"postpartum hemorrhage" AND transfusion

WHO postpartum haemorrhage recommendations 2025 massive transfusion obstetric hemorrhage

obstetric postpartum hemorrhage uterine atony clinical management illustration

https://www.ncbi.nlm.nih.gov/books/NBK619236

~/

mkdir -p "/tmp/workspace/haemorrhagic-shock-obstetrics/src" "/tmp/workspace/haemorrhagic-shock-obstetrics/output" && python - <<'PY' import os print(os.path.isdir('/tmp/workspace/haemorrhagic-shock-obstetrics/output')) PY

python - <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.text import MSO_AUTO_SIZE from pptx.enum.shapes import MSO_AUTO_SHAPE_TYPE from pptx.enum.text import MSO_VERTICAL_ANCHOR from pptx.oxml.xmlchemy import OxmlElement from pptx.enum.shapes import PP_PLACEHOLDER from pptx.enum.dml import MSO_LINE_DASH_STYLE from pptx.enum.shapes import MSO_SHAPE_TYPE from pptx.enum.text import MSO_ANCHOR from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.shapes import MSO_SHAPE from pptx.enum.text import PP_ALIGN, MSO_ANCHOR import os OUT='/tmp/workspace/haemorrhagic-shock-obstetrics/output/Haemorrhagic_Shock_in_Obstetrics.pptx' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # palette NAVY=RGBColor(15,37,64); BLUE=RGBColor(24,91,139); TEAL=RGBColor(0,137,139); RED=RGBColor(190,49,61); ORANGE=RGBColor(228,124,50); GOLD=RGBColor(237,180,69); PALE=RGBColor(238,245,248); LIGHT=RGBColor(248,250,252); GRAY=RGBColor(82,98,112); DARK=RGBColor(32,45,57); WHITE=RGBColor(255,255,255); GREEN=RGBColor(40,135,96) def bg(s): r=s.background.fill; r.solid(); r.fore_color.rgb=LIGHT sh=s.shapes.add_shape(MSO_SHAPE.RECTANGLE,0,0,Inches(.22),Inches(7.5)); sh.fill.solid();sh.fill.fore_color.rgb=TEAL;sh.line.fill.background() def rect(s,x,y,w,h,fill, radius=False, line=None): sh=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if radius else MSO_SHAPE.RECTANGLE, Inches(x),Inches(y),Inches(w),Inches(h)); sh.fill.solid();sh.fill.fore_color.rgb=fill sh.line.color.rgb=line if line else fill return sh def tx(s,x,y,w,h,text,size=20,color=DARK,bold=False,align=PP_ALIGN.LEFT, valign=MSO_ANCHOR.TOP): tb=s.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)); tf=tb.text_frame;tf.clear();tf.word_wrap=True;tf.margin_left=Inches(.05);tf.margin_right=Inches(.05);tf.margin_top=Inches(.02);tf.margin_bottom=Inches(.02);tf.vertical_anchor=valign for i,line in enumerate(text.split('\n')): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=line;p.alignment=align;p.space_after=Pt(4) for r in p.runs:r.font.name='Aptos';r.font.size=Pt(size);r.font.bold=bold;r.font.color.rgb=color return tb def title(s,n,heading,sub=''): tx(s,.55,.28,11.9,.42,heading,26,NAVY,True) if sub: tx(s,.57,.72,11.5,.26,sub,10,GRAY) tx(s,12.35,.32,.55,.26,f'{n:02}',12,TEAL,True,PP_ALIGN.RIGHT) rect(s,.55,1.05,12.15,.02,TEAL) def footer(s,source='Educational summary | Local protocol and senior clinical judgement take precedence'): rect(s,.55,7.12,12.15,.015,RGBColor(205,215,222));tx(s,.57,7.18,11.7,.18,source,8,GRAY) def bullet(s,x,y,w,h,items,size=18,color=DARK): tb=s.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h));tf=tb.text_frame;tf.clear();tf.word_wrap=True;tf.margin_left=Inches(.12);tf.margin_right=0;tf.margin_top=0 for i,it in enumerate(items): p=tf.paragraphs[0] if i==0 else tf.add_paragraph();p.text=it;p.level=0;p.space_after=Pt(8);p.font.size=Pt(size);p.font.name='Aptos';p.font.color.rgb=color;p.font.bold=False;p.text='• '+it return tb def pill(s,x,y,w,text,fill=TEAL): rect(s,x,y,w,.35,fill,True);tx(s,x+.05,y+.05,w-.1,.22,text,10,WHITE,True,PP_ALIGN.CENTER) def arrow(s,x1,y1,x2,y2,color=TEAL,width=2): ln=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x1),Inches(y1),Inches(x2),Inches(y2));ln.line.color.rgb=color;ln.line.width=Pt(width);ln.line.end_arrowhead=True # title s=prs.slides.add_slide(blank);bg(s) rect(s,.55,.45,12.1,6.35,NAVY,True) rect(s,.55,.45,.2,6.35,RED) tx(s,1.08,1.22,10.7,1.3,'Haemorrhagic Shock\nin Obstetrics',38,WHITE,True) tx(s,1.12,2.75,9.7,.6,'Recognition, resuscitation, transfusion and definitive haemorrhage control',19,RGBColor(211,230,237)) # stylized circulation graphic for x,y,r,c,lab in [(10.65,1.6,.63,RED,'BLEEDING'),(10.65,3.15,.63,ORANGE,'SHOCK'),(10.65,4.7,.63,TEAL,'CONTROL')]: sh=s.shapes.add_shape(MSO_SHAPE.OVAL, Inches(x),Inches(y),Inches(r),Inches(r));sh.fill.solid();sh.fill.fore_color.rgb=c;sh.line.color.rgb=WHITE;tx(s,x,y+.20,r,.2,lab,8,WHITE,True,PP_ALIGN.CENTER) arrow(s,10.97,2.23,10.97,3.1,WHITE);arrow(s,10.97,3.78,10.97,4.65,WHITE) pill(s,1.1,5.35,2.05,'OBSTETRIC EMERGENCY',RED) tx(s,1.12,6.17,8,.25,'Teaching deck | September 2026',11,RGBColor(191,210,220)) # objectives s=prs.slides.add_slide(blank);bg(s);title(s,2,'Learning objectives','A practical framework for the first minutes and the next hour') items=[('1','Recognise concealed or overt obstetric bleeding before hypotension develops.'),('2','Use shock index (Allgöwer index), clinical trajectory and serial measures to grade severity.'),('3','Start haemostatic resuscitation while pursuing the cause and definitive source control.'),('4','Organise team-based care, massive transfusion and post-event prevention.')] for i,(n,t) in enumerate(items): y=1.35+i*1.32;rect(s,.8,y,.65,.65,[TEAL,BLUE,ORANGE,RED][i],True);tx(s,.8,y+.14,.65,.25,n,18,WHITE,True,PP_ALIGN.CENTER);tx(s,1.65,y+.04,10.3,.55,t,20,NAVY,False) footer(s) # definition s=prs.slides.add_slide(blank);bg(s);title(s,3,'Definition and the obstetric context') rect(s,.75,1.35,5.6,4.9,PALE,True);tx(s,1.05,1.65,4.95,.4,'Haemorrhagic shock',26,NAVY,True) tx(s,1.05,2.25,4.95,1.45,'Acute circulatory failure from blood loss causing inadequate oxygen delivery, tissue hypoperfusion and oxygen debt.',21,DARK) rect(s,1.05,4.25,4.85,1.2,WHITE,True);tx(s,1.3,4.48,4.3,.55,'Hypotension is a late sign in healthy pregnant patients.',17,RED,True,PP_ALIGN.CENTER,MSO_ANCHOR.MIDDLE) rect(s,6.7,1.35,5.7,4.9,WHITE,True);tx(s,7.0,1.65,5.05,.35,'Postpartum haemorrhage (PPH)',25,NAVY,True) bullet(s,7.0,2.28,4.9,2.2,['Traditional: ≥500 mL vaginal birth or ≥1,000 mL caesarean birth.','ACOG: ≥1,000 mL cumulative loss or any loss with hypovolaemic signs within 24 h.','WHO 2025 early action: objectively measured ≥500 mL, OR ≥300 mL plus abnormal haemodynamics.'],16) pill(s,7.02,5.35,3.2,'TREAT THE PATIENT, NOT A NUMBER',RED);footer(s,'Sources: Barash Clinical Anesthesia, 9e, pp. 3516-17; WHO Consolidated PPH Guidelines, 2025') # causes 4Ts s=prs.slides.add_slide(blank);bg(s);title(s,4,'Aetiology: think “4 Ts”','Bleeding may be external, intrauterine or concealed') cs=[('TONE','Uterine atony\nMost common cause',TEAL),('TRAUMA','Laceration, haematoma\nRupture, inversion',RED),('TISSUE','Retained placenta\nAccreta spectrum',ORANGE),('THROMBIN','DIC, inherited or\nacquired coagulopathy',BLUE)] for i,(a,b,c) in enumerate(cs): x=.78+i*3.1;rect(s,x,1.55,2.72,3.38,c,True);tx(s,x+.2,1.88,2.3,.38,a,22,WHITE,True,PP_ALIGN.CENTER);rect(s,x+.35,2.55,2.02,.02,WHITE);tx(s,x+.22,3.0,2.28,.9,b,16,WHITE,False,PP_ALIGN.CENTER) tx(s,.85,5.42,11.5,.55,'Antepartum causes to anticipate: placental abruption, placenta praevia/accreta spectrum, uterine rupture and operative bleeding.',19,NAVY,True,PP_ALIGN.CENTER) footer(s,'Sources: Tintinalli Emergency Medicine, “Postpartum Hemorrhage”; Miller’s Anesthesia, 10e, pp. 8905-06') # path s=prs.slides.add_slide(blank);bg(s);title(s,5,'Pathogenesis: circulatory centralisation to decompensation') steps=[('Blood loss','↓ preload\n↓ stroke volume',RED),('Compensation','Catecholamines\nvasoconstriction',ORANGE),('Centralisation','Flow prioritised to\nheart and brain',GOLD),('Oxygen debt','Tissue hypoxia\nlactate, acidosis',BLUE),('Failure','Coagulopathy,\nhypothermia, DIC',NAVY)] for i,(a,b,c) in enumerate(steps): x=.55+i*2.5;rect(s,x,2.0,2.05,2.05,c,True);tx(s,x+.14,2.3,1.77,.32,a,18,WHITE,True,PP_ALIGN.CENTER);tx(s,x+.18,2.83,1.7,.7,b,13,WHITE,False,PP_ALIGN.CENTER) if i<4:arrow(s,x+2.07,3.02,x+2.45,3.02,GRAY) tx(s,.82,4.65,11.3,.52,'Early signs of centralisation: tachycardia, cool clammy peripheries, delayed capillary refill, oliguria and anxiety, while blood pressure may remain “normal”.',18,NAVY,True,PP_ALIGN.CENTER) rect(s,1.75,5.55,9.7,.64,RGBColor(252,231,230),True);tx(s,1.9,5.75,9.35,.22,'Break the cycle: stop blood loss + restore oxygen-carrying capacity + correct coagulopathy and hypothermia.',15,RED,True,PP_ALIGN.CENTER) footer(s,'Source: Miller’s Anesthesia, 10e, “Pathophysiology of Hemorrhagic Shock,” pp. 9382-83') # shock index s=prs.slides.add_slide(blank);bg(s);title(s,6,'Shock index (Allgöwer index)') rect(s,.75,1.45,5.25,3.9,NAVY,True);tx(s,1.05,1.85,4.65,.38,'SI = heart rate ÷ systolic BP',28,WHITE,True,PP_ALIGN.CENTER) rect(s,1.35,2.7,4.1,.82,RGBColor(39,72,102),True);tx(s,1.55,2.93,3.7,.25,'Example: HR 120 / SBP 100 = 1.2',18,WHITE,False,PP_ALIGN.CENTER) tx(s,1.05,4.15,4.65,.6,'Trend serially. In pregnancy, a rising SI can reveal occult hypovolaemia before hypotension.',16,RGBColor(211,230,237),False,PP_ALIGN.CENTER) levels=[('≤0.9','Usually reassuring','GREEN'),('0.9-1.0','Concerning: reassess','GOLD'),('>1.0','Abnormal: activate response','ORANGE'),('≥1.3','High risk: urgent escalation','RED')] for i,(a,b,cname) in enumerate(levels): c={'GREEN':GREEN,'GOLD':GOLD,'ORANGE':ORANGE,'RED':RED}[cname];y=1.42+i*1.08;rect(s,6.55,y,5.6,.8,c,True);tx(s,6.8,y+.17,1.15,.25,a,20,WHITE,True);tx(s,8.1,y+.2,3.7,.22,b,16,WHITE,False) tx(s,6.65,6.0,5.35,.35,'Interpret with baseline BP, drugs, pain and clinical context.',13,GRAY,False,PP_ALIGN.CENTER);footer(s,'WHO 2025 uses SI >1 among abnormal haemodynamic signs for early PPH action') # clinical severity s=prs.slides.add_slide(blank);bg(s);title(s,7,'Clinical picture by severity','Estimated blood loss is imprecise: severity is clinical and dynamic') cols=[('Compensated','<15-20% loss',GREEN,['Anxiety, thirst','Mild tachycardia','Normal BP / mentation']),('Progressive','20-30% loss',GOLD,['Tachycardia, cool skin','Delayed capillary refill','Narrowing pulse pressure']),('Decompensated','30-40% loss',ORANGE,['Hypotension, tachypnoea','Oliguria, confusion','Rising lactate / acidosis']),('Profound','>40% loss',RED,['Altered consciousness','Marked hypotension','Anuria, coagulopathy'])] for i,(a,b,c,its) in enumerate(cols): x=.55+i*3.12;rect(s,x,1.45,2.75,4.85,WHITE,True,c);rect(s,x,1.45,2.75,.78,c,True);tx(s,x+.15,1.62,2.45,.24,a,16,WHITE,True,PP_ALIGN.CENTER);tx(s,x+.15,2.47,2.45,.24,b,14,c,True,PP_ALIGN.CENTER);bullet(s,x+.22,3.0,2.28,2.55,its,14) footer(s,'Adapted for teaching from haemorrhagic-shock physiology; clinical signs, trajectory and response to treatment guide escalation') # diagnosis monitoring s=prs.slides.add_slide(blank);bg(s);title(s,8,'Diagnosis and monitoring') left=['Quantify blood loss: calibrated drape, suction, weighed swabs and operative estimate.','Continuous HR, BP, SpO₂; serial SI, mental state, skin perfusion and urine output.','Two large-bore IVs; send group & screen/crossmatch, CBC, PT/INR, aPTT, fibrinogen, blood gas/lactate, ionised Ca²⁺.','Repeat labs and clinical assessment frequently during active bleeding.'] bullet(s,.78,1.45,6.0,4.8,left,17) rect(s,7.15,1.48,4.95,4.75,PALE,True);tx(s,7.48,1.8,4.25,.3,'Look for concealed bleeding',20,NAVY,True);bullet(s,7.45,2.4,4.15,2.65,['Boggy uterus or retained tissue','Genital tract trauma / expanding haematoma','Abruption or uterine rupture','Intra-abdominal bleeding after surgery'],16) rect(s,7.45,5.27,4.15,.55,WHITE,True);tx(s,7.58,5.43,3.9,.18,'Fibrinogen is especially important in obstetric haemorrhage.',12,RED,True,PP_ALIGN.CENTER) footer(s,'Source: WHO Consolidated PPH Guidelines, 2025: objective blood-loss measurement and early haemodynamic triggers') # first response algorithm s=prs.slides.add_slide(blank);bg(s);title(s,9,'First response: act in parallel, not sequentially') boxes=[('1. CALL','Obstetric haemorrhage team\nObstetrics + anaesthesia + blood bank',RED),('2. RESUSCITATE','Airway/oxygen as needed\n2 large-bore IVs, warm patient',ORANGE),('3. IDENTIFY','4 Ts: Tone, Trauma, Tissue, Thrombin\nExamine uterus and genital tract',BLUE),('4. TREAT','Massage + uterotonic + TXA\nFluids, blood, source control',TEAL)] for i,(a,b,c) in enumerate(boxes): x=.62+i*3.1;rect(s,x,1.85,2.72,2.35,c,True);tx(s,x+.18,2.18,2.35,.27,a,18,WHITE,True,PP_ALIGN.CENTER);tx(s,x+.18,2.75,2.35,.72,b,14,WHITE,False,PP_ALIGN.CENTER) if i<3:arrow(s,x+2.73,3.0,x+3.05,3.0,GRAY) rect(s,.85,5.0,11.4,.78,NAVY,True);tx(s,1.1,5.22,10.9,.25,'WHO first-line bundle: uterine massage + oxytocic + tranexamic acid + IV fluids + genital-tract examination + escalation of care',16,WHITE,True,PP_ALIGN.CENTER) footer(s,'Source: WHO Consolidated PPH Guidelines, 2025, Recommendation 29') # fluids and txa s=prs.slides.add_slide(blank);bg(s);title(s,10,'Resuscitation: fluids, warming and antifibrinolysis') rect(s,.72,1.38,3.82,4.95,PALE,True);tx(s,1.0,1.72,3.25,.3,'Fluids',22,NAVY,True);bullet(s,.98,2.3,3.18,3.35,['Use warmed isotonic crystalloid initially.','Avoid large volumes that dilute clotting factors and worsen oedema.','Do not let fluid administration delay blood products or control of bleeding.'],16) rect(s,4.78,1.38,3.82,4.95,RGBColor(255,246,231),True);tx(s,5.08,1.72,3.2,.3,'Temperature & calcium',22,NAVY,True);bullet(s,5.03,2.3,3.13,3.35,['Active warming: patient, fluids and blood.','Monitor ionised Ca²⁺ during major transfusion; replace per local protocol.','Prevent hypothermia, acidosis and coagulopathy.'],16) rect(s,8.84,1.38,3.82,4.95,RGBColor(252,231,230),True);tx(s,9.12,1.72,3.25,.3,'Tranexamic acid',22,NAVY,True);bullet(s,9.08,2.3,3.18,3.35,['Give early for diagnosed PPH, within 3 h of birth, in addition to standard care.','Typical WHO regimen: 1 g IV over 10 min; repeat 1 g if bleeding continues after 30 min or restarts within 24 h.'],15) footer(s,'Sources: WHO Consolidated PPH Guidelines, 2025; Miller’s Anesthesia, 10e, management of massive obstetric haemorrhage') # MTP s=prs.slides.add_slide(blank);bg(s);title(s,11,'Massive transfusion protocol (MTP)') rect(s,.72,1.42,3.35,4.9,NAVY,True);tx(s,1.0,1.78,2.8,.3,'Activate early when',21,WHITE,True);bullet(s,.96,2.35,2.75,2.65,['Ongoing major blood loss','Shock / rapidly rising SI','Likely need for multiple red-cell units','Coagulopathy or high-risk aetiology'],15,WHITE) pill(s,1.15,5.55,2.45,'ONE PHONE CALL TO BLOOD BANK',RED) rect(s,4.38,1.42,7.85,1.08,PALE,True);tx(s,4.7,1.75,7.2,.28,'Use balanced, protocolled component therapy: red cells + plasma + platelets in approximately 1:1:1 ratios where appropriate.',17,NAVY,True,PP_ALIGN.CENTER) for i,(n,c,sub) in enumerate([('RBC',RED,'Oxygen carriage'),('PLASMA',GOLD,'Clotting factors'),('PLATELETS',TEAL,'Primary haemostasis')]): x=4.65+i*2.43;sh=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(3.15),Inches(1.45),Inches(1.45));sh.fill.solid();sh.fill.fore_color.rgb=c;sh.line.color.rgb=WHITE;tx(s,x,3.52,1.45,.25,n,16,WHITE,True,PP_ALIGN.CENTER);tx(s,x-.15,4.8,1.75,.32,sub,12,NAVY,True,PP_ALIGN.CENTER) arrow(s,5.98,3.88,6.85,3.88,GRAY);arrow(s,8.4,3.88,9.28,3.88,GRAY) tx(s,4.72,5.42,7.05,.48,'Targeted therapy is guided by fibrinogen, platelet count, PT/aPTT and, where available, viscoelastic testing. Follow local MTP thresholds.',15,GRAY,False,PP_ALIGN.CENTER) footer(s,'Source: Miller’s Anesthesia, 10e, “Management of Massive Obstetric Hemorrhage”; ratios vary by institution and laboratory guidance') # vasopressors/source s=prs.slides.add_slide(blank);bg(s);title(s,12,'Vasopressors and definitive source control') rect(s,.75,1.42,4.8,4.95,RGBColor(255,246,231),True);tx(s,1.02,1.75,4.2,.33,'Vasopressors: a bridge, not a substitute',21,NAVY,True);bullet(s,1.0,2.35,4.12,2.85,['Prioritise haemorrhage control and blood-product resuscitation.','Use only when severe hypotension persists despite, or while obtaining, adequate volume and blood.','Titrate with anaesthesia/critical-care leadership; norepinephrine is commonly used.'],16) rect(s,5.85,1.42,6.35,4.95,PALE,True);tx(s,6.15,1.75,5.75,.33,'Source control escalation',21,NAVY,True) items=[('Tone','Bimanual massage, oxytocin; additional uterotonics as suitable'),('Tamponade','Intrauterine balloon / vacuum-induced tamponade'),('Trauma/Tissue','Repair lacerations; remove retained tissue; manage inversion/rupture'),('Surgery/IR','Compression sutures, devascularisation, embolisation, hysterectomy')] for i,(a,b) in enumerate(items): y=2.3+i*.78;rect(s,6.12,y,1.22,.48,[TEAL,BLUE,ORANGE,RED][i],True);tx(s,6.15,y+.13,1.15,.16,a,11,WHITE,True,PP_ALIGN.CENTER);tx(s,7.52,y+.08,4.1,.3,b,14,DARK) footer(s,'Source: WHO Consolidated PPH Guidelines, 2025; choice depends on cause, stability, resources and fertility goals') # prevention organization s=prs.slides.add_slide(blank);bg(s);title(s,13,'Prevention and organisation of care') cols=[('Before birth',TEAL,['Identify placenta accreta spectrum and other high-risk patients.','Correct antenatal anaemia where feasible.','Plan place of birth, blood availability and multidisciplinary care.']),('At birth',BLUE,['Active prevention with uterotonic per local/WHO guidance.','Objective measurement of postpartum loss.','Routine uterine tone assessment after birth.']),('System readiness',RED,['Haemorrhage cart, blood bank pathway and escalation criteria.','Roles, closed-loop communication and regular simulation.','Debrief, audit, documentation and follow-up.'])] for i,(a,c,its) in enumerate(cols): x=.72+i*4.08;rect(s,x,1.48,3.65,4.95,WHITE,True,c);rect(s,x,1.48,3.65,.72,c,True);tx(s,x+.18,1.7,3.3,.24,a,18,WHITE,True,PP_ALIGN.CENTER);bullet(s,x+.25,2.53,3.08,3.2,its,16) footer(s,'Sources: WHO Consolidated PPH Guidelines, 2025; Miller’s Anesthesia, 10e: multidisciplinary coordination') # scenario s=prs.slides.add_slide(blank);bg(s);title(s,14,'Clinical application: a 10-minute scenario') rect(s,.78,1.4,3.55,4.95,NAVY,True);tx(s,1.08,1.75,2.95,.35,'Case trigger',22,WHITE,True);tx(s,1.08,2.35,2.9,2.05,'After vaginal birth: ongoing bleeding, estimated loss 650 mL, HR 118, SBP 102.\n\nShock index = 1.16',20,WHITE,False);pill(s,1.22,5.45,2.65,'ACT NOW: NOT “OBSERVE”',RED) acts=[('0-2 min','Call team, quantify loss, uterine massage, two IVs, samples, warm patient.'),('2-5 min','Oxytocic + IV TXA, examine 4 Ts, begin warmed crystalloid and prepare blood.'),('5-10 min','If bleeding continues: activate MTP, correct coagulopathy, balloon/repair/escalate source control.')] for i,(a,b) in enumerate(acts): y=1.58+i*1.48;rect(s,4.72,y,1.35,.72,[TEAL,ORANGE,RED][i],True);tx(s,4.78,y+.22,1.23,.18,a,13,WHITE,True,PP_ALIGN.CENTER);rect(s,6.28,y,5.75,.72,WHITE,True);tx(s,6.52,y+.14,5.2,.42,b,15,NAVY) footer(s,'WHO 2025 early criteria: ≥500 mL measured blood loss, or ≥300 mL plus abnormal haemodynamic sign such as SI >1') # takeaways s=prs.slides.add_slide(blank);bg(s);title(s,15,'Take-home messages') items=[('Recognise early','Normal blood pressure does not exclude significant obstetric blood loss.'),('Use SI','Allgöwer shock index is fast, repeatable and detects worsening compensation.'),('Treat in parallel','Resuscitation, haemostatic therapy and source control start together.'),('Activate systems','MTP and a coordinated multidisciplinary team prevent avoidable delay.'),('Prevent & learn','Risk assessment, quantified loss, simulation and review improve outcomes.')] for i,(a,b) in enumerate(items): y=1.3+i*1.0;rect(s,.82,y,2.1,.58,[TEAL,BLUE,ORANGE,RED,NAVY][i],True);tx(s,.95,y+.17,1.82,.18,a,14,WHITE,True,PP_ALIGN.CENTER);tx(s,3.22,y+.1,8.7,.34,b,17,NAVY) footer(s) # references s=prs.slides.add_slide(blank);bg(s);title(s,16,'Selected references') refs=['World Health Organization. Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage. Geneva: WHO; 2025.','Miller RD et al. Miller’s Anesthesia, 10th ed. Sections: Management of Massive Obstetric Hemorrhage; Pathophysiology of Hemorrhagic Shock.','Barash PG et al. Clinical Anesthesia, 9th ed. Postpartum Hemorrhage, pp. 3516-17.','WHO, FIGO and ICM. New objective criteria and first-response MOTIVE care bundle, 2025.','Vogel JP et al. Effectiveness of care bundles for prevention and treatment of postpartum hemorrhage: systematic review. Am J Obstet Gynecol. 2024. PMID 38336124.'] bullet(s,.92,1.4,11.45,4.65,refs,17) rect(s,.9,6.15,11.35,.55,PALE,True);tx(s,1.05,6.32,11.0,.18,'For teaching only. Apply local institutional obstetric-haemorrhage protocols and involve senior obstetric, anaesthesia and transfusion specialists early.',12,RED,True,PP_ALIGN.CENTER) footer(s,'Prepared September 2026') # Add slide numbers remain prs.save(OUT) print(OUT, os.path.getsize(OUT)) PY

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/haemorrhagic-shock-obstetrics/output/Haemorrhagic_Shock_in_Obstetrics.pptx') prs=Presentation(str(p)) print('slides', len(prs.slides), 'size', p.stat().st_size) for i,s in enumerate(prs.slides,1): texts=[] for sh in s.shapes: if getattr(sh,'has_text_frame',False) and sh.text.strip(): texts.append(sh.text.replace('\n',' | ')) print(i, ' :: '.join(texts)[:180]) PY