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// ══════════════════════════════════════════════
//  SLIDE 1 — COVER
// ══════════════════════════════════════════════
addTitleSlide(
  "POST-DATED DELIVERY",
  "OBG Practical Examination Preparation\nCase Sheet · History · Examination · Diagnosis · Management · Viva"
);

// ══════════════════════════════════════════════
//  SLIDE 2 — OVERVIEW / AGENDA
// ══════════════════════════════════════════════
addContentSlide("Session Outline", [
  { text: "01  Case Sheet — Clinical Scenario", bold: true },
  { text: "02  History Taking with 'WHY' of Each Question", bold: true },
  { text: "03  Differential Diagnosis with Explanation", bold: true },
  { text: "04  Summary — Positive History & Examination Findings", bold: true },
  { text: "05  Examination Procedure — Step by Step", bold: true },
  { text: "06  Diagnosis with Full Explanation", bold: true },
  { text: "07  Case Discussion — Pathophysiology & Complications", bold: true },
  { text: "08  Investigations", bold: true },
  { text: "09  Management — Complete Protocol", bold: true },
  { text: "10  Viva Questions & Model Answers", bold: true },
], { fontSize: 14 });

// ══════════════════════════════════════════════
//  SLIDE 3 — DEFINITION & TERMINOLOGY
// ══════════════════════════════════════════════
addContentSlide("Definition & Terminology", [
  { text: "Post-Dated / Post-Term Pregnancy  (Preferred term: POST-TERM)", bold: true, color: C.teal },
  { text: "Any pregnancy continuing beyond 42 completed weeks (294 days) from the first day of the LMP", bold: false },
  "",
  { text: "Terminology Clarified:", bold: true, color: C.navy },
  { text: "Post-dates = >40 weeks (misleading — just past EDC, NOT truly abnormal)", color: C.grey, italic: true },
  { text: "Post-term = >42 weeks (clinically significant — preferred ACOG/FIGO term)", bold: true, color: C.green },
  { text: "Prolonged pregnancy = >42 weeks (synonym)", bold: false },
  "",
  { text: "Incidence: 4–14% of all pregnancies (varies with dating accuracy)", bold: false, color: C.grey },
  { text: "WHO Definition: Pregnancy exceeding 42 weeks or 294 days from LMP", bold: false },
], { fontSize: 13 });

// ══════════════════════════════════════════════
//  SECTION HEADER — CASE SHEET
// ══════════════════════════════════════════════
addSectionHeader("SECTION 1", "Case Sheet — Clinical Scenario");

// ══════════════════════════════════════════════
//  SLIDE 4 — CASE SHEET (PART 1)
// ══════════════════════════════════════════════
addContentSlide("Case Sheet  |  Patient Details & Chief Complaint", [
  { text: "NAME: Mrs. Meena R.                          AGE: 26 years", bold: true, fontSize: 14 },
  { text: "IP No: XXXX     Date of Admission: ______     Ward: Obstetrics", bold: false },
  "",
  { text: "Chief Complaint:", bold: true, color: C.teal },
  { text: "Amenorrhoea for 10 months — No spontaneous onset of labour pains", bold: true, fontSize: 14 },
  "",
  { text: "Informant: Patient herself (Reliable)", bold: false },
  "",
  { text: "Obstetric Formula:", bold: true, color: C.teal },
  { text: "Gravida 1, Para 0, Live births 0, Abortion 0   (G1P0L0A0)", bold: true, fontSize: 14, color: C.red },
  "",
  { text: "Referred from: Primary Health Centre / Self-referred", bold: false },
], { fontSize: 13 });

// ══════════════════════════════════════════════
//  SLIDE 5 — HISTORY OF PRESENT ILLNESS
// ══════════════════════════════════════════════
addContentSlide("History of Present Illness  |  With 'WHY'", [
  { text: "LMP: 1st January 2024  →  EDD (by Naegele's rule): 8th October 2024", bold: true, color: C.teal, fontSize: 14 },
  { text: "Today's date exceeds EDD by 2 weeks → Pregnancy at 42+ weeks gestation", color: C.red, bold: true },
  "",
  { text: "Patient has not developed labour pains despite passing her EDD by 14 days", bold: false },
  { text: "No leaking per vaginum (to rule out PROM)", bold: false },
  { text: "No bleeding per vaginum (to rule out abruption/placenta praevia)", bold: false },
  { text: "Foetal movements PRESENT but reduced in frequency over last 48 hours", bold: true, color: C.red },
  { text: "No headache, blurring of vision, epigastric pain (to rule out PIH/Pre-eclampsia)", bold: false },
  { text: "No urinary symptoms (to rule out UTI precipitating preterm labour)", bold: false },
  { text: "Antenatal check-ups done — 4 visits, last at 40 weeks", bold: false },
], { fontSize: 12.5 });

// ══════════════════════════════════════════════
//  SLIDE 6 — MENSTRUAL & OBSTETRIC HISTORY WITH WHY
// ══════════════════════════════════════════════
addContentSlide("Menstrual & Obstetric History  |  With 'WHY' of Each Question", [
  { text: "MENSTRUAL HISTORY:", bold: true, color: C.teal },
  { text: "LMP — WHY: To calculate gestational age using Naegele's rule (EDD = LMP − 3 months + 7 days)", bold: false, indentLevel: 1 },
  { text: "Cycle regularity — WHY: Irregular cycles make LMP-based dating unreliable; USG confirmation needed", indentLevel: 1 },
  { text: "Cycle length — WHY: Cycles >35 days → ovulation delayed → add extra days to EDD", indentLevel: 1 },
  { text: "Sure of LMP? — WHY: Uncertain LMP is the MOST COMMON cause of apparent post-datism", bold: true, color: C.red, indentLevel: 1 },
  "",
  { text: "OBSTETRIC HISTORY:", bold: true, color: C.teal },
  { text: "Previous post-term delivery — WHY: Strong recurrence risk (2–3× higher in subsequent pregnancies)", indentLevel: 1 },
  { text: "Previous macrosomic baby — WHY: Macrosomia risk increases with post-term", indentLevel: 1 },
  { text: "Previous unexplained stillbirth — WHY: Indicates uteroplacental dysfunction tendency", indentLevel: 1 },
  { text: "Previous CS/shoulder dystocia — WHY: Guides current delivery planning", indentLevel: 1 },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SLIDE 7 — PERSONAL, FAMILY, MEDICAL HISTORY WITH WHY
// ══════════════════════════════════════════════
addContentSlide("Personal, Family & Medical History  |  With 'WHY'", [
  { text: "PERSONAL HISTORY:", bold: true, color: C.teal },
  { text: "Diet — Vegetarian/Non-vegetarian (WHY: Nutritional status affects fetal growth)", indentLevel: 1 },
  { text: "Occupation/stress (WHY: Stress → cortisol → can delay labour onset)", indentLevel: 1 },
  { text: "Parity — Primiparity (WHY: Post-term is more common in primigravidae)", indentLevel: 1, bold: true },
  { text: "Male fetus history (WHY: Male fetuses have slightly higher risk of post-term)", indentLevel: 1 },
  "",
  { text: "FAMILY HISTORY:", bold: true, color: C.teal },
  { text: "Mother/sister with post-term deliveries — WHY: Genetic predisposition (maternal genes control fetal HPA axis, which triggers labour)", indentLevel: 1 },
  { text: "Placental sulphatase deficiency — WHY: X-linked recessive disorder → absent oestrogen rise → no labour trigger", indentLevel: 1 },
  "",
  { text: "MEDICAL HISTORY:", bold: true, color: C.teal },
  { text: "Thyroid disorders (WHY: Hypothyroidism can prolong pregnancy)", indentLevel: 1 },
  { text: "Diabetes mellitus (WHY: Macrosomia risk further increases in diabetics)", indentLevel: 1 },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SECTION HEADER — DIFFERENTIAL DIAGNOSIS
// ══════════════════════════════════════════════
addSectionHeader("SECTION 2", "Differential Diagnosis");

// ══════════════════════════════════════════════
//  SLIDE 8 — DIFFERENTIAL DIAGNOSIS
// ══════════════════════════════════════════════
addBoxedSlide("Differential Diagnosis — Post-Dated Delivery", [
  {
    label: "1. Incorrect Dating (Most Common)", color: C.navy,
    text: "Wrong LMP recall\nIrregular cycles\nOvulation > day 14\nAbsence of early USG\n→ EXCLUSION DIAGNOSIS"
  },
  {
    label: "2. True Post-Term Pregnancy", color: C.teal,
    text: "Confirmed by early USG\nLMP + USG both agree\n>42 weeks gestation\nClinically significant"
  },
  {
    label: "3. Fetal Anencephaly", color: C.red,
    text: "Absent fetal pituitary\nNo CRH/ACTH → no cortisol\nNo labour trigger\nPolyhydramnios present"
  },
  {
    label: "4. Placental Sulphatase Deficiency", color: "#7B2D8B",
    text: "X-linked recessive\nMale fetus affected\nLow estriol levels\nResistant to induction"
  },
  {
    label: "5. Missed Abortion (Late)", color: C.grey,
    text: "IUD with closed cervix\nNo fetal movements\nNo FH sounds\nUSG confirms"
  },
  {
    label: "6. Post-term + IUGR", color: C.red,
    text: "Reduced fundal height\nOligohydramnios\nPoor fetal growth\nHigh risk for IUD"
  },
]);

// ══════════════════════════════════════════════
//  SECTION HEADER — SUMMARY OF POSITIVE FINDINGS
// ══════════════════════════════════════════════
addSectionHeader("SECTION 3", "Summary of Positive Findings");

// ══════════════════════════════════════════════
//  SLIDE 9 — SUMMARY — POSITIVE HISTORY
// ══════════════════════════════════════════════
addTwoColSlide(
  "Summary — Positive History & Examination Findings",
  "Positive History",
  [
    { text: "G1P0 — Primigravida", bold: true, color: C.red },
    "Amenorrhoea × 10 months",
    "LMP confirmed → EDD passed by 14 days",
    "No onset of labour pains",
    "Reduced fetal movements × 48 hrs",
    "No significant medical/surgical illness",
    "No previous post-term history (but family history +)",
    "No PROM, no bleeding PV",
    "4 ANC visits done",
    "First trimester USG confirming dates",
  ],
  "Positive Examination Findings",
  [
    { text: "GA: 42 weeks by dates + USG", bold: true, color: C.red },
    "Fundal height: 38–40 cm (appropriate)",
    "Lie: Longitudinal",
    "Presentation: Cephalic",
    "Head: 3/5 palpable (not engaged)",
    "FHS: 136 bpm (regular)",
    "AFI reduced on USG (oligohydramnios)",
    "P/V: Cervix — posterior, firm, 1 cm dilated",
    "Bishop score: 3–4 (unfavourable cervix)",
    "No meconium staining noted yet",
  ]
);

// ══════════════════════════════════════════════
//  SECTION HEADER — EXAMINATION PROCEDURE
// ══════════════════════════════════════════════
addSectionHeader("SECTION 4", "Examination Procedure — Step by Step");

// ══════════════════════════════════════════════
//  SLIDE 10 — GENERAL & SYSTEMIC EXAMINATION
// ══════════════════════════════════════════════
addContentSlide("Examination Procedure  |  General & Systemic", [
  { text: "GENERAL EXAMINATION:", bold: true, color: C.teal },
  { text: "Build/Nourishment — assess maternal well-being", indentLevel: 1 },
  { text: "Pallor (anaemia → fetal hypoxia risk)", indentLevel: 1 },
  { text: "Oedema (pre-eclampsia?)", indentLevel: 1 },
  { text: "Vitals: BP, Pulse, Temperature, SpO2", indentLevel: 1 },
  { text: "Height & Weight → BMI (obesity → risk factor for post-term)", indentLevel: 1 },
  "",
  { text: "SYSTEMIC EXAMINATION:", bold: true, color: C.teal },
  { text: "CVS, RS — baseline assessment before induction", indentLevel: 1 },
  { text: "CNS — deep tendon reflexes (rule out impending eclampsia)", indentLevel: 1 },
], { fontSize: 13 });

// ══════════════════════════════════════════════
//  SLIDE 11 — OBSTETRIC EXAMINATION
// ══════════════════════════════════════════════
addContentSlide("Examination Procedure  |  Obstetric Examination", [
  { text: "ABDOMINAL EXAMINATION — Sequence:", bold: true, color: C.teal },
  { text: "INSPECTION: Abdominal distension, linea nigra, striae, scar (previous CS)", indentLevel: 1 },
  { text: "FUNDAL HEIGHT: Tape measure — symphysis to fundus in cm (=weeks of gestation)", indentLevel: 1 },
  { text: "FUNDAL GRIP: Identify fetal part at fundus (breech = soft, irregular, non-ballottable)", indentLevel: 1 },
  { text: "LATERAL GRIPS: Palpate sides → identify back (smooth, resistant) & limbs (nodular)", indentLevel: 1 },
  { text: "PAWLIK'S GRIP: Presenting part at lower pole — is it head? Is it engaged?", indentLevel: 1 },
  { text: "ENGAGEMENT: 5th rule — how many fifths of head are palpable above pelvic brim", indentLevel: 1 },
  { text: "FHS: Auscultate with Pinard's / Doppler — below umbilicus in cephalic, above in breech", bold: true, indentLevel: 1 },
  "",
  { text: "IMPORTANT in Post-Dated: Assess amniotic fluid volume — reduced AFI = oligohydramnios", bold: true, color: C.red },
], { fontSize: 12.5 });

// ══════════════════════════════════════════════
//  SLIDE 12 — PER VAGINUM EXAMINATION
// ══════════════════════════════════════════════
addContentSlide("Examination Procedure  |  Per Vaginum (Bishop Score)", [
  { text: "P/V EXAMINATION (Sterile technique, after ruling out placenta praevia):", bold: true, color: C.teal },
  { text: "Cervical POSITION: Posterior → Midposition → Anterior (anterior = favourable)", indentLevel: 1 },
  { text: "Cervical CONSISTENCY: Firm → Medium → Soft (soft = favourable)", indentLevel: 1 },
  { text: "Cervical EFFACEMENT: 0–30% → 40–50% → 60–70% → 80%", indentLevel: 1 },
  { text: "Cervical DILATION: Closed → 1–2 cm → 3–4 cm → 5+ cm", indentLevel: 1 },
  { text: "Presenting part STATION: -3 → -2 → -1/0 → +1", indentLevel: 1 },
  "",
  { text: "BISHOP SCORE INTERPRETATION:", bold: true, color: C.teal },
  { text: "Score ≤6 → Unfavourable cervix → CERVICAL RIPENING required first", bold: true, color: C.red },
  { text: "Score 7–8 → Favourable → Proceed with Oxytocin induction", color: C.green },
  { text: "Score 9–13 → Very favourable → ARM ± low-dose oxytocin", color: C.green },
  "",
  { text: "In post-dated: Also note colour of liquor if membranes ruptured (meconium?)", bold: true, color: C.red },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SECTION HEADER — DIAGNOSIS
// ══════════════════════════════════════════════
addSectionHeader("SECTION 5", "Diagnosis with Explanation");

// ══════════════════════════════════════════════
//  SLIDE 13 — DIAGNOSIS
// ══════════════════════════════════════════════
addContentSlide("Diagnosis  |  How to State It in Examination", [
  { text: "FINAL DIAGNOSIS:", bold: true, color: C.teal, fontSize: 15 },
  { text: "\"Mrs. Meena R., 26 years, G1P0L0A0 at 42 weeks gestation (Post-Dated Pregnancy) with unfavourable cervix (Bishop score 4), presenting for induction of labour.\"", bold: true, color: C.red, fontSize: 13 },
  "",
  { text: "EXPLAIN EACH COMPONENT:", bold: true, color: C.navy },
  { text: "G1P0 — Why relevant: Primiparity is a risk factor for post-term", indentLevel: 1 },
  { text: "42 weeks — Confirmed by dates (LMP) + first trimester USG (most accurate, ±7 days at 9–16 wks)", indentLevel: 1 },
  { text: "Post-Dated — Beyond 42 completed weeks from LMP", indentLevel: 1 },
  { text: "Unfavourable cervix — Bishop score <6 → requires ripening before oxytocin", indentLevel: 1 },
  { text: "Induction of Labour — ACOG recommends induction at or before 42 6/7 weeks to prevent perinatal mortality", bold: true, color: C.red, indentLevel: 1 },
], { fontSize: 12.5 });

// ══════════════════════════════════════════════
//  SECTION HEADER — CASE DISCUSSION
// ══════════════════════════════════════════════
addSectionHeader("SECTION 6", "Case Discussion — Pathophysiology & Complications");

// ══════════════════════════════════════════════
//  SLIDE 14 — PATHOPHYSIOLOGY
// ══════════════════════════════════════════════
addContentSlide("Case Discussion  |  Why Does Labour Not Start?", [
  { text: "NORMAL LABOUR TRIGGER (Feto-Placental HPA Axis):", bold: true, color: C.teal },
  { text: "Fetal maturity → Hypothalamus releases CRH → Pituitary releases ACTH", indentLevel: 1 },
  { text: "ACTH → Fetal adrenal cortex → DHEA-S production", indentLevel: 1 },
  { text: "DHEA-S → Placenta aromatizes → Oestradiol surge", indentLevel: 1 },
  { text: "Oestrogen↑ → Oxytocin receptors↑, Gap junctions↑, Prostaglandins↑ → LABOUR", bold: true, indentLevel: 1, color: C.green },
  "",
  { text: "IN POST-TERM — WHY DOES THIS FAIL?", bold: true, color: C.red },
  { text: "Defect in fetal HPA axis (genetic predisposition in 30–50% cases)", indentLevel: 1 },
  { text: "Placental sulphatase deficiency → Cannot aromatize DHEA-S → No oestrogen rise", indentLevel: 1 },
  { text: "Fetal anencephaly → No hypothalamus → No CRH → No labour trigger", indentLevel: 1 },
  { text: "Incorrect dates → Most common apparent cause", bold: true, color: C.red, indentLevel: 1 },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SLIDE 15 — PLACENTAL & FETAL COMPLICATIONS
// ══════════════════════════════════════════════
addContentSlide("Case Discussion  |  Why Are Complications Dangerous?", [
  { text: "PLACENTAL SENESCENCE (WHY complications occur):", bold: true, color: C.teal },
  { text: "After 42 weeks, placental function DECLINES — calcium deposition, fibrosis, infarcts", indentLevel: 1 },
  { text: "Uteroplacental blood flow ↓ → Fetal hypoxia → IUD, seizures", indentLevel: 1 },
  { text: "Amniotic fluid ↓ (oligohydramnios) → Cord compression → Fetal distress", bold: true, color: C.red, indentLevel: 1 },
  { text: "Meconium passage into oligohydramniotic fluid → Thick meconium → MAS risk ↑↑", bold: true, color: C.red, indentLevel: 1 },
  "",
  { text: "PERINATAL MORTALITY STATISTICS:", bold: true, color: C.teal },
  { text: "Term (38–40 weeks): Baseline", indentLevel: 1 },
  { text: "42 weeks: TWICE the rate of term", bold: true, color: C.red, indentLevel: 1 },
  { text: "43 weeks: FOUR times the rate", bold: true, color: C.red, indentLevel: 1 },
  { text: "44 weeks: FIVE to SEVEN times the rate", bold: true, color: C.red, indentLevel: 1 },
  { text: "Absolute risk: ~1–2 per 1000 ongoing pregnancies at 41–42 weeks (still low but preventable)", indentLevel: 1 },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SLIDE 16 — FETAL COMPLICATIONS TABLE
// ══════════════════════════════════════════════
addTwoColSlide(
  "Complications of Post-Dated Delivery",
  "Fetal / Neonatal Complications",
  [
    { text: "Macrosomia (>4 kg) — uteroplacental NOT insufficient", bold: false },
    { text: "Dysmaturity Syndrome (Clifford Syndrome) — up to 20%", bold: true, color: C.red },
    { text: "Meconium Aspiration Syndrome (MAS)", bold: true, color: C.red },
    { text: "Intrauterine Death / Stillbirth", bold: true, color: C.red },
    "Neonatal seizures / asphyxia",
    "Shoulder dystocia (macrosomia)",
    "5-min Apgar <4",
    "Hypoglycaemia, polycythaemia",
    "SIDS (subtle HPA axis defect persists)",
  ],
  "Maternal Complications",
  [
    "Labour dystocia (macrosomia / poor contractions)",
    { text: "Caesarean section rate ↑↑", bold: true, color: C.red },
    "Postpartum haemorrhage (PPH)",
    "3rd/4th degree perineal lacerations",
    "Maternal infection — chorioamnionitis, endometritis",
    "Obstetric fistula (prolonged obstructed labour)",
    "Psychological distress / anxiety",
    { text: "Note: NO increased risk of PPD (Swanson)", italic: true, color: C.grey },
  ]
);

// ══════════════════════════════════════════════
//  SLIDE 17 — DYSMATURITY SYNDROME
// ══════════════════════════════════════════════
addContentSlide("Dysmaturity Syndrome (Clifford Syndrome)", [
  { text: "DEFINITION:", bold: true, color: C.teal },
  { text: "SGA infant (small for gestational age) born post-term due to CHRONIC uteroplacental insufficiency (not macrosomic)", bold: false },
  { text: "Incidence: Affects 10–20% of post-term pregnancies", bold: true, color: C.red },
  "",
  { text: "CAUSE: Placental insufficiency → Chronic intrauterine malnutrition", bold: false },
  "",
  { text: "FEATURES (Clifford's Stages):", bold: true, color: C.teal },
  { text: "Stage I: Dry, peeling, parchment-like skin. Loose, wrinkled. Thin SQ fat", indentLevel: 1 },
  { text: "Stage II: Stage I + Meconium staining of skin, umbilical cord, membranes (green)", bold: true, color: C.red, indentLevel: 1 },
  { text: "Stage III: Stage II + Yellow-green staining (old meconium) — worst prognosis", bold: true, color: C.red, indentLevel: 1 },
  "",
  { text: "NEONATAL RISKS: Seizures, asphyxia, long-term neurological damage, increased risk of SIDS", bold: true, color: C.red },
], { fontSize: 12.5 });

// ══════════════════════════════════════════════
//  SECTION HEADER — INVESTIGATIONS
// ══════════════════════════════════════════════
addSectionHeader("SECTION 7", "Investigations");

// ══════════════════════════════════════════════
//  SLIDE 18 — INVESTIGATIONS
// ══════════════════════════════════════════════
addBoxedSlide("Investigations — Post-Dated Pregnancy", [
  {
    label: "1. Confirm Gestational Age", color: C.navy,
    text: "• LMP + Naegele's rule\n• First trimester USG (gold std)\n• Second trimester USG (±14d)"
  },
  {
    label: "2. Fetal Well-being — NST", color: C.teal,
    text: "• Non-Stress Test (NST)\n• Reactive = 2 accels 15bpm ×15s in 20 min\n• Non-reactive → proceed to BPP"
  },
  {
    label: "3. BPP (Biophysical Profile)", color: C.teal,
    text: "• 5 parameters, each scored 0 or 2\n• NST + Movements + Tone\n  + Breathing + AFI\n• Score 8–10 = normal; ≤4 = deliver"
  },
  {
    label: "4. Modified BPP", color: "#0E5C7A",
    text: "• NST + AFI only\n• Acceptable alternative to full BPP\n• AFI <5 cm = oligohydramnios\n  → delivery indicated"
  },
  {
    label: "5. Doppler Velocimetry", color: C.gold,
    text: "• Umbilical artery S/D ratio\n• NOT routine in uncomplicated\n  post-term\n• Use if IUGR suspected"
  },
  {
    label: "6. Routine Labs", color: C.grey,
    text: "• CBC, Blood group & Rh\n• Urine R/E (protein?)\n• Blood glucose\n• Coagulation profile\n• Cervical assessment/Bishop score"
  },
]);

// ══════════════════════════════════════════════
//  SECTION HEADER — MANAGEMENT
// ══════════════════════════════════════════════
addSectionHeader("SECTION 8", "Management — Complete Protocol");

// ══════════════════════════════════════════════
//  SLIDE 19 — MANAGEMENT OVERVIEW
// ══════════════════════════════════════════════
addContentSlide("Management — Algorithm Overview", [
  { text: "DECISION POINT AT 41 WEEKS:", bold: true, color: C.teal, fontSize: 14 },
  { text: "Two options: EXPECTANT MANAGEMENT vs. INDUCTION OF LABOUR", bold: true },
  { text: "ACOG recommends: Offer induction at 41 0/7 weeks; MANDATE before 42 6/7 weeks", bold: true, color: C.red },
  "",
  { text: "EXPECTANT MANAGEMENT (if patient declines induction at 41 wks):", bold: true, color: C.navy },
  { text: "Twice weekly NST + BPP (or modified BPP = NST + AFI)", indentLevel: 1 },
  { text: "Daily fetal movement counting (kick chart)", indentLevel: 1 },
  { text: "USG for AFI every 3–4 days", indentLevel: 1 },
  { text: "If AFI <5 cm or non-reactive NST → DELIVER IMMEDIATELY", bold: true, color: C.red, indentLevel: 1 },
  "",
  { text: "INDUCTION OF LABOUR — Indicated at ≥41 weeks (mandatory at 42+ weeks):", bold: true, color: C.teal },
  { text: "Step 1: Assess Bishop score → Unfavourable (<6)? → CERVICAL RIPENING first", bold: true, indentLevel: 1 },
  { text: "Step 2: After ripening → Oxytocin induction / ARM", indentLevel: 1 },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SLIDE 20 — CERVICAL RIPENING
// ══════════════════════════════════════════════
addTwoColSlide(
  "Management  |  Cervical Ripening (Bishop Score <6)",
  "Mechanical Methods",
  [
    { text: "1. Membrane Sweeping / Stripping", bold: true, color: C.teal },
    "   Separates amniotic sac from cervix",
    "   Stimulates local PG release",
    "   Reduces post-term induction rate",
    "",
    { text: "2. Foley Catheter Balloon", bold: true, color: C.teal },
    "   16–20Fr catheter inserted past os",
    "   Balloon inflated with 30–60 mL saline",
    "   Mechanical cervical pressure → PG release",
    "",
    { text: "3. Laminaria (Osmotic Dilators)", bold: true, color: C.teal },
    "   Hygroscopic seaweed dilators",
    "   Cervical os left overnight",
  ],
  "Pharmacological Methods",
  [
    { text: "1. Misoprostol (PGE1) — Vaginal / Oral", bold: true, color: C.red },
    "   Vaginal: 25 mcg q4–6h (max 6 doses)",
    "   Oral: 25–50 mcg q4h",
    "   NOT for previous CS (uterine rupture risk)",
    "",
    { text: "2. Dinoprostone (PGE2)", bold: true, color: C.teal },
    "   Gel: 0.5 mg intra-cervical q6h ×3",
    "   Insert (Cervidil): 10 mg slow-release,",
    "   remove after 12h or on labour",
    "",
    { text: "3. Oxytocin NOT used for ripening", bold: true, color: C.grey },
    "   Only used after favourable cervix",
  ]
);

// ══════════════════════════════════════════════
//  SLIDE 21 — INDUCTION WITH OXYTOCIN
// ══════════════════════════════════════════════
addContentSlide("Management  |  Induction of Labour — Oxytocin Protocol", [
  { text: "INDICATIONS FOR OXYTOCIN INDUCTION:", bold: true, color: C.teal },
  { text: "Bishop score ≥6 (favourable cervix)", indentLevel: 1 },
  { text: "After successful cervical ripening", indentLevel: 1 },
  { text: "PROM at term, PIH, post-term ≥42 weeks", indentLevel: 1 },
  "",
  { text: "PROTOCOL — Low-Dose Oxytocin Regimen:", bold: true, color: C.navy },
  { text: "Start: 0.5–2 mU/min IV", bold: true, indentLevel: 1 },
  { text: "Increase: By 1–2 mU/min every 30–60 minutes", indentLevel: 1 },
  { text: "Maximum: 20–40 mU/min (institution-dependent)", indentLevel: 1 },
  { text: "Target: 3 contractions in 10 min, each lasting 40–60 seconds", bold: true, color: C.green, indentLevel: 1 },
  "",
  { text: "MONITORING DURING INDUCTION:", bold: true, color: C.red },
  { text: "Continuous CTG monitoring (FHR + uterine contractions)", bold: true, indentLevel: 1 },
  { text: "Watch for hyperstimulation (>5 contractions/10 min) → STOP oxytocin", bold: true, color: C.red, indentLevel: 1 },
  { text: "4-hourly vaginal examination for progress", indentLevel: 1 },
  { text: "Meconium in liquor? → Grade, shift to tertiary care with NICU", indentLevel: 1 },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SLIDE 22 — MANAGEMENT FLOW (INTRAPARTUM)
// ══════════════════════════════════════════════
addContentSlide("Management  |  Intrapartum Care", [
  { text: "INTRAPARTUM MONITORING:", bold: true, color: C.teal },
  { text: "IV access + IV fluids", indentLevel: 1 },
  { text: "Continuous CTG — watch for late decelerations (uteroplacental insufficiency)", bold: true, indentLevel: 1 },
  { text: "Assess liquor colour at rupture of membranes — clear / meconium stained", bold: true, color: C.red, indentLevel: 1 },
  { text: "Meconium stained liquor → Paediatric team on standby for MAS suctioning", bold: true, color: C.red, indentLevel: 1 },
  { text: "Regular vaginal examination — active phase progress (>1 cm/hr)", indentLevel: 1 },
  { text: "Anticipate shoulder dystocia (macrosomic baby)", bold: true, color: C.red, indentLevel: 1 },
  "",
  { text: "INDICATIONS FOR EMERGENCY CS IN POST-DATED:", bold: true, color: C.red },
  { text: "Failed induction after proper trial", indentLevel: 1 },
  { text: "Non-reassuring FHR (Category III CTG)", bold: true, indentLevel: 1 },
  { text: "Thick meconium + FHR changes", indentLevel: 1 },
  { text: "Active phase arrest / Cephalopelvic disproportion", indentLevel: 1 },
], { fontSize: 12.5 });

// ══════════════════════════════════════════════
//  SECTION HEADER — VIVA
// ══════════════════════════════════════════════
addSectionHeader("SECTION 9", "Viva Questions & Model Answers");

// ══════════════════════════════════════════════
//  SLIDE 23 — VIVA Q&A — DEFINITIONS & BASICS
// ══════════════════════════════════════════════
addContentSlide("Viva Q&A  |  Definitions & Basics", [
  { text: "Q1. Define post-dated pregnancy.", bold: true, color: C.teal },
  { text: "A: Pregnancy continuing beyond 42 completed weeks (294 days) from the first day of the LMP. Preferred term is 'post-term'. (Note: ACOG defines it as >42 0/7 weeks)", bold: false, color: C.navy },
  "",
  { text: "Q2. What is the difference between post-dates and post-term?", bold: true, color: C.teal },
  { text: "A: Post-dates = beyond 40 weeks (just past EDD, not necessarily abnormal). Post-term = beyond 42 weeks (clinically significant). Post-term is the preferred ACOG/FIGO nomenclature.", color: C.navy },
  "",
  { text: "Q3. What is the incidence of post-term pregnancy?", bold: true, color: C.teal },
  { text: "A: 4–14% of all pregnancies. Most are due to inaccurate dating. True post-term (confirmed by early USG) is much less common (~2–7%).", color: C.navy },
  "",
  { text: "Q4. What is the most common cause of apparent post-datism?", bold: true, color: C.teal },
  { text: "A: Incorrect dating — uncertain LMP, irregular cycles (ovulation after day 14), or absence of first trimester USG confirmation.", bold: true, color: C.red },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SLIDE 24 — VIVA — RISK FACTORS & COMPLICATIONS
// ══════════════════════════════════════════════
addContentSlide("Viva Q&A  |  Risk Factors & Complications", [
  { text: "Q5. What are the risk factors for post-term pregnancy?", bold: true, color: C.teal },
  { text: "A: Primiparity, male fetus, previous post-term delivery, family history, placental sulphatase deficiency, fetal anencephaly, non-Hispanic White race. Most cases have NO identifiable cause.", color: C.navy },
  "",
  { text: "Q6. What is dysmaturity syndrome? What causes it?", bold: true, color: C.teal },
  { text: "A: Also called Clifford syndrome. SGA infant born post-term due to chronic uteroplacental insufficiency. Features: peeling skin, absent subcutaneous fat, meconium staining. Affects 10–20% of post-term pregnancies. Caused by uteroplacental insufficiency, not macrosomia.", bold: false, color: C.navy },
  "",
  { text: "Q7. How does perinatal mortality change with gestational age?", bold: true, color: C.teal },
  { text: "A: At 42 wks = 2× term rate; at 43 wks = 4× term rate; at 44 wks = 5–7× term rate. Absolute risk ~1–2 per 1000 ongoing pregnancies at 41–42 weeks.", bold: true, color: C.red },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SLIDE 25 — VIVA — INVESTIGATIONS
// ══════════════════════════════════════════════
addContentSlide("Viva Q&A  |  Investigations", [
  { text: "Q8. What is the gold standard for confirming gestational age?", bold: true, color: C.teal },
  { text: "A: First trimester USG (<14 weeks), accurate to ±7 days (9–16 wks). CRL-based dating is most accurate. >28 weeks USG has ±21 days error margin — unreliable for dating.", color: C.navy },
  "",
  { text: "Q9. What is a reactive NST?", bold: true, color: C.teal },
  { text: "A: TWO accelerations of ≥15 bpm lasting ≥15 seconds within a 20-minute tracing. (Before 32 weeks: ≥10 bpm × 10 seconds acceptable.)", color: C.navy },
  "",
  { text: "Q10. What are the 5 components of BPP?", bold: true, color: C.teal },
  { text: "A: NST + Fetal movements (≥3 in 30 min) + Fetal tone (extension-flexion) + Fetal breathing movements (≥30 sec) + Amniotic fluid index (AFI ≥5 cm). Each scored 0 or 2. Max = 10.", color: C.navy },
  "",
  { text: "Q11. What is the modified BPP?", bold: true, color: C.teal },
  { text: "A: NST + AFI only. If NST reactive AND AFI ≥5 cm → considered normal. Acceptable alternative to full BPP.", color: C.navy },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SLIDE 26 — VIVA — MANAGEMENT
// ══════════════════════════════════════════════
addContentSlide("Viva Q&A  |  Management", [
  { text: "Q12. When do you induce labour in post-dated pregnancy?", bold: true, color: C.teal },
  { text: "A: ACOG — offer induction at 41 0/7 weeks. MANDATORY before 42 6/7 weeks. Induction at 41 weeks reduces perinatal mortality without increasing CS rate.", bold: true, color: C.red },
  "",
  { text: "Q13. What is Bishop score? What score indicates cervical ripening?", bold: true, color: C.teal },
  { text: "A: 5-parameter cervical scoring system (dilation, effacement, station, consistency, position). Score <6 (AAFP) or <8 (ACOG) → cervical ripening required before oxytocin induction.", color: C.navy },
  "",
  { text: "Q14. What are cervical ripening methods?", bold: true, color: C.teal },
  { text: "A: Mechanical: Membrane sweeping, Foley balloon, Laminaria. Pharmacological: Misoprostol 25 mcg q4-6h vaginal (NOT in prev CS); Dinoprostone gel 0.5 mg q6h ×3 or 10 mg slow-release insert.", color: C.navy },
  "",
  { text: "Q15. What should NOT be used for cervical ripening?", bold: true, color: C.teal },
  { text: "A: Oxytocin — used only for induction AFTER the cervix is favourable, NOT for ripening.", bold: true, color: C.red },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SLIDE 27 — VIVA — NAEGELE'S RULE & BISHOP TABLE
// ══════════════════════════════════════════════
addContentSlide("Viva Q&A  |  Naegele's Rule & Bishop Score Table", [
  { text: "Q16. How do you calculate EDD using Naegele's rule?", bold: true, color: C.teal },
  { text: "A: EDD = LMP − 3 months + 7 days. Example: LMP = 1st Jan 2024 → EDD = 8th Oct 2024.", bold: false, color: C.navy },
  { text: "Memory trick: Subtract 3 months, add 7 days (and 1 year if result crosses calendar year)", italic: true, color: C.grey },
  "",
  { text: "BISHOP SCORE TABLE:", bold: true, color: C.teal },
  { text: "Parameter         0           1          2          3", bold: true, color: C.navy },
  { text: "Dilation (cm)     Closed      1–2        3–4        5+", color: C.navy },
  { text: "Effacement (%)    0–30        40–50      60–70      80", color: C.navy },
  { text: "Station           -3          -2         -1/0       +1", color: C.navy },
  { text: "Consistency       Firm        Medium     Soft       —", color: C.navy },
  { text: "Position          Posterior   Mid        Anterior   —", color: C.navy },
  { text: "Interpretation: <6 = unfavourable (ripen first); 6–8 = borderline; >8 = favourable (induce)", bold: true, color: C.red },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SLIDE 28 — VIVA — PATHOPHYSIOLOGY QUES
// ══════════════════════════════════════════════
addContentSlide("Viva Q&A  |  Pathophysiology", [
  { text: "Q17. What role does the fetal HPA axis play in initiating labour?", bold: true, color: C.teal },
  { text: "A: Fetal hypothalamus → CRH → pituitary ACTH → adrenal DHEA-S → placenta aromatizes to oestradiol → oestrogen surge → oxytocin receptors + gap junctions + PGF2α → uterine contractions. Defect at ANY step → post-term.", color: C.navy },
  "",
  { text: "Q18. Why does fetal anencephaly cause post-term?", bold: true, color: C.teal },
  { text: "A: Absent hypothalamus → no CRH secretion → no ACTH → no adrenal DHEA-S → no oestrogen surge → labour never initiated. Also associated with polyhydramnios.", color: C.navy },
  "",
  { text: "Q19. What is placental sulphatase deficiency?", bold: true, color: C.teal },
  { text: "A: X-linked recessive condition affecting male fetuses. Placental sulphatase enzyme absent → cannot convert DHEA-S sulphate to DHEA → no aromatization to oestrogen → low estriol → no labour trigger. Very resistant to induction.", bold: false, color: C.navy },
  "",
  { text: "Q20. What causes oligohydramnios in post-term pregnancy?", bold: true, color: C.teal },
  { text: "A: Uteroplacental insufficiency → reduced fetal renal blood flow → reduced fetal urine output → reduced amniotic fluid. AFI <5 cm = oligohydramnios → cord compression risk → indication for immediate delivery.", bold: true, color: C.red },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SLIDE 29 — VIVA — MECONIUM & NEONATAL
// ══════════════════════════════════════════════
addContentSlide("Viva Q&A  |  Meconium & Neonatal Care", [
  { text: "Q21. Why is meconium aspiration syndrome more common in post-term?", bold: true, color: C.teal },
  { text: "A: Post-term fetus under hypoxic stress → gastrointestinal motility↑ → meconium passage into amniotic fluid → occurs in 4–22% of deliveries, more in post-term. Oligohydramnios → thick meconium → aspiration at birth. MAS = respiratory distress in neonate born through meconium-stained fluid.", color: C.navy },
  "",
  { text: "Q22. How do you manage meconium-stained liquor at delivery?", bold: true, color: C.teal },
  { text: "A: Thin meconium — routine care. Thick meconium — paediatric team present at birth; if baby vigorous (breathing, good tone, HR >100) → routine suctioning only; if NOT vigorous → endotracheal intubation + suction before positive pressure ventilation.", bold: true, color: C.red },
  "",
  { text: "Q23. What is shoulder dystocia and how to manage it?", bold: true, color: C.teal },
  { text: "A: Impaction of anterior shoulder behind maternal pubic symphysis after head delivery. Management: McRoberts manoeuvre (hyperflexion of hips), suprapubic pressure, Rubin II manoeuvre, Woods screw, deliver posterior arm, Zavanelli manoeuvre.", color: C.navy },
], { fontSize: 12 });

// ══════════════════════════════════════════════
//  SLIDE 30 — SUMMARY CARD
// ══════════════════════════════════════════════
addContentSlide("Quick Revision Summary  |  Post-Dated Delivery", [
  { text: "DEFINITION: >42 completed weeks (294 days) from LMP", bold: true, color: C.teal },
  { text: "MOST COMMON CAUSE: Incorrect dating (uncertain LMP)", bold: true, color: C.red },
  { text: "RISK FACTORS: Primiparity, male fetus, family hx, prev post-term, anencephaly, sulphatase def.", bold: false },
  { text: "DIAGNOSIS: LMP + Early USG (gold standard) + Clinical examination", bold: false },
  { text: "FETAL RISKS: IUD, MAS, Dysmaturity (Clifford) syndrome, macrosomia, shoulder dystocia", bold: true, color: C.red },
  { text: "MATERNAL RISKS: Dystocia, CS, PPH, perineal lacerations, infection", bold: false },
  { text: "SURVEILLANCE: NST + BPP or Modified BPP (NST + AFI) — twice weekly at 41+ wks", bold: true, color: C.teal },
  { text: "MANAGEMENT: Induction at 41 wks (offer), mandatory before 42 6/7 wks", bold: true, color: C.red },
  { text: "CERVICAL RIPENING: Misoprostol / Dinoprostone / Foley balloon (Bishop <6)", bold: false },
  { text: "INDUCTION: Oxytocin IV (low dose, titrate); ARM when feasible", bold: false },
  { text: "PERINATAL MORTALITY: 2× at 42 wks, 4× at 43 wks, 5–7× at 44 wks compared to term", bold: true, color: C.red },
], { fontSize: 12.5, label: "Ref: Creasy & Resnik MFM | Swanson's Family Medicine Review | ACOG Guidelines" });

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