3.2, 2.55, 3.0, 2.0, { fontSize: 10.5 });
});

// Management flowchart
addSubtitle(s, "▶ Management of Atonic PPH – Stepwise Approach", 4.72, ACCENT4);
const pphSteps = [
  ["Call for HELP + IV Access", ACCENT1],
  ["Bimanual Compression", "1B3A6B"],
  ["Oxytocin 10U IM / 20U IV", ACCENT3],
  ["Ergometrine 0.5mg IM", ACCENT4],
  ["Carboprost (PGF2α) 0.25mg IM", "7B2FBE"],
  ["Misoprostol 1000µg PR", ACCENT2],
  ["B-Lynch / Brace Suture", "E76F51"],
  ["Hysterectomy (Last resort)", "8B1A1A"],
];
pphSteps.forEach((step, i) => {
  const row = Math.floor(i / 4);
  const col = i % 4;
  addBox(s, 0.3 + col * 3.25, 5.2 + row * 0.88, 3.0, 0.72, step[1], step[0], WHITE, 10, true);
  if (col < 3 && i < pphSteps.length - 1 && row === Math.floor((i + 1) / 4))
    addHArrow(s, 3.33 + col * 3.25, 5.57 + row * 0.88, 0.2);
});
addBox(s, 0.3, 7.0, 12.5, 0.36, "1B3A6B",
  "AMTSL: Active Management of Third Stage of Labour – Oxytocin + CCT + Uterine massage → reduces PPH by 60%", ACCENT1, 11, true);

// ─── SLIDE 10: APH ────────────────────────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "6.  ANTE-PARTUM HAEMORRHAGE (APH)  |  Jul 23, Jul 19, Apr 21, Mar 22", 0.18, ACCENT1, 21);
addBox(s, 0.3, 0.88, 12.5, 0.42, ACCENT2,
  "Definition: Bleeding from genital tract after 28 weeks gestation and before delivery of the baby", WHITE, 12, true);

// Comparison table
addSubtitle(s, "Comparison: Placenta Previa vs Abruptio Placenta", 1.45, ACCENT4);
const aphComp = [
  ["Feature", "Placenta Previa", "Abruptio Placenta"],
  ["Onset", "Sudden, painless", "Sudden with pain"],
  ["Bleeding", "Revealed, bright red", "May be concealed/revealed; dark"],
  ["Pain", "Absent", "Severe, board-like rigidity"],
  ["Uterus", "Soft, non-tender", "Tender, tense, woody hard"],
  ["Fetal parts", "High / malpresentation", "Palpable (if no tenderness)"],
  ["Fetal heart", "Usually present", "Often fetal distress/IUD"],
  ["Management", "Steroids + CS if major", "Emergency delivery"],
];
aphComp.forEach((row, ri) => {
  row.forEach((cell, ci) => {
    const isHdr = ri === 0;
    const colrs = [ACCENT1, "1B3A6B", ACCENT2];
    addBox(s, 0.25 + ci * 4.35, 1.9 + ri * 0.56, 4.1, 0.5,
      isHdr ? ACCENT1 : colrs[ci], cell, isHdr ? DARK_TEXT : WHITE, isHdr ? 12 : 10.5, isHdr);
  });
});
addBox(s, 0.3, 6.5, 12.5, 0.42, "1B3A6B",
  "Couvelaire Uterus: Extravasation of blood into uterine musculature in severe abruption → Blue, toneless uterus → Risk of PPH + DIC", ACCENT4, 11, true);
addBox(s, 0.3, 7.0, 12.5, 0.36, "1B3A6B",
  "Grading: Grade 0 (no symptoms) → Grade 1 (mild) → Grade 2 (moderate) → Grade 3 (severe: DIC, IUD)", ACCENT1, 11, true);

// ─── SLIDE 11: PRETERM LABOUR ─────────────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "7.  PRETERM LABOUR  |  Apr 21, Sep 20", 0.18, ACCENT1, 24);
addBox(s, 0.3, 0.88, 12.5, 0.42, ACCENT2,
  "Definition: Regular uterine contractions + cervical changes before 37 completed weeks with ≥3 contractions/10 min, each ≥30 sec", WHITE, 11.5, true);

// Two columns
const ptlLeft = {
  "Etiological Factors": ["Cervical incompetence", "PPROM", "Infections (UTI, chorioamnionitis)", "Multiple pregnancy", "Polyhydramnios", "Uterine anomalies", "Low socioeconomic status", "Previous preterm birth", "Trauma / surgery"],
  "Clinical Features": ["Regular painful contractions", "Cervical effacement & dilatation", "Pelvic pressure", "Bloody show", "Intact/ruptured membranes"],
};
let yPos = 1.45;
Object.entries(ptlLeft).forEach(([hdr, items]) => {
  addSubtitle(s, hdr, yPos, ACCENT4);
  bulletList(s, items, 0.3, yPos + 0.42, 5.8, items.length * 0.32 + 0.1, { fontSize: 11 });
  yPos += items.length * 0.32 + 0.85;
});

addSubtitle(s, "Prediction", 1.45, ACCENT3);
bulletList(s, ["Cervical length <25mm on TVS", "fFN (Fetal Fibronectin) – high NPV", "History of PTB"], 6.5, 1.88, 6.0, 1.1, { fontSize: 11 });

addSubtitle(s, "Prevention", 2.75, ACCENT3);
bulletList(s, ["Cervical cerclage (McDonald/Shirodkar)", "Progesterone supplementation (17-OHPC IM)", "Treat infections early", "Avoid uterine over-distension"], 6.5, 3.18, 6.0, 1.2, { fontSize: 11 });

addSubtitle(s, "Management", 4.1, ACCENT3);
bulletList(s, [
  "Tocolytics: Nifedipine (1st line), Atosiban, Indomethacin, Ritodrine",
  "Corticosteroids: Betamethasone 12mg IM × 2 doses (48h apart) if 24–34 wks",
  "MgSO4 for neuroprotection if <32 wks",
  "GBS prophylaxis if indicated",
  "Plan delivery in tertiary centre with NICU",
], 6.5, 4.55, 6.0, 2.4, { fontSize: 11 });

// ─── SLIDE 12: GDM ────────────────────────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "8.  GESTATIONAL DIABETES MELLITUS (GDM)  |  Mar 22, Sep 20", 0.18, ACCENT1, 21);
addBox(s, 0.3, 0.88, 12.5, 0.42, ACCENT4,
  "Definition: Carbohydrate intolerance of variable severity with onset or first recognition during pregnancy", DARK_TEXT, 12, true);

// Risk Factors
addSubtitle(s, "Risk Factors", 1.45, ACCENT2);
const rfs = ["BMI >30", "Previous GDM", "Prev macrosomia (>4kg)", "Family hx DM (1st degree)", "PCOS", "Ethnicity (S.Asian, Afro-Carib)", "Age >35", "Glycosuria on dipstick"];
const rfColors = [ACCENT2, ACCENT1, ACCENT3, ACCENT4, "7B2FBE", "E76F51", "00B4D8", ACCENT2];
rfs.forEach((rf, i) => {
  addBox(s, 0.3 + (i % 4) * 3.2, 1.9 + Math.floor(i / 4) * 0.58, 3.0, 0.48, rfColors[i], rf, WHITE, 11, true);
});

// Screening
addSubtitle(s, "Screening (DIPSI Method)", 3.25, ACCENT3);
bulletList(s, [
  "50g OGCT (Glucose Challenge Test): 1h plasma glucose",
  "  - ≥140 mg/dL → proceed to 75g 2h OGTT",
  "DIPSI: 75g glucose load (non-fasting) → 2h glucose",
  "  - ≥140 mg/dL = GDM  |  ≥120–139 = IGT",
  "Screen at 24–28 wks (or earlier if high risk)",
], 0.3, 3.72, 6.0, 1.8, { fontSize: 11 });

// Complications
addSubtitle(s, "Complications", 3.25, ACCENT2);
const gdmComps = [
  ["Maternal", ["PIH / Pre-eclampsia", "Polyhydramnios", "Recurrent UTI", "C-section rate ↑", "Future T2DM (50% risk)"]],
  ["Fetal", ["Macrosomia", "Congenital anomalies", "IUGR", "IUFD", "Shoulder dystocia"]],
  ["Neonatal", ["Hypoglycaemia", "Hypocalcaemia", "Polycythaemia", "RDS", "Jaundice"]],
];
gdmComps.forEach(([hdr, items], ci) => {
  addBox(s, 6.5 + ci * 2.28, 3.7, 2.1, 0.4, ACCENT2, hdr, WHITE, 11, true);
  bulletList(s, items, 6.5 + ci * 2.28, 4.15, 2.1, 1.8, { fontSize: 10 });
});

// Management flowchart
addSubtitle(s, "▶ Management Flowchart", 6.1, ACCENT4);
const gdmFlow = [
  ["Diagnose GDM", ACCENT2],
  ["MNT × 2 weeks", ACCENT1],
  ["Target: FBS <95, PPBS <120", ACCENT3],
  ["Not achieved → Insulin", ACCENT4],
  ["Monitor BPP + Growth USG", "7B2FBE"],
  ["Deliver at 38–39 wks", "E76F51"],
];
gdmFlow.forEach((step, i) => {
  addBox(s, 0.25 + i * 2.18, 6.55, 2.0, 0.65, step[1], step[0], i === 3 ? DARK_TEXT : WHITE, 10.5, true);
  if (i < gdmFlow.length - 1) addHArrow(s, 2.28 + i * 2.18, 6.88, 0.17);
});

// ─── SLIDE 13: CESAREAN SECTION ───────────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "9.  CESAREAN SECTION (C-SECTION)  |  Apr 24", 0.18, ACCENT1, 24);
addBox(s, 0.3, 0.88, 12.5, 0.42, ACCENT4,
  "Definition: Delivery of fetus, placenta, and membranes through incisions in the anterior abdominal wall and uterine wall after 28 weeks", DARK_TEXT, 11.5, true);

addSubtitle(s, "Types", 1.45, ACCENT2);
const csTypes = [
  ["Lower Segment CS (LSCS)", "Most common; transverse incision; less morbidity; allows VBAC"],
  ["Classical CS", "Vertical uterine incision; used for preterm, anterior placenta previa; high risk of rupture"],
  ["Emergency CS", "Category 1 (immediate threat) to Category 4 (elective)"],
  ["Perimortem CS", "Maternal cardiac arrest – delivery within 5 min"],
];
csTypes.forEach(([type, desc], i) => {
  addBox(s, 0.3, 1.95 + i * 0.68, 3.5, 0.58, ACCENT2, type, WHITE, 11, true);
  slide_addText(s, desc, 3.9, 2.02 + i * 0.68, 8.8, 0.45, 11);
});

addSubtitle(s, "Indications", 4.9, ACCENT3);
const csInd = [
  ["Absolute", ["Contracted pelvis", "Placenta previa (major)", "Previous 2+ CS", "Transverse lie at term"]],
  ["Relative", ["Cephalopelvic disproportion", "Fetal distress", "Malpresentation", "Cord prolapse", "Previous uterine surgery"]],
  ["Complications", ["Anaesthetic risks", "Haemorrhage", "Wound infection", "DVT/PE", "Bladder/bowel injury", "Placenta accreta next preg."]],
];
csInd.forEach(([hdr, items], ci) => {
  addBox(s, 0.3 + ci * 4.35, 5.35, 4.1, 0.45, ACCENT3, hdr, DARK_TEXT, 12, true);
  bulletList(s, items, 0.3 + ci * 4.35, 5.85, 4.1, 1.6, { fontSize: 11 });
});

function slide_addText(sl, text, x, y, w, h, fontSize) {
  sl.addText(text, { x, y, w, h, fontSize, color: WHITE, fontFace: "Calibri", valign: "middle" });
}

// ─── SLIDE 14: RH-NEGATIVE PREGNANCY ──────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "10.  RH-NEGATIVE PREGNANCY  |  Sep 20", 0.18, ACCENT1, 24);
addBox(s, 0.3, 0.88, 12.5, 0.42, ACCENT4,
  "Rh-isoimmunisation: When Rh-negative mother develops antibodies against Rh-positive fetal RBCs → Haemolytic Disease of Fetus/Newborn (HDFN)", DARK_TEXT, 11, true);

addSubtitle(s, "Etiopathogenesis", 1.45, ACCENT2);
const rhPath = ["Rh-D positive fetus (Father Rh+)", "Fetomaternal hemorrhage (FMH)", "Mother sensitized → IgM (1st preg.) → IgG (2nd+)", "IgG crosses placenta → hemolysis of fetal RBCs", "Hydrops fetalis / IUD in severe cases"];
rhPath.forEach((step, i) => {
  addBox(s, 0.3 + i * 2.58, 1.95, 2.4, 0.72, i % 2 === 0 ? "1B3A6B" : "1B2A4B", step, ACCENT1, 10.5, true);
  if (i < rhPath.length - 1) addHArrow(s, 2.73 + i * 2.58, 2.3, 0.15);
});

addSubtitle(s, "Diagnosis", 2.9, ACCENT3);
bulletList(s, [
  "ICT (Indirect Coomb's Test) in mother – detects antibodies",
  "DCT (Direct Coomb's Test) in neonate – confirms HDFN",
  "Liley chart: Spectrophotometric analysis of amniotic fluid (OD450)",
  "MCA Doppler (PSV) – elevated → fetal anaemia",
  "Kleihauer-Betke test – quantifies FMH",
], 0.3, 3.35, 6.2, 1.85, { fontSize: 11.5 });

addSubtitle(s, "Prophylaxis & Management", 2.9, ACCENT2);
bulletList(s, [
  "Anti-D immunoglobulin (300µg = 1500IU) prevents sensitisation",
  "Antenatal: 28 & 34 weeks in non-sensitised Rh-ve mothers",
  "Postnatal: within 72 hours of delivery (if baby Rh+)",
  "Also after: miscarriage, amniocentesis, CVS, ectopic, APH",
  "Sensitised: Monitor antibody titres, MCA Doppler",
  "IUT (Intrauterine Transfusion) if severe fetal anaemia",
  "Early delivery if fetal compromise",
], 6.5, 3.35, 6.2, 2.7, { fontSize: 11 });

addBox(s, 0.3, 7.05, 12.5, 0.35, ACCENT2,
  "ROUTINE ANTENATAL ANTI-D PROPHYLAXIS (RAADP): 500IU at 28 weeks → reduces sensitisation from 1.5% to 0.2%", WHITE, 11, true);

// ─── SLIDE 15: LABOUR ─────────────────────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "11.  LABOUR  |  Feb 23", 0.18, ACCENT1, 24);
addBox(s, 0.3, 0.88, 12.5, 0.42, ACCENT4,
  "Definition: Regular painful uterine contractions causing progressive effacement and dilatation of cervix with descent of presenting part", DARK_TEXT, 12, true);

addSubtitle(s, "Stages of Labour", 1.45, ACCENT2);
const labourStages = [
  ["Stage 1", "Onset of labour → Full dilatation (10cm)", "Latent: 0–3cm | Active: 3–10cm (1cm/hr nullip, 1.5cm/hr multip)", ACCENT2],
  ["Stage 2", "Full dilatation → Delivery of baby", "Pushing phase; max 2hr nullip / 1hr multip (with epidural: +1hr)", ACCENT3],
  ["Stage 3", "Delivery of baby → Delivery of placenta", "Up to 30 min; AMTSL given", ACCENT1],
  ["Stage 4", "1 hour postpartum", "Monitoring for PPH, vitals, uterine tone", ACCENT4],
];
labourStages.forEach(([stg, def, detail, clr], i) => {
  addBox(s, 0.3, 1.95 + i * 1.05, 1.5, 0.85, clr, stg, WHITE, 14, true);
  s.addText(def, { x: 1.9, y: 2.0 + i * 1.05, w: 5.5, h: 0.35, fontSize: 11, color: WHITE, fontFace: "Calibri", bold: true });
  s.addText(detail, { x: 1.9, y: 2.38 + i * 1.05, w: 10.8, h: 0.35, fontSize: 10.5, color: LIGHT_GRAY, fontFace: "Calibri" });
});

addSubtitle(s, "Mechanism of Labour (LOA – Most Common)", 6.25, ACCENT3);
const mech = ["Engagement", "Descent", "Flexion", "Internal Rotation", "Extension", "Restitution", "External Rotation", "Expulsion"];
mech.forEach((step, i) => {
  addBox(s, 0.3 + i * 1.62, 6.7, 1.48, 0.55, i % 2 === 0 ? ACCENT1 : "1B3A6B", step, WHITE, 9.5, true);
  if (i < mech.length - 1) addHArrow(s, 1.81 + i * 1.62, 6.97, 0.11);
});

// ─── SLIDE 16: SECTION HEADER – SHORT NOTES ───────────────────────
s = addSlide(DARK_BG);
sectionHeader(s, "SHORT NOTE TOPICS", "Key Points, Definitions & Exam Highlights", ACCENT2);

// ─── SLIDE 17: PERINATAL & MATERNAL MORTALITY ─────────────────────
s = addSlide(MID_BG);
addTitle(s, "SHORT NOTE: PERINATAL & MATERNAL MORTALITY  |  Jan 20, Feb 24, Jul 23", 0.18, ACCENT2, 19);
addSubtitle(s, "Perinatal Mortality", 0.88, ACCENT4);
bulletList(s, [
  "Definition: Deaths from 28 weeks gestation to 7 days of life",
  "Perinatal Mortality Rate (PMR) = (Stillbirths + Early neonatal deaths) / 1000 total births",
  "India PMR ≈ 21–23/1000 (2021 SRS)",
  "Causes: Birth asphyxia, prematurity, congenital anomalies, infection, IUGR",
], 0.3, 1.35, 12.5, 1.5, { fontSize: 12 });

addSubtitle(s, "Maternal Mortality Ratio (MMR)", 3.0, ACCENT2);
bulletList(s, [
  "Definition: Maternal deaths per 100,000 live births",
  "India MMR = 97/100,000 (2018–20 SRS) – major improvement from 254 (2004–06)",
  "WHO target: <70/100,000 by 2030 (SDG 3.1)",
], 0.3, 3.45, 12.5, 1.1, { fontSize: 12 });

addSubtitle(s, "Causes of Maternal Death (HAEMORRHAGE – leading cause in India)", 4.7, ACCENT3);
const mmCauses = ["Haemorrhage (38%)", "Hypertensive disorders (20%)", "Sepsis (11%)", "Obstructed labour (9%)", "Unsafe abortion (8%)", "Other (14%)"];
mmCauses.forEach((cause, i) => {
  addBox(s, 0.3 + (i % 3) * 4.35, 5.15 + Math.floor(i / 3) * 0.72, 4.1, 0.58, [ACCENT2, "7B2FBE", ACCENT4, ACCENT1, ACCENT3, "E76F51"][i], cause, WHITE, 12, true);
});

addSubtitle(s, "Strategies to Reduce Maternal Mortality", 6.6, ACCENT1);
bulletList(s, [
  "JSSK – Janani Shishu Suraksha Karyakaram | JSY – Janani Suraksha Yojana | Muthulakshmi Reddy Scheme",
  "Skilled birth attendance | EmOC facilities | ANC quality | Blood banking | Transport",
], 0.3, 7.05, 12.5, 0.42, { fontSize: 11 });

// ─── SLIDE 18: PUERPERIUM ─────────────────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "SHORT NOTE: PUERPERIUM  |  Apr 21, Jan 20", 0.18, ACCENT2, 24);
addBox(s, 0.3, 0.88, 12.5, 0.42, ACCENT4,
  "Puerperium: Period from delivery of placenta to return of reproductive organs to non-pregnant state – approximately 6 weeks", DARK_TEXT, 12, true);

addSubtitle(s, "Problems Associated with Puerperium", 1.45, ACCENT3);
const puerp = [
  ["PPH", "Primary (24h) or secondary (after 24h–6 wks). Causes: uterine atony, retained products, infection"],
  ["Puerperal Sepsis", "Temp >38°C on 2 of first 10 days (excluding 1st 24h). Common organisms: E. coli, Group B Strep, Staph aureus"],
  ["DVT/PE", "Hypercoagulable state, immobility. Anticoagulate with LMWH"],
  ["Mastitis", "Engorgement → cracked nipple → infection. Tx: Flucloxacillin, continue breastfeeding"],
  ["Depression", "Baby blues (day 3–5, self-limiting) vs Postnatal depression vs Puerperal psychosis (emergency)"],
  ["Sheehan Syndrome", "Postpartum pituitary necrosis due to severe PPH → panhypopituitarism"],
];
puerp.forEach(([cond, detail], i) => {
  addBox(s, 0.3, 1.95 + i * 0.77, 2.8, 0.62, [ACCENT2, ACCENT1, ACCENT3, ACCENT4, "7B2FBE", "E76F51"][i], cond, WHITE, 12, true);
  s.addText(detail, { x: 3.2, y: 2.02 + i * 0.77, w: 9.7, h: 0.58, fontSize: 10.5, color: LIGHT_GRAY, fontFace: "Calibri", valign: "middle" });
});

// ─── SLIDE 19: FETUS & NEWBORN ────────────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "SHORT NOTE: FETUS & NEWBORN  |  Multiple Exams", 0.18, ACCENT2, 24);

// APGAR Score table
addSubtitle(s, "APGAR Score (Jan 19)", 0.88, ACCENT4);
const apgar = [
  ["Sign", "0", "1", "2"],
  ["Appearance (Color)", "Blue/Pale all over", "Blue extremities", "Pink all over"],
  ["Pulse (Heart Rate)", "Absent", "<100 bpm", "≥100 bpm"],
  ["Grimace (Reflex)", "No response", "Grimace", "Cry / Cough"],
  ["Activity (Muscle Tone)", "Limp", "Some flexion", "Active motion"],
  ["Respiration", "Absent", "Slow/Irregular", "Good, crying"],
];
apgar.forEach((row, ri) => {
  row.forEach((cell, ci) => {
    const isHdr = ri === 0;
    addBox(s, 0.25 + ci * 3.2, 1.35 + ri * 0.58, 3.05, 0.52,
      isHdr ? ACCENT1 : (ri % 2 ? "1B2A4B" : "0D1B2A"), cell, isHdr ? DARK_TEXT : WHITE, isHdr ? 11 : 10, isHdr);
  });
});

// Neonatal Resuscitation
addSubtitle(s, "Neonatal Resuscitation (NRP) – Feb 23", 4.9, ACCENT3);
const nrpSteps = ["Warm & Dry", "Stimulate", "Assess HR/Breathing", "PPV (BMV) if HR<100", "Chest compressions if HR<60", "Drugs: Epinephrine"];
nrpSteps.forEach((step, i) => {
  addBox(s, 0.25 + i * 2.18, 5.38, 2.0, 0.65, [ACCENT3, ACCENT1, ACCENT4, ACCENT2, "7B2FBE", "E76F51"][i], step, WHITE, 10.5, true);
  if (i < nrpSteps.length - 1) addHArrow(s, 2.28 + i * 2.18, 5.7, 0.17);
});

// RDS
addSubtitle(s, "RDS (Respiratory Distress Syndrome) – Apr 21", 6.2, ACCENT2);
bulletList(s, [
  "Surfactant deficiency → Type II pneumocytes immature (before 34 wks)",
  "Features: Grunting, nasal flaring, intercostal retractions, cyanosis within 6h of birth",
  "Prevention: Antenatal corticosteroids (24–34 wks) | Treatment: Surfactant therapy + CPAP/ventilation",
], 0.3, 6.65, 12.5, 0.78, { fontSize: 11 });

// ─── SLIDE 20: MATERNAL ADAPTATIONS ──────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "SHORT NOTE: MATERNAL ADAPTATIONS IN PREGNANCY  |  Aug 21, Feb 24", 0.18, ACCENT2, 18);

addSubtitle(s, "Cardiovascular Changes", 0.88, ACCENT1);
bulletList(s, [
  "CO increases 40–50% (peaks 28–32 wks) – due to ↑HR and ↑SV",
  "Blood volume ↑ 45–50% (plasma 50% > RBC 20% → physiological anaemia)",
  "SVR decreases → BP falls in 2nd trimester, rises near term",
  "Cardiac output: Supine position causes aortocaval compression → SVC syndrome",
], 0.3, 1.35, 12.5, 1.3, { fontSize: 11.5 });

addSubtitle(s, "Haematological Changes", 2.82, ACCENT4);
bulletList(s, [
  "WBC rises to 9,000–15,000 (non-infective, physiological leukocytosis)",
  "ESR increases (not useful in pregnancy diagnostics)",
  "Coagulation: Hypercoagulable state (↑Fibrinogen, ↑F VII/VIII/X, ↓Protein S) → DVT risk",
  "Platelets: Slight decrease due to dilution (gestational thrombocytopenia)",
], 0.3, 3.3, 12.5, 1.3, { fontSize: 11.5 });

addSubtitle(s, "Respiratory Changes", 4.77, ACCENT3);
bulletList(s, [
  "Tidal volume ↑ 40%; Respiratory rate slightly increases",
  "FRC decreases (diaphragm elevation)",
  "Chronic respiratory alkalosis: PaCO2 ↓ to 30 mmHg → compensatory metabolic acidosis",
  "Oxygen demand increases 20%",
], 0.3, 5.25, 6.2, 1.3, { fontSize: 11.5 });

addSubtitle(s, "Other Changes", 4.77, ACCENT2);
bulletList(s, [
  "Renal: GFR ↑ 50%, creatinine/urea lower; glycosuria common",
  "GI: Nausea/vomiting (HCG effect); delayed gastric emptying; GERD",
  "Endocrine: Pituitary enlarges; prolactin ↑; insulin resistance in 3rd trimester",
  "Skin: Linea nigra, melasma, striae gravidarum, palmar erythema",
], 6.5, 5.25, 6.2, 1.3, { fontSize: 11.5 });

addBox(s, 0.3, 6.68, 12.5, 0.38, "1B3A6B",
  "NYHA Classification in Pregnancy: Class I & II → vaginal delivery possible; Class III → hospitalize from 28 wks; Class IV → terminate/C-section", ACCENT1, 11, true);

addBox(s, 0.3, 7.1, 12.5, 0.32, "1B3A6B",
  "Fetal Circulation: Foramen ovale + Ductus arteriosus + Ductus venosus → Closed at birth | PaO2 low (fetal Hb compensates)", ACCENT4, 11, true);

// ─── SLIDE 21: ANEUPLOIDY & PRENATAL SCREENING ────────────────────
s = addSlide(MID_BG);
addTitle(s, "SHORT NOTE: ANEUPLOIDY SCREENING & PRENATAL DIAGNOSIS  |  Feb 24, Aug 22", 0.18, ACCENT2, 18);

addSubtitle(s, "First Trimester Screening (11–14 weeks)", 0.88, ACCENT4);
bulletList(s, [
  "NT (Nuchal Translucency) + PAPP-A + Free β-hCG → Combined test",
  "NT >3.5mm → high risk for trisomies 21, 18, 13",
  "Cell-free DNA (cfDNA/NIPT): Sensitivity >99% for Down syndrome",
  "Trisomy 21 (Down): ↓PAPP-A, ↑hCG, ↑NT, absent nasal bone",
], 0.3, 1.35, 6.2, 1.7, { fontSize: 11.5 });

addSubtitle(s, "Second Trimester Screening", 0.88, ACCENT2);
bulletList(s, [
  "Quad screen: AFP + hCG + uE3 + Inhibin A",
  "AFP ↑ → NTD (open spina bifida, anencephaly)",
  "Triple test (15–20 wks): AFP + hCG + uE3",
  "Anomaly scan at 18–20 wks",
], 6.5, 1.35, 6.2, 1.7, { fontSize: 11.5 });

addSubtitle(s, "CVS (Chorionic Villus Sampling)", 3.2, ACCENT3);
bulletList(s, [
  "Timing: 10–12 weeks gestation",
  "Route: Transcervical or transabdominal",
  "Advantage: Early diagnosis, rapid result",
  "Risk: Miscarriage 0.5–1%; limb defects if <10 wks",
], 0.3, 3.65, 6.2, 1.5, { fontSize: 11.5 });

addSubtitle(s, "Amniocentesis", 3.2, ACCENT2);
bulletList(s, [
  "Timing: 15–18 weeks gestation (optimal 16 wks)",
  "Provides: Karyotype, AFP, metabolic studies",
  "Risk: Miscarriage 0.5–1%; culture takes 2–3 weeks",
  "Technique: USG-guided, 20mL amniotic fluid",
], 6.5, 3.65, 6.2, 1.5, { fontSize: 11.5 });

// Down syndrome markers table
addSubtitle(s, "Down Syndrome (Trisomy 21) Marker Summary", 5.35, ACCENT1);
const ds = [
  ["Test", "NT", "PAPP-A", "hCG", "AFP", "uE3"],
  ["Trisomy 21", "↑", "↓", "↑", "↓", "↓"],
  ["Trisomy 18", "↑", "↓", "↓", "↓", "↓"],
  ["Trisomy 13", "↑", "↓", "↓", "N", "N"],
];
ds.forEach((row, ri) => {
  row.forEach((cell, ci) => {
    addBox(s, 0.25 + ci * 2.58, 5.82 + ri * 0.52, 2.45, 0.46,
      ri === 0 ? ACCENT1 : (ri % 2 ? "1B2A4B" : "0D1B2A"), cell, ri === 0 ? DARK_TEXT : WHITE, ri === 0 ? 12 : 13, ri === 0);
  });
});
addBox(s, 0.3, 7.0, 12.5, 0.36, "1B3A6B",
  "Preimplantation Genetic Diagnosis (PGD): Biopsy of 1 blastomere from 8-cell embryo → for single gene defects, chromosomal translocations | Jul 24, Aug 21", ACCENT4, 11, true);

// ─── SLIDE 22: LABOUR & DELIVERY SHORT NOTES ─────────────────────
s = addSlide(MID_BG);
addTitle(s, "SHORT NOTE: LABOUR & DELIVERY  |  Multiple Exams", 0.18, ACCENT2, 23);

// Bishop Score
addSubtitle(s, "Bishop Score & Interpretation (Jul 23, Sep 20)", 0.88, ACCENT3);
const bishop = [
  ["Feature", "0", "1", "2", "3"],
  ["Dilatation", "Closed", "1–2cm", "3–4cm", "≥5cm"],
  ["Effacement", "<30%", "40–50%", "60–70%", "≥80%"],
  ["Station", "-3", "-2", "-1/0", "+1/+2"],
  ["Consistency", "Firm", "Medium", "Soft", "–"],
  ["Position", "Posterior", "Mid", "Anterior", "–"],
];
bishop.forEach((row, ri) => {
  row.forEach((cell, ci) => {
    addBox(s, 0.25 + ci * 2.58, 1.35 + ri * 0.5, 2.45, 0.44,
      ri === 0 ? ACCENT3 : (ri % 2 ? "1B2A4B" : "0D1B2A"), cell, ri === 0 ? DARK_TEXT : WHITE, ri === 0 ? 11 : 10.5, ri === 0);
  });
});
s.addText("Score ≥6: Favourable (induction likely to succeed)  |  Score ≤5: Unfavourable (cervical ripening first)", {
  x: 13.2, y: 1.35, w: 0.01, h: 0.01, fontSize: 1, color: MID_BG
}); // invisible spacer
s.addText("Score ≥6 = Favourable (induction likely to succeed)  |  Score ≤5 = Unfavourable → ripen first (PGE2/misoprostol/Foley's)", {
  x: 0.3, y: 4.55, w: 12.5, h: 0.38, fontSize: 11, color: ACCENT4, fontFace: "Calibri", bold: true
});

// Episiotomy
addSubtitle(s, "Episiotomy  |  Jul 19, Jan 20", 5.1, ACCENT2);
bulletList(s, [
  "Definition: Surgical incision of perineum to enlarge vaginal outlet during delivery",
  "Types: Mediolateral (most common in India) vs Median (higher fistula risk)",
  "Indications: Fetal distress, forceps/vacuum delivery, large baby, rigid perineum",
  "Complications: Haematoma, infection, extension, dyspareunia, incontinence",
], 0.3, 5.55, 6.2, 1.65, { fontSize: 11 });

// Cord Prolapse
addSubtitle(s, "Cord Prolapse  |  Jan 20", 5.1, ACCENT1);
bulletList(s, [
  "Definition: Descent of umbilical cord below presenting part after ROM",
  "Risk factors: Malpresentation (footling breech), high presenting part, polyhydramnios, preterm, multiparity",
  "Management: Elevate presenting part manually + emergency C-section",
  "If at full dilatation – immediate vaginal delivery",
], 6.5, 5.55, 6.2, 1.65, { fontSize: 11 });

addBox(s, 0.3, 7.28, 12.5, 0.15, "1B3A6B",
  "Partograph: Tool to monitor labour progress – alert line (1cm/hr) & action line (4h after) → guides intervention decisions", ACCENT5, 10, false);

// ─── SLIDE 23: SECTION HEADER – SPECIAL TOPICS ───────────────────
s = addSlide(DARK_BG);
sectionHeader(s, "SPECIAL TOPICS", "Frequently Repeated Short Notes", ACCENT3);

// ─── SLIDE 24: AFTER-COMING HEAD / INSTRUMENTAL DELIVERY ──────────
s = addSlide(MID_BG);
addTitle(s, "AFTER-COMING HEAD IN BREECH  &  INSTRUMENTAL DELIVERY  |  Feb 24, Jul 23", 0.18, ACCENT3, 18);

addSubtitle(s, "Delivery of After-coming Head in Breech", 0.88, ACCENT4);
const breechMethods = [
  ["Mauriceau-Smellie-Veit (MSV)", "Jaw flexion + traction on shoulders; most common; safe"],
  ["Burns-Marshall Technique", "Fetal body raised in arc; gravity delivers head"],
  ["Forceps to After-coming Head", "Piper's forceps; safest; 1st assistant holds the body"],
  ["Wigand-Martin-Winckel", "Assistant elevates body; operator uses suprapubic pressure"],
];
breechMethods.forEach(([method, desc], i) => {
  addBox(s, 0.3, 1.42 + i * 0.72, 3.8, 0.58, [ACCENT3, ACCENT1, ACCENT4, ACCENT2][i], method, WHITE, 11, true);
  s.addText(desc, { x: 4.2, y: 1.49 + i * 0.72, w: 8.7, h: 0.5, fontSize: 11, color: WHITE, fontFace: "Calibri", valign: "middle" });
});

addSubtitle(s, "Vacuum Delivery (Ventouse) – Jul 23, Sep 20", 4.35, ACCENT3);
bulletList(s, [
  "Prerequisites: Fully dilated cervix, ROM, no CPD, vertex presentation, ≥36 wks",
  "Complications: Chignon (scalp oedema), cephalhaematoma, subgaleal haematoma, neonatal jaundice",
  "Contraindications: Face/brow presentation, gestation <34 wks, fetal bleeding disorders",
], 0.3, 4.8, 12.5, 1.15, { fontSize: 11.5 });

addSubtitle(s, "Kielland Forceps – Apr 21  |  External Cephalic Version – Apr 24, Jan 19", 6.1, ACCENT2);
bulletList(s, [
  "Kielland: Rotational forceps; sliding lock; used for deep transverse arrest, asynclitism – HIGHEST maternal risk",
  "ECV: Manual turning of breech to cephalic at ≥36 wks; success 50–60%; risk: FHR change, PPROM, abruption",
  "ECV prerequisites: Singleton, adequate liquor, no placenta previa, FHR reactive, theatre standby",
], 0.3, 6.55, 12.5, 0.85, { fontSize: 11 });

// ─── SLIDE 25: INFECTIONS & MISCELLANEOUS ─────────────────────────
s = addSlide(MID_BG);
addTitle(s, "INFECTIONS, ABORTION & MISCELLANEOUS", 0.18, ACCENT3, 23);

addSubtitle(s, "Septic Abortion (Apr 24)", 0.88, ACCENT2);
bulletList(s, [
  "Definition: Abortion complicated by genital tract infection",
  "Organisms: E. coli, Clostridium, anaerobes, Staph",
  "Features: Fever >38°C, uterine tenderness, foul-smelling discharge, altered sensorium in severe cases",
  "Management: Admit, IV antibiotics (Ampicillin + Gentamicin + Metronidazole), suction evacuation after stabilization, ICU if septic shock",
], 0.3, 1.35, 6.2, 1.9, { fontSize: 11 });

addSubtitle(s, "Asymptomatic Bacteriuria (Jan 20, Sep 20, Mar 22, Apr 24)", 0.88, ACCENT1);
bulletList(s, [
  "Definition: ≥10⁵ CFU/mL of single organism in midstream urine, no symptoms",
  "Incidence: 4–7% in pregnancy; 25–40% progress to pyelonephritis if untreated",
  "Organisms: E. coli (most common), Klebsiella, GBS",
  "Complications: Pyelonephritis, preterm labour, LBW, IUGR, hypertension",
  "Treatment: Nitrofurantoin / Amoxicillin / Cephalexin × 7 days (sensitivity-guided)",
], 6.5, 1.35, 6.2, 1.9, { fontSize: 11 });

addSubtitle(s, "Hydatidiform Mole (Aug 22)", 3.45, ACCENT4);
bulletList(s, [
  "Complete mole: 46XX (paternal origin), no fetal tissue; partial mole: triploid (69XXX/XXY), some fetal parts",
  "Features: Exaggerated morning sickness, very large uterus, no FHR, snowstorm USG, very high β-hCG",
  "Management: Suction evacuation, weekly β-hCG monitoring until 3 normal values",
  "Contraception for 1 year; risk of choriocarcinoma (2%) → GTN surveillance",
], 0.3, 3.95, 6.2, 1.9, { fontSize: 11 });

addSubtitle(s, "HIV in Pregnancy (Apr 21)", 3.45, ACCENT2);
bulletList(s, [
  "MTCT risk: 15–45% without intervention (reduced to <2% with ART)",
  "Perinatal prevention: ART to all HIV+ pregnant women (Option B+), AZT to neonate ×6 wks",
  "Delivery: C-section not routinely recommended if viral load <1000 copies/mL",
  "Breastfeeding: In India – exclusive breastfeeding + ART preferred over formula",
], 6.5, 3.95, 6.2, 1.9, { fontSize: 11 });

addSubtitle(s, "Inversion of Uterus (Feb 23)", 5.55, ACCENT3);
bulletList(s, [
  "Definition: Uterus turns inside out; 3rd/4th stage emergency",
  "Degrees: Incomplete (fundus doesn't pass cervix) vs Complete vs Prolapsed",
  "Treatment: O'Sullivan's hydrostatic method (first line) → Manual replacement → Haultain's (surgical)",
], 0.3, 6.0, 12.5, 1.0, { fontSize: 11 });
addBox(s, 0.3, 7.1, 12.5, 0.35, ACCENT2, "Polyhydramnios (AFI >25 cm): Causes: GDM, fetal anomalies (NTD, GI obstruction), hydrops, idiopathic | Tx: Treat cause, amnioreduction, indomethacin", WHITE, 11, false);

// ─── SLIDE 26: ANC & SCREENING ────────────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "ANTENATAL CARE  |  Apr 21, Jul 23, Jan 20, Feb 24", 0.18, ACCENT3, 23);

addSubtitle(s, "ANC Schedule (WHO 2016: 8+ Contacts)", 0.88, ACCENT4);
const ancSchedule = [
  ["First Visit (<12 wks)", "Dating USG, Blood group, Rh, CBC, VDRL, HIV, HBsAg, urine RE"],
  ["Second Visit (14–20 wks)", "Mid-trimester anomaly screening, review blood tests"],
  ["Third Visit (24–28 wks)", "OGTT, 50g GCT, anomaly scan, review growth"],
  ["Fourth Visit (28–32 wks)", "Anti-D if Rh-, repeat CBC, BP monitoring"],
  ["Fifth Visit (34–36 wks)", "Presentation, fetal wellbeing, GBS swab if indicated"],
  ["Sixth Visit (38–40 wks)", "Assess labour readiness, NST, plan delivery"],
];
ancSchedule.forEach(([visit, action], i) => {
  addBox(s, 0.3, 1.38 + i * 0.67, 3.5, 0.56, i % 2 === 0 ? ACCENT3 : "1B3A6B", visit, WHITE, 10.5, true);
  s.addText(action, { x: 3.9, y: 1.45 + i * 0.67, w: 9.1, h: 0.48, fontSize: 10.5, color: WHITE, fontFace: "Calibri", valign: "middle" });
});

addSubtitle(s, "Hyperemesis Gravidarum  |  Jul 24, Apr 21", 5.55, ACCENT2);
bulletList(s, [
  "Severe persistent nausea/vomiting leading to >5% weight loss, dehydration, ketonuria, electrolyte imbalance",
  "Cause: High HCG (peaks 8–10 wks), Helicobacter pylori, psychological, thyrotoxicosis (transient gestational)",
  "Management: Hospitalize → IV fluids (NS + KCl) → Antiemetics (Promethazine / Ondansetron) → Pyridoxine B6 → Thiamine → Enteral/parenteral nutrition if refractory",
], 0.3, 6.0, 12.5, 1.15, { fontSize: 11 });

// ─── SLIDE 27: EXAM YEAR FREQUENCY CHART ─────────────────────────
s = addSlide(MID_BG);
addTitle(s, "📊  EXAM FREQUENCY ANALYSIS  |  Most Repeated Topics", 0.18, ACCENT4, 22);

const freqData = [
  ["Hypertensive Disorders (PET/Eclampsia/HELLP/MgSO4)", 12, ACCENT2],
  ["Anemia in Pregnancy", 9, ACCENT1],
  ["PPH / APH", 9, "E76F51"],
  ["Multiple / Twin Pregnancy (incl. TTTS)", 9, "7B2FBE"],
  ["GDM / Diabetes in Pregnancy", 8, ACCENT3],
  ["Maternal/Perinatal Mortality", 8, ACCENT4],
  ["Preterm Labour / Neonatal complications", 7, "00B4D8"],
  ["Labour & Delivery (Bishop, Partograph, etc.)", 7, "8B2FC9"],
  ["Rh-negative Pregnancy / Anti-D", 6, ACCENT5],
  ["Aneuploidy Screening / CVS / Amniocentesis", 5, "FF6B6B"],
];

const maxFreq = 12;
s.addText("Times Appeared in Exams (2019–2024 - approximate count)", {
  x: 0.3, y: 0.85, w: 12.5, h: 0.35, fontSize: 12, color: LIGHT_GRAY, fontFace: "Calibri", italic: true
});
freqData.forEach(([topic, count, color], i) => {
  const barW = (count / maxFreq) * 9.5;
  s.addText(topic, { x: 0.3, y: 1.28 + i * 0.55, w: 5.5, h: 0.45, fontSize: 10.5, color: WHITE, fontFace: "Calibri", align: "right", valign: "middle" });
  s.addShape(pres.ShapeType.rect, {
    x: 5.9, y: 1.32 + i * 0.55, w: barW, h: 0.38,
    fill: { color }, line: { color }
  });
  s.addText(`${count}x`, { x: 5.95 + barW, y: 1.32 + i * 0.55, w: 0.5, h: 0.38, fontSize: 10.5, color: color, fontFace: "Calibri", bold: true });
});
addBox(s, 0.3, 6.85, 12.5, 0.55, "1B3A6B",
  "⭐ TOP PRIORITY: Hypertensive Disorders, Twin Pregnancy (esp. TTTS), Anemia in Pregnancy, PPH, GDM – These appear in EVERY exam cycle!", ACCENT4, 12, true);

// ─── SLIDE 28: QUICK REVISION CARDS ──────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "⚡  QUICK REVISION – KEY MNEMONICS & FACTS", 0.18, ACCENT4, 22);

const mnemonics = [
  ["4 T's of PPH", "Tone • Tissue • Trauma • Thrombin", ACCENT2],
  ["HELLP", "Haemolysis • Elevated Liver • Low Platelets", ACCENT1],
  ["APGAR", "Appearance • Pulse • Grimace • Activity • Respiration", ACCENT3],
  ["Pre-Eclampsia Rx", "MgSO4 + Antihypertensives + Deliver", ACCENT4],
  ["GDM Diagnosis", "75g OGTT: FBS≥92, 1h≥180, 2h≥153 (IADPSG)", "7B2FBE"],
  ["Rh Prophylaxis", "Anti-D 300µg within 72h postpartum / 28+34 wks ante", "E76F51"],
  ["Preterm Tocolytics", "Nifedipine (1st) • Atosiban • Indomethacin • Ritodrine", "00B4D8"],
  ["PTL Steroids", "Betamethasone 12mg IM ×2 doses, 24h apart (24–34 wks)", ACCENT5],
  ["Eclampsia Convulsion Tx", "MgSO4 Loading: 4g IV slow • Pritchard / Zuspan regimen", "FF6B6B"],
];

mnemonics.forEach((mn, i) => {
  const row = Math.floor(i / 3);
  const col = i % 3;
  addBox(s, 0.3 + col * 4.35, 1.0 + row * 1.55, 4.1, 0.48, mn[2], mn[0], WHITE, 12, true);
  s.addText(mn[1], { x: 0.35 + col * 4.35, y: 1.52 + row * 1.55, w: 4.0, h: 0.88, fontSize: 11, color: LIGHT_GRAY, fontFace: "Calibri", align: "center", valign: "middle" });
});

// ─── SLIDE 29: BIOPHYSICAL PROFILE ───────────────────────────────
s = addSlide(MID_BG);
addTitle(s, "BIOPHYSICAL PROFILE (BPP)  &  ANTEPARTUM FETAL SURVEILLANCE  |  Aug 21, Feb 23", 0.18, ACCENT3, 17);

addSubtitle(s, "BPP Components (Manning Score – each scored 0 or 2)", 0.88, ACCENT4);
const bppComp = [
  ["NST (Non-Stress Test)", "≥2 accelerations of ≥15 bpm for ≥15 sec in 20 min = reactive (score 2)"],
  ["Fetal Breathing Movements", "≥1 episode ≥30 sec in 30 min (score 2)"],
  ["Fetal Body Movements", "≥3 discrete body/limb movements in 30 min (score 2)"],
  ["Fetal Tone", "≥1 episode of extension → return to flexion (score 2)"],
  ["Amniotic Fluid Volume", "≥1 pocket of ≥2cm in 2 perpendicular planes (score 2)"],
];
bppComp.forEach(([comp, detail], i) => {
  addBox(s, 0.3, 1.38 + i * 0.72, 3.8, 0.58, [ACCENT1, ACCENT3, ACCENT4, ACCENT2, "7B2FBE"][i], comp, WHITE, 11, true);
  s.addText(detail, { x: 4.2, y: 1.45 + i * 0.72, w: 8.8, h: 0.54, fontSize: 11, color: WHITE, fontFace: "Calibri", valign: "middle" });
});

// BPP Interpretation
addSubtitle(s, "BPP Interpretation", 5.0, ACCENT1);
const bppIntr = [
  ["8–10", "Normal", "No intervention"],
  ["6", "Equivocal", "Repeat in 24h / Deliver if mature"],
  ["4", "Abnormal", "Deliver immediately"],
  ["0–2", "Grossly Abnormal", "Emergency delivery"],
];
bppIntr.forEach(([score, interp, action], i) => {
  const clrs = [ACCENT3, ACCENT4, ACCENT2, "8B1A1A"];
  addBox(s, 0.25 + i * 3.27, 5.48, 3.0, 0.45, clrs[i], score, WHITE, 12, true);
  s.addText(`${interp} → ${action}`, { x: 0.25 + i * 3.27, y: 5.97, w: 3.0, h: 0.38, fontSize: 10, color: WHITE, fontFace: "Calibri", align: "center" });
});

addBox(s, 0.3, 6.5, 12.5, 0.35, "1B3A6B",
  "Modified BPP: NST + AFI (quick, practical, widely used)  |  Contraction Stress Test (CST): 3 contractions/10 min → assess fetal reserve", ACCENT5, 11, false);
addBox(s, 0.3, 6.9, 12.5, 0.45, "1B3A6B",
  "Post-Maturity Syndrome (Apr 24): Meconium staining, loss of vernix, dry/peeling skin, long nails, worried facies – Clifford grading I/II/III", ACCENT4, 11, false);

// ─── SLIDE 30: CLOSING / EXAM TIPS ───────────────────────────────
s = addSlide(DARK_BG);
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.25, h: 7.5, fill: { color: ACCENT3 }, line: { color: ACCENT3 } });
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.1, fill: { color: ACCENT3 }, line: { color: ACCENT3 } });
s.addShape(pres.ShapeType.rect, { x: 0, y: 7.4, w: 13.3, h: 0.1, fill: { color: ACCENT3 }, line: { color: ACCENT3 } });
s.addText("EXAM TIPS & STRATEGY", {
  x: 0.5, y: 0.35, w: 12.3, h: 0.75, fontSize: 36, bold: true, color: WHITE, fontFace: "Calibri", align: "center"
});
s.addText("Obstetrics 2019–2024 – Final Revision Checklist", {
  x: 0.5, y: 1.15, w: 12.3, h: 0.4, fontSize: 17, color: ACCENT3, fontFace: "Calibri", align: "center"
});
const tips = [
  ["📌 Must-Master Topics", "Hypertensive Disorders (PET, Eclampsia, HELLP, MgSO4 regimens) • PPH management stepwise • Twin pregnancy complications • GDM screening & management"],
  ["📊 Definitions to memorize", "PPH (≥500ml SVD / ≥1000ml CS) • GDM (DIPSI/IADPSG criteria) • Perinatal mortality definition • Maternal mortality ratio vs rate"],
  ["🔢 Numbers to know", "Anti-D: 300µg / 500IU within 72h • Corticosteroids: 24–34 wks • BPP: 8-10 normal • Bishop ≥6 favourable • MgSO4 loading 4g IV"],
  ["🩺 Flowcharts to draw", "PPH Management (4T's + stepwise Tx) • Eclampsia management • GDM screening flowchart • Rh-negative management"],
  ["✏ Short note structure", "Definition → Classification → Etiology → Diagnosis → Complications → Management → Prevention → Recent advances"],
];
tips.forEach(([hdr, detail], i) => {
  addBox(s, 0.4, 1.68 + i * 0.98, 3.2, 0.75, [ACCENT2, ACCENT1, ACCENT3, ACCENT4, "7B2FBE"][i], hdr, WHITE, 12, true);
  s.addText(detail, { x: 3.7, y: 1.73 + i * 0.98, w: 9.3, h: 0.72, fontSize: 10.5, color: LIGHT_GRAY, fontFace: "Calibri", valign: "middle" });
});
s.addText("Good Luck! Prepare systematically and practice flowcharts repeatedly.", {
  x: 0.5, y: 7.1, w: 12.3, h: 0.35, fontSize: 13, color: ACCENT3, fontFace: "Calibri", align: "center", bold: true
});

// ─── WRITE FILE ───────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/obstetrics-ppt/Obstetrics_2019_2024_Complete_Guide.pptx" })
  .then(() => console.log("✅ PPTX created successfully!"))
  .catch(e => console.error("❌ Error:", e));

cd /home/daytona/workspace/obstetrics-ppt && node create_ppt.js 2>&1

ls -lh /home/daytona/workspace/obstetrics-ppt/