const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Medical Education";
pres.title = "Hypertensive Disorders in Pregnancy";

// ─── COLOR PALETTE ───────────────────────────────────────────────
const C = {
  darkNavy:   "0A1628",
  navy:       "132847",
  midBlue:    "1A3D6B",
  accent:     "C8922A",   // gold
  accentLight:"F0C060",
  teal:       "1B7A8C",
  tealLight:  "2AABB8",
  white:      "FFFFFF",
  offWhite:   "F4F6FA",
  lightGray:  "D8E0EC",
  textDark:   "1A2840",
  red:        "C0392B",
  green:      "1A7A4A",
  softGold:   "FFF3CD",
};

// ─── HELPER: add a dark gradient background ──────────────────────
function darkBg(slide) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { type: "solid", color: C.darkNavy } });
}

function lightBg(slide) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { type: "solid", color: C.offWhite } });
}

function accentBar(slide, y = 0.72, w = 10, h = 0.06) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y, w, h, fill: { type: "solid", color: C.accent } });
}

function sidePanel(slide, color = C.midBlue, x = 0, w = 0.22) {
  slide.addShape(pres.ShapeType.rect, { x, y: 0, w, h: 5.625, fill: { type: "solid", color } });
}

function slideTitle(slide, text, y = 0.18, color = C.white) {
  slide.addText(text, {
    x: 0.38, y, w: 9.3, h: 0.52,
    fontSize: 22, bold: true, color, fontFace: "Calibri",
    margin: 0,
  });
}

function sectionLabel(slide, text, color = C.accentLight) {
  slide.addText(text, {
    x: 0.38, y: 0.74, w: 9.2, h: 0.3,
    fontSize: 11, italic: true, color, fontFace: "Calibri", margin: 0,
  });
}

function bulletBox(slide, items, x = 0.38, y = 1.1, w = 9.2, h = 4.1, fontSize = 14, color = C.textDark) {
  const rows = items.map((item, i) => ({
    text: item.text || item,
    options: {
      bullet: { type: "bullet", indent: (item.indent || 0) * 12 },
      bold: item.bold || false,
      fontSize: item.size || fontSize,
      color: item.color || color,
      breakLine: i < items.length - 1,
      paraSpaceAfter: item.spaceAfter || 4,
    },
  }));
  slide.addText(rows, { x, y, w, h, valign: "top", fontFace: "Calibri" });
}

function footer(slide, num) {
  slide.addText(`Hypertensive Disorders in Pregnancy  |  Slide ${num}`, {
    x: 0.38, y: 5.38, w: 9.5, h: 0.22,
    fontSize: 9, color: C.lightGray, fontFace: "Calibri", margin: 0,
  });
  slide.addText("Source: Creasy & Resnik's Maternal-Fetal Medicine, 9th Ed.", {
    x: 0.38, y: 5.38, w: 9.5, h: 0.22,
    fontSize: 9, color: C.lightGray, fontFace: "Calibri", align: "right", margin: 0,
  });
}

// ─── COLORED BOX helper ─────────────────────────────────────────
function colorBox(slide, text, x, y, w, h, bg, fg = C.white, fs = 13, bold = false) {
  slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { type: "solid", color: bg }, line: { color: bg } });
  slide.addText(text, { x, y, w, h, fontSize: fs, color: fg, fontFace: "Calibri", align: "center", valign: "middle", bold, margin: 4 });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  // decorative shapes
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.5, h: 5.625, fill: { type: "solid", color: C.accent } });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 0, w: 9.5, h: 0.08, fill: { type: "solid", color: C.teal } });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 5.545, w: 9.5, h: 0.08, fill: { type: "solid", color: C.teal } });

  s.addText("HYPERTENSIVE DISORDERS", {
    x: 0.7, y: 0.9, w: 9, h: 0.7,
    fontSize: 34, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 3,
  });
  s.addText("IN PREGNANCY", {
    x: 0.7, y: 1.6, w: 9, h: 0.7,
    fontSize: 34, bold: true, color: C.accentLight, fontFace: "Calibri", charSpacing: 3,
  });
  s.addShape(pres.ShapeType.rect, { x: 0.7, y: 2.38, w: 5, h: 0.06, fill: { type: "solid", color: C.accent } });
  s.addText("Focus on Pre-eclampsia: Definition · Etiopathology · Prediction · Prevention · Investigations · Management", {
    x: 0.7, y: 2.55, w: 9, h: 0.6,
    fontSize: 15, color: C.lightGray, fontFace: "Calibri", italic: true,
  });
  s.addText("Based on Creasy & Resnik's Maternal-Fetal Medicine, 9th Edition\nAmerican College of Obstetricians and Gynecologists (ACOG) Guidelines", {
    x: 0.7, y: 4.5, w: 9, h: 0.7,
    fontSize: 11, color: C.tealLight, fontFace: "Calibri",
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 2 — OVERVIEW / CONTENTS
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sidePanel(s, C.midBlue);
  accentBar(s);
  slideTitle(s, "OVERVIEW — Topics Covered", 0.18, C.textDark);

  const topics = [
    { text: "Classification of Hypertensive Disorders in Pregnancy", bold: true, color: C.midBlue, size: 14 },
    { text: "Definition & Diagnostic Criteria for Pre-eclampsia", bold: true, color: C.midBlue, size: 14 },
    { text: "Epidemiology & Risk Factors", bold: true, color: C.midBlue, size: 14 },
    { text: "Etiopathology — Placentation, Angiogenesis, Inflammation", bold: true, color: C.midBlue, size: 14 },
    { text: "Prediction of Pre-eclampsia (1st & 2nd Trimester Screening)", bold: true, color: C.midBlue, size: 14 },
    { text: "Prevention Strategies (Aspirin, Calcium, Lifestyle)", bold: true, color: C.midBlue, size: 14 },
    { text: "Investigations — Laboratory, Imaging, Biomarkers", bold: true, color: C.midBlue, size: 14 },
    { text: "Management — Antepartum, Intrapartum & Postpartum", bold: true, color: C.midBlue, size: 14 },
    { text: "Complications — HELLP Syndrome & Eclampsia", bold: true, color: C.midBlue, size: 14 },
  ];
  bulletBox(s, topics, 0.5, 1.0, 9.1, 4.3, 14);
  footer(s, 2);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 3 — CLASSIFICATION
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sidePanel(s, C.teal);
  accentBar(s);
  slideTitle(s, "Classification of Hypertensive Disorders in Pregnancy (ACOG)", 0.18, C.textDark);

  const boxes = [
    { label: "1. GESTATIONAL\nHYPERTENSION", bg: C.midBlue },
    { label: "2. PRE-ECLAMPSIA\n/ ECLAMPSIA", bg: C.accent },
    { label: "3. CHRONIC\nHYPERTENSION", bg: C.teal },
    { label: "4. SUPERIMPOSED\nPRE-ECLAMPSIA", bg: C.red },
  ];

  boxes.forEach((b, i) => {
    colorBox(s, b.label, 0.38 + i * 2.34, 1.1, 2.1, 1.1, b.bg, C.white, 13, true);
  });

  const notes = [
    { text: "Gestational Hypertension:", bold: true, size: 13, color: C.midBlue },
    { text: "New BP ≥140/90 mmHg after 20 weeks; NO proteinuria or end-organ damage. Resolves by 12 weeks postpartum.", size: 12 },
    { text: "Pre-eclampsia:", bold: true, size: 13, color: C.accent },
    { text: "Hypertension PLUS proteinuria OR end-organ damage after 20 weeks.", size: 12 },
    { text: "Eclampsia:", bold: true, size: 13, color: C.red },
    { text: "Onset of new tonic-clonic seizures in a woman with pre-eclampsia, not attributable to other causes.", size: 12 },
    { text: "Chronic Hypertension:", bold: true, size: 13, color: C.teal },
    { text: "Pre-existing BP ≥140/90 mmHg before 20 weeks or persisting >12 weeks postpartum.", size: 12 },
    { text: "Superimposed Pre-eclampsia:", bold: true, size: 13, color: C.red },
    { text: "Worsening hypertension + new proteinuria/end-organ damage in a woman with chronic hypertension.", size: 12 },
  ];
  bulletBox(s, notes, 0.38, 2.3, 9.2, 2.9, 12);
  footer(s, 3);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 4 — DEFINITION OF PRE-ECLAMPSIA
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  sidePanel(s, C.accent, 0, 0.3);
  s.addText("DEFINITION OF PRE-ECLAMPSIA", {
    x: 0.5, y: 0.15, w: 9.2, h: 0.55,
    fontSize: 23, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 2,
  });
  accentBar(s, 0.72, 9.8, 0.04);

  // Definition box
  s.addShape(pres.ShapeType.roundRect, { x: 0.38, y: 0.82, w: 9.2, h: 1.22, fill: { type: "solid", color: C.midBlue }, rectRadius: 0.1 });
  s.addText([
    { text: "Pre-eclampsia", options: { bold: true, fontSize: 16, color: C.accentLight } },
    { text: " is defined as new-onset hypertension (≥140/90 mmHg systolic or diastolic) occurring after 20 weeks' gestation accompanied by ", options: { fontSize: 14, color: C.white } },
    { text: "proteinuria (≥300 mg/24 h or protein:creatinine ratio ≥0.3)", options: { bold: true, fontSize: 14, color: C.accentLight } },
    { text: " OR end-organ dysfunction in the absence of proteinuria.", options: { fontSize: 14, color: C.white } },
  ], { x: 0.5, y: 0.88, w: 9, h: 1.1, fontFace: "Calibri", valign: "middle" });

  const criteria = [
    { text: "Hypertension criteria: ≥140 mmHg systolic OR ≥90 mmHg diastolic on ≥2 occasions ≥4 hours apart", bold: true, color: C.accentLight, size: 13 },
    { text: "Proteinuria: ≥300 mg in 24-hour urine; protein:creatinine ratio ≥0.3; dipstick 2+ (only if quantitative tests unavailable)", size: 13, color: C.lightGray },
    { text: "End-organ damage criteria (even without proteinuria):", bold: true, color: C.accentLight, size: 13 },
    { text: "Thrombocytopenia: Platelets <100,000/μL", size: 12, indent: 1 },
    { text: "Renal insufficiency: Creatinine >1.1 mg/dL (no prior renal disease)", size: 12, indent: 1 },
    { text: "Impaired liver function: Liver enzymes >2× upper normal limit", size: 12, indent: 1 },
    { text: "Pulmonary edema", size: 12, indent: 1 },
    { text: "New-onset cerebral or visual disturbances", size: 12, indent: 1 },
  ];
  bulletBox(s, criteria, 0.38, 2.15, 9.2, 3.2, 13, C.white);
  footer(s, 4);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 5 — SEVERE FEATURES
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sidePanel(s, C.red);
  accentBar(s);
  slideTitle(s, "Pre-eclampsia WITH SEVERE FEATURES — Criteria (ACOG)", 0.18, C.textDark);
  sectionLabel(s, "Any ONE of the following qualifies as 'severe features'", C.red);

  const left = [
    { text: "Severe BP:", bold: true, color: C.red, size: 14 },
    { text: "SBP ≥160 mmHg OR DBP ≥110 mmHg on ≥2 occasions ≥4 h apart", size: 13 },
    { text: "Thrombocytopenia:", bold: true, color: C.red, size: 14 },
    { text: "Platelet count <100,000/μL", size: 13 },
    { text: "Renal insufficiency:", bold: true, color: C.red, size: 14 },
    { text: "Creatinine >1.1 mg/dL OR doubling of baseline creatinine", size: 13 },
    { text: "Liver dysfunction:", bold: true, color: C.red, size: 14 },
    { text: "Transaminases >2× ULN; persistent epigastric / RUQ pain", size: 13 },
  ];

  const right = [
    { text: "Pulmonary edema", bold: true, color: C.red, size: 14 },
    { text: "New-onset headache unresponsive to analgesics", size: 13 },
    { text: "Visual disturbances:", bold: true, color: C.red, size: 14 },
    { text: "Blurred vision, scotomata, photopsia", size: 13 },
    { text: "NOTE:", bold: true, color: C.midBlue, size: 13 },
    { text: "Proteinuria >5 g/24h and fetal growth restriction are NO LONGER criteria for severe features (ACOG 2020)", size: 12, color: C.midBlue },
  ];

  bulletBox(s, left, 0.38, 1.05, 4.55, 4.2, 13);
  bulletBox(s, right, 5.1, 1.05, 4.55, 4.2, 13);

  // divider
  s.addShape(pres.ShapeType.line, { x: 5.02, y: 1.05, w: 0, h: 4.1, line: { color: C.lightGray, width: 1 } });
  footer(s, 5);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 6 — EPIDEMIOLOGY & RISK FACTORS
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  sidePanel(s, C.teal);
  s.addText("EPIDEMIOLOGY & RISK FACTORS", {
    x: 0.38, y: 0.15, w: 9.3, h: 0.55,
    fontSize: 22, bold: true, color: C.white, fontFace: "Calibri",
  });
  accentBar(s, 0.72);

  // Stats boxes
  colorBox(s, "INCIDENCE\n3–8% of pregnancies worldwide", 0.38, 0.82, 2.5, 1.0, C.midBlue, C.white, 12, true);
  colorBox(s, "MATERNAL MORTALITY\nLeading cause globally", 3.0, 0.82, 2.5, 1.0, C.red, C.white, 12, true);
  colorBox(s, "RECURRENCE RISK\n~20% in subsequent pregnancy", 5.62, 0.82, 2.5, 1.0, C.teal, C.white, 12, true);
  colorBox(s, "PERINATAL MORTALITY\n5× increased risk", 8.24, 0.82, 1.5, 1.0, C.accent, C.white, 11, true);

  const highrisk = [
    { text: "HIGH-RISK FACTORS (any single factor — USPSTF Grade B):", bold: true, color: C.accentLight, size: 14 },
    { text: "Previous history of pre-eclampsia (strongest risk factor)", size: 13 },
    { text: "Multifetal gestation (twins, triplets)", size: 13 },
    { text: "Chronic hypertension; Pregestational diabetes (T1DM / T2DM)", size: 13 },
    { text: "Renal disease; Autoimmune conditions (SLE, antiphospholipid syndrome)", size: 13 },
    { text: "MODERATE-RISK FACTORS (≥2 factors — consider aspirin):", bold: true, color: C.accentLight, size: 14, spaceAfter: 2 },
    { text: "Nulliparity; BMI ≥30 kg/m²; Age ≥35 years", size: 13 },
    { text: "Family history of pre-eclampsia; African-American race", size: 13 },
    { text: "Low socioeconomic status; Previous LBW/SGA infant; Inter-pregnancy interval >10 years", size: 13 },
  ];
  bulletBox(s, highrisk, 0.38, 1.9, 9.2, 3.4, 13, C.white);
  footer(s, 6);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 7 — PATHOGENESIS OVERVIEW
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sidePanel(s, C.midBlue);
  accentBar(s);
  slideTitle(s, "ETIOPATHOGENESIS — Overview (Two-Stage Model)", 0.18, C.textDark);
  sectionLabel(s, "Pre-eclampsia develops in two stages separated in time", C.midBlue);

  // Stage boxes
  s.addShape(pres.ShapeType.roundRect, { x: 0.38, y: 1.05, w: 4.0, h: 1.5, fill: { type: "solid", color: C.midBlue }, rectRadius: 0.1 });
  s.addText("STAGE 1\n(Before 20 Weeks)", { x: 0.38, y: 1.05, w: 4.0, h: 0.5, fontSize: 14, bold: true, color: C.accentLight, fontFace: "Calibri", align: "center", valign: "middle" });
  s.addText("Abnormal placentation\nImpaired trophoblast invasion\nDefective spiral artery remodeling", { x: 0.38, y: 1.55, w: 4.0, h: 1.0, fontSize: 12, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });

  s.addText("→", { x: 4.42, y: 1.55, w: 0.6, h: 0.6, fontSize: 28, bold: true, color: C.accent, fontFace: "Calibri", align: "center", valign: "middle" });

  s.addShape(pres.ShapeType.roundRect, { x: 5.05, y: 1.05, w: 4.55, h: 1.5, fill: { type: "solid", color: C.teal }, rectRadius: 0.1 });
  s.addText("STAGE 2\n(Clinical Syndrome)", { x: 5.05, y: 1.05, w: 4.55, h: 0.5, fontSize: 14, bold: true, color: C.accentLight, fontFace: "Calibri", align: "center", valign: "middle" });
  s.addText("Placental ischemia → release of factors\nMaternal systemic inflammation\nEndothelial dysfunction → BP↑, proteinuria, HELLP", { x: 5.05, y: 1.55, w: 4.55, h: 1.0, fontSize: 12, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });

  const cascade = [
    { text: "KEY CONCEPT:", bold: true, color: C.midBlue, size: 14 },
    { text: "Stage 1 (pre-clinical) = abnormal placentation → placental hypoperfusion/ischemia", size: 13 },
    { text: "Stage 2 (clinical) = maternal response to placental-derived signals — angiogenic imbalance + systemic inflammation", size: 13 },
    { text: "The transition from Stage 1→2 depends on maternal constitutional factors (genetics, cardiovascular reserve, immune response)", size: 13, color: C.teal },
    { text: "NOT all women with abnormal placentation develop pre-eclampsia — maternal factors determine the clinical expression", size: 12, italic: true },
  ];
  bulletBox(s, cascade, 0.38, 2.65, 9.2, 2.7, 13);
  footer(s, 7);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 8 — ABNORMAL PLACENTATION
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  sidePanel(s, C.accent);
  s.addText("STAGE 1: Abnormal Trophoblast Invasion & Placentation", {
    x: 0.38, y: 0.15, w: 9.3, h: 0.55,
    fontSize: 21, bold: true, color: C.white, fontFace: "Calibri",
  });
  accentBar(s, 0.72);

  const items = [
    { text: "Normal Spiral Artery Remodeling:", bold: true, color: C.accentLight, size: 14 },
    { text: "Extravillous trophoblasts (EVT) invade decidua and myometrium → replace musculoelastic walls of spiral arteries → low-resistance, high-capacity uteroplacental blood flow", size: 13 },
    { text: "In Pre-eclampsia:", bold: true, color: C.red, size: 14 },
    { text: "Trophoblast invasion is shallow — restricted to the decidua only (fails to reach the myometrial segment)", size: 13 },
    { text: "Spiral arteries remain narrow, tortuous, high-resistance → uteroplacental ischemia/hypoperfusion", size: 13 },
    { text: "Oxidative Stress:", bold: true, color: C.accentLight, size: 14 },
    { text: "Ischemia-reperfusion injury → reactive oxygen species (ROS) → placental oxidative stress", size: 13 },
    { text: "Role of Immune Tolerance:", bold: true, color: C.accentLight, size: 14 },
    { text: "Inadequate maternal immune tolerance to paternal antigens → failure of normal trophoblast invasion", size: 13 },
    { text: "Increased incidence with new partners, first pregnancies, limited prior semen exposure", size: 12, indent: 1 },
  ];
  bulletBox(s, items, 0.38, 0.85, 9.2, 4.35, 13, C.white);
  footer(s, 8);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 9 — ANGIOGENIC IMBALANCE
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sidePanel(s, C.teal);
  accentBar(s);
  slideTitle(s, "STAGE 2: Angiogenic Imbalance — The Central Mechanism", 0.18, C.textDark);
  sectionLabel(s, "Placental ischemia → systemic release of anti-angiogenic factors → maternal endothelial dysfunction", C.teal);

  // Pro vs Anti angiogenic
  s.addShape(pres.ShapeType.rect, { x: 0.38, y: 1.0, w: 4.2, h: 0.4, fill: { type: "solid", color: C.green } });
  s.addText("PRO-ANGIOGENIC (reduced in pre-eclampsia)", { x: 0.38, y: 1.0, w: 4.2, h: 0.4, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });

  s.addShape(pres.ShapeType.rect, { x: 5.5, y: 1.0, w: 4.1, h: 0.4, fill: { type: "solid", color: C.red } });
  s.addText("ANTI-ANGIOGENIC (ELEVATED in pre-eclampsia)", { x: 5.5, y: 1.0, w: 4.1, h: 0.4, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });

  const pro = [
    { text: "VEGF (Vascular Endothelial Growth Factor)", bold: true, size: 13, color: C.green },
    { text: "Promotes vascular health, endothelial survival", size: 12 },
    { text: "PlGF (Placental Growth Factor)", bold: true, size: 13, color: C.green },
    { text: "↓ weeks before clinical onset — excellent early biomarker", size: 12 },
  ];
  const anti = [
    { text: "sFlt-1 (Soluble FMS-like Tyrosine Kinase-1)", bold: true, size: 13, color: C.red },
    { text: "Decoy receptor — binds VEGF & PlGF → neutralizes them → endothelial dysfunction", size: 12 },
    { text: "sEng (Soluble Endoglin)", bold: true, size: 13, color: C.red },
    { text: "Antagonizes TGF-β → impairs nitric oxide signaling → vasoconstriction", size: 12 },
  ];
  bulletBox(s, pro, 0.38, 1.45, 4.7, 1.8, 12);
  bulletBox(s, anti, 5.1, 1.45, 4.7, 1.8, 12);

  const consequence = [
    { text: "Consequences of Endothelial Dysfunction:", bold: true, color: C.midBlue, size: 14 },
    { text: "Hypertension (vasospasm, increased SVR) | Proteinuria (glomerular endotheliosis) | Edema (↑ capillary permeability)", size: 13 },
    { text: "Coagulopathy (endothelial activation → platelet aggregation → HELLP) | Cerebral involvement → eclampsia", size: 13 },
    { text: "sFlt-1/PlGF ratio >38 can rule-in pre-eclampsia within 4 weeks (NPV >99% for ratio <38)", size: 12, color: C.teal, italic: true },
  ];
  bulletBox(s, consequence, 0.38, 3.35, 9.2, 1.95, 13);
  footer(s, 9);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 10 — GENETIC & IMMUNOLOGICAL FACTORS
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  sidePanel(s, C.midBlue);
  s.addText("ETIOPATHOGENESIS — Genetic, Immunological & Maternal Factors", {
    x: 0.38, y: 0.15, w: 9.3, h: 0.55,
    fontSize: 20, bold: true, color: C.white, fontFace: "Calibri",
  });
  accentBar(s, 0.72);

  const items = [
    { text: "Genetic Predisposition:", bold: true, color: C.accentLight, size: 14 },
    { text: "~50% heritability; HLA-related immune gene variants, angiotensinogen gene (AGT M235T) polymorphism", size: 13 },
    { text: "First GWAS (McGinnis et al.) identified FLT1 locus — fetal genome variants at sFlt-1 gene → increased placental sFlt-1 → pre-eclampsia", size: 13 },
    { text: "MTHFR gene mutation → hyperhomocysteinemia → endothelial damage; Lipoprotein lipase variants → dyslipidemia", size: 13 },
    { text: "Immunological Factors:", bold: true, color: C.accentLight, size: 14 },
    { text: "Failure of maternal immune tolerance to paternal antigens at the implantation site", size: 13 },
    { text: "Altered Treg/Th17 balance → pro-inflammatory state at the placental interface", size: 13 },
    { text: "Maternal Cardiovascular & Metabolic Factors:", bold: true, color: C.accentLight, size: 14 },
    { text: "Pre-existing endothelial dysfunction, insulin resistance, dyslipidemia sensitize the vasculature", size: 13 },
    { text: "Women with chronic hypertension → 25% chance of superimposed pre-eclampsia", size: 13 },
    { text: "Paternal factors:", bold: true, color: C.accentLight, size: 14 },
    { text: "New partner increases risk; limited prior exposure to partner's semen → reduced immune tolerance", size: 13 },
  ];
  bulletBox(s, items, 0.38, 0.85, 9.2, 4.35, 13, C.white);
  footer(s, 10);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 11 — PATHOPHYSIOLOGY: ORGAN EFFECTS
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sidePanel(s, C.red);
  accentBar(s);
  slideTitle(s, "PATHOPHYSIOLOGY — Multi-Organ Effects of Pre-eclampsia", 0.18, C.textDark);

  const organs = [
    ["KIDNEY", "Glomerular endotheliosis (pathognomonic)\nReduced GFR, proteinuria, urate retention\nOliguria / acute renal failure (severe cases)", C.teal],
    ["LIVER", "Periportal / ischemic hepatocellular necrosis\nCapsular hemorrhage → risk of rupture\nElevated AST/ALT → HELLP syndrome", C.accent],
    ["CNS", "Cerebral vasospasm / edema\nEclamptic seizures\nCerebral hemorrhage (main cause of death)", C.red],
    ["HEMATOLOGIC", "Thrombocytopenia (platelet activation)\nDIC in severe cases\nHELLP: Hemolysis + ELT + LP", C.midBlue],
    ["UTEROPLACENTAL", "Reduced uteroplacental blood flow\nFetal growth restriction (FGR)\nAbruptio placentae, IUFD", C.green],
    ["CARDIOVASCULAR", "↑ SVR, vasospasm → hypertension\nReduced plasma volume (hemoconcentration)\nDiastolic dysfunction (long-term risk)", "6A3D9A"],
  ];

  organs.forEach((o, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    colorBox(s, o[0] + "\n" + o[2], 0.35 + col * 3.12, 1.05 + row * 2.2, 2.8, 2.0, o[2], C.white, 11, false);
  });
  footer(s, 11);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 12 — PREDICTION: 1ST TRIMESTER SCREENING
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  sidePanel(s, C.teal);
  s.addText("PREDICTION OF PRE-ECLAMPSIA — 1st Trimester Screening (11–13+6 Weeks)", {
    x: 0.38, y: 0.15, w: 9.3, h: 0.55,
    fontSize: 19, bold: true, color: C.white, fontFace: "Calibri",
  });
  accentBar(s, 0.72);

  const items = [
    { text: "FMF Combined Algorithm (Nicolaides / Fetal Medicine Foundation):", bold: true, color: C.accentLight, size: 14 },
    { text: "Detection rate 75–90% for preterm pre-eclampsia with 10% FPR using combination:", size: 13 },
    { text: "Mean Arterial Pressure (MAP) — elevated", size: 13, indent: 1 },
    { text: "Uterine Artery Pulsatility Index (UtA-PI) by Doppler — elevated bilateral notching / high PI indicates poor remodeling", size: 13, indent: 1 },
    { text: "Maternal serum PAPP-A (Pregnancy-Associated Plasma Protein A) — low PAPP-A associated with early-onset PE", size: 13, indent: 1 },
    { text: "Serum PlGF (Placental Growth Factor) — low levels predict PE 5–8 weeks before onset", size: 13, indent: 1 },
    { text: "ROLNIK et al. ASPRE Trial (2017):", bold: true, color: C.accentLight, size: 14 },
    { text: "FMF algorithm used to identify high-risk women → aspirin 150 mg/day from 11–14 weeks → 62% reduction in preterm PE", size: 13 },
    { text: "Other 1st Trimester Biomarkers:", bold: true, color: C.accentLight, size: 14 },
    { text: "PP-13 (Placental Protein 13): low levels in 1st trimester — useful for early-onset PE, less so for term PE", size: 13 },
    { text: "Cell-free fetal DNA, activin A — under investigation", size: 13 },
  ];
  bulletBox(s, items, 0.38, 0.85, 9.2, 4.35, 13, C.white);
  footer(s, 12);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 13 — PREDICTION: 2ND TRIMESTER & BIOMARKERS
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sidePanel(s, C.midBlue);
  accentBar(s);
  slideTitle(s, "PREDICTION — 2nd Trimester Screening & Angiogenic Biomarkers", 0.18, C.textDark);
  sectionLabel(s, "Angiogenic factors are most useful from mid-gestation onward", C.midBlue);

  const left = [
    { text: "sFlt-1/PlGF Ratio:", bold: true, color: C.red, size: 14 },
    { text: "Rises 5–8 weeks before clinical onset of pre-eclampsia", size: 13 },
    { text: "Ratio >38: Rules IN pre-eclampsia within 4 weeks (PPV ~65%)", size: 13 },
    { text: "Ratio <38: Rules OUT pre-eclampsia within 1 week (NPV >99%)", size: 13 },
    { text: "Particularly elevated in: severe PE, early-onset PE, PE + FGR", size: 13 },
    { text: "sFlt-1 and sEng rise from midgestation — peak near onset", size: 13 },
    { text: "PlGF falls from 16 weeks onward in women destined for PE", size: 13 },
  ];
  const right = [
    { text: "2nd Trimester Uterine Artery Doppler (18–24 weeks):", bold: true, color: C.midBlue, size: 14 },
    { text: "Bilateral notching OR mean PI >95th centile → high risk", size: 13 },
    { text: "DR: 50–60% for early-onset PE; <25% for late-onset PE", size: 13 },
    { text: "Clinical Risk Factor Scoring:", bold: true, color: C.midBlue, size: 14 },
    { text: "ACOG: Any high-risk factor OR ≥2 moderate-risk factors → initiate aspirin", size: 13 },
    { text: "The FMF risk calculator combines all parameters into a patient-specific % risk", size: 13 },
    { text: "Urinary PlGF — low levels from late 2nd trimester: supplementary marker", size: 13 },
  ];
  bulletBox(s, left, 0.38, 1.05, 4.5, 4.1, 13);
  bulletBox(s, right, 5.1, 1.05, 4.5, 4.1, 13);
  s.addShape(pres.ShapeType.line, { x: 5.02, y: 1.05, w: 0, h: 4.0, line: { color: C.lightGray, width: 1 } });
  footer(s, 13);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 14 — PREVENTION: ASPIRIN
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  sidePanel(s, C.accent);
  s.addText("PREVENTION OF PRE-ECLAMPSIA — Low-Dose Aspirin", {
    x: 0.38, y: 0.15, w: 9.3, h: 0.55,
    fontSize: 22, bold: true, color: C.white, fontFace: "Calibri",
  });
  accentBar(s, 0.72);

  const items = [
    { text: "Mechanism of Aspirin:", bold: true, color: C.accentLight, size: 14 },
    { text: "Inhibits COX-1 → reduces thromboxane A2 (vasoconstrictor) while relatively sparing prostacyclin (vasodilator) → improved uteroplacental blood flow", size: 13 },
    { text: "Dose & Timing:", bold: true, color: C.accentLight, size: 14 },
    { text: "USPSTF recommendation: 81 mg/day from ≥12 weeks' gestation (Grade B)", size: 13 },
    { text: "ASPRE Trial (Rolnik 2017): 150 mg/day from 11–14 weeks in high-risk women → 62% reduction in preterm PE", size: 13 },
    { text: "WHO: 75–150 mg/day from early 2nd trimester in high-risk populations", size: 13 },
    { text: "Start BEFORE 16 weeks for maximum benefit; continue until delivery or 36 weeks", size: 13 },
    { text: "Efficacy:", bold: true, color: C.accentLight, size: 14 },
    { text: "Meta-analyses: ~10–20% reduction in overall PE; ~62% in preterm PE (high-risk, FMF-identified)", size: 13 },
    { text: "72 women need to be treated to prevent 1 case of PE (low-risk); NNT ~10–15 in high-risk", size: 13 },
    { text: "Indications (HIGH-RISK — USPSTF):", bold: true, color: C.accentLight, size: 14 },
    { text: "Previous PE | Multifetal gestation | Chronic HTN | DM (pre-gestational) | Renal disease | Autoimmune disease (SLE, APS)", size: 13 },
  ];
  bulletBox(s, items, 0.38, 0.85, 9.2, 4.35, 13, C.white);
  footer(s, 14);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 15 — PREVENTION: CALCIUM, OTHER MEASURES
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sidePanel(s, C.teal);
  accentBar(s);
  slideTitle(s, "PREVENTION — Calcium, Antioxidants & Other Strategies", 0.18, C.textDark);

  const items = [
    { text: "Calcium Supplementation:", bold: true, color: C.teal, size: 14 },
    { text: "WHO trial: Calcium 1.5–2 g/day recommended in populations with LOW dietary calcium intake → reduces risk of PE and serious complications", size: 13 },
    { text: "In populations with adequate calcium intake (US/Europe): large RCT showed NO reduction in PE incidence", size: 13 },
    { text: "Mechanism: Calcium → reduces PTH → reduces intracellular calcium in smooth muscle → vasodilation", size: 13 },
    { text: "Antioxidants (Vitamins C & E):", bold: true, color: C.teal, size: 14 },
    { text: "Initial small RCT showed benefit; BUT large trials (10,154 women) showed NO significant benefit; excess LBW infants observed", size: 13 },
    { text: "NOT routinely recommended", size: 13, bold: true, color: C.red },
    { text: "Low Molecular Weight Heparin (LMWH):", bold: true, color: C.teal, size: 14 },
    { text: "Meta-analysis of 6 RCTs: suggested benefit for composite placental outcomes; BUT subsequent large RCT (AFFIRM) showed NO reduction in PE", size: 13 },
    { text: "NOT recommended for routine PE prevention; reserved for women with APS / thrombophilia", size: 13 },
    { text: "NOT Recommended / Ineffective:", bold: true, color: C.red, size: 14 },
    { text: "Sodium restriction | Fish oil / omega-3 | Diuretics | Bed rest alone | Vitamin D supplementation (insufficient evidence)", size: 13 },
  ];
  bulletBox(s, items, 0.38, 1.0, 9.2, 4.25, 13);
  footer(s, 15);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 16 — INVESTIGATIONS
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  sidePanel(s, C.midBlue);
  s.addText("INVESTIGATIONS IN PRE-ECLAMPSIA", {
    x: 0.38, y: 0.15, w: 9.3, h: 0.55,
    fontSize: 22, bold: true, color: C.white, fontFace: "Calibri",
  });
  accentBar(s, 0.72);

  const labs = [
    { text: "MATERNAL LABORATORY INVESTIGATIONS:", bold: true, color: C.accentLight, size: 14 },
    { text: "Complete Blood Count: thrombocytopenia (PLT <100,000) → HELLP; hemoconcentration (↑Hct)", size: 13 },
    { text: "Renal Function: Serum creatinine (>1.1 mg/dL), uric acid (>6 mg/dL — early marker), BUN, electrolytes", size: 13 },
    { text: "Liver Function Tests: AST, ALT (>2× ULN in HELLP), LDH (hemolysis marker), bilirubin", size: 13 },
    { text: "Coagulation: PT, aPTT, fibrinogen (screen for DIC in severe cases)", size: 13 },
    { text: "Urinalysis: Proteinuria — 24-hour urine protein (gold standard ≥300 mg) OR spot protein:creatinine ratio ≥0.3", size: 13 },
    { text: "Peripheral blood smear: Schistocytes (microangiopathic hemolysis) in HELLP", size: 13 },
    { text: "ANGIOGENIC BIOMARKERS:", bold: true, color: C.accentLight, size: 14 },
    { text: "sFlt-1/PlGF ratio: >38 rules in; <38 rules out (within 1 week)", size: 13 },
    { text: "IMAGING & FETAL INVESTIGATIONS:", bold: true, color: C.accentLight, size: 14 },
    { text: "Fetal ultrasound: EFW, amniotic fluid index, biophysical profile, UA Doppler (S/D ratio, RI, PI, absent/reversed EDV)", size: 13 },
    { text: "Cardiotocography (CTG): baseline monitoring; non-stress test", size: 13 },
    { text: "CT/MRI brain: only if focal neurological deficit, persistent seizures or atypical presentation; NOT routine", size: 13 },
  ];
  bulletBox(s, labs, 0.38, 0.85, 9.2, 4.5, 13, C.white);
  footer(s, 16);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 17 — MANAGEMENT OVERVIEW / PHILOSOPHY
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sidePanel(s, C.midBlue);
  accentBar(s);
  slideTitle(s, "MANAGEMENT — Philosophy & Key Principles", 0.18, C.textDark);
  sectionLabel(s, "Based on ACOG guidelines and Creasy & Resnik's Maternal-Fetal Medicine", C.midBlue);

  // 3 tenets
  const tenets = [
    ["TENET 1", "Delivery is always appropriate therapy for the MOTHER but not always for the FETUS", C.midBlue],
    ["TENET 2", "Signs/symptoms are NOT pathogenetically important — vasospasm/poor perfusion is the underlying mechanism. Treating BP alone does not reverse pathology", C.teal],
    ["TENET 3", "Pathologic changes of PE begin weeks before clinical diagnosis. Antihypertensives do NOT treat the disease — only prevent acute complications", C.accent],
  ];

  tenets.forEach((t, i) => {
    s.addShape(pres.ShapeType.roundRect, { x: 0.38, y: 1.05 + i * 1.35, w: 9.2, h: 1.15, fill: { type: "solid", color: t[2] }, rectRadius: 0.08 });
    s.addText(t[0], { x: 0.5, y: 1.1 + i * 1.35, w: 1.5, h: 0.4, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(t[1], { x: 2.1, y: 1.08 + i * 1.35, w: 7.2, h: 1.1, fontSize: 13, color: C.white, fontFace: "Calibri", valign: "middle" });
  });

  s.addText("Goals of Management: (1) Prevent maternal morbidity/mortality  (2) Achieve maximum fetal maturity before delivery  (3) Avoid iatrogenic complications", {
    x: 0.38, y: 5.1, w: 9.2, h: 0.35,
    fontSize: 11, italic: true, color: C.midBlue, fontFace: "Calibri",
  });
  footer(s, 17);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 18 — TIMING OF DELIVERY
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  sidePanel(s, C.accent);
  s.addText("MANAGEMENT — Timing of Delivery", {
    x: 0.38, y: 0.15, w: 9.3, h: 0.55,
    fontSize: 22, bold: true, color: C.white, fontFace: "Calibri",
  });
  accentBar(s, 0.72);

  // Gestational age table
  const rows = [
    ["<24 weeks", "Extremely poor perinatal outcomes even with expectant Mx; termination usually recommended (severe PE)", C.red],
    ["24–34 weeks", "Expectant management (2-week delay) where feasible; steroids for lung maturity; intensive maternal + fetal monitoring", C.teal],
    ["34–37 weeks (PE without severe features)", "Expectant to 37 weeks; reduces neonatal RDS and childhood respiratory morbidity without increased maternal risk", C.midBlue],
    ["≥37 weeks", "Delivery indicated — neonatal benefit of continuing pregnancy is minimal; risk of maternal complications outweighs benefit", C.accent],
    ["Any GA — Severe PE with danger signs", "Expedite delivery regardless of GA: non-reassuring FHR, abruption, thrombocytopenia, worsening renal/liver function, headache, visual changes, epigastric pain", C.red],
  ];

  rows.forEach((r, i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.38, y: 0.88 + i * 0.88, w: 2.3, h: 0.82, fill: { type: "solid", color: r[2] } });
    s.addText(r[0], { x: 0.38, y: 0.88 + i * 0.88, w: 2.3, h: 0.82, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(r[1], { x: 2.75, y: 0.9 + i * 0.88, w: 6.95, h: 0.78, fontSize: 12, color: C.white, fontFace: "Calibri", valign: "middle" });
  });
  footer(s, 18);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 19 — ANTIHYPERTENSIVE THERAPY
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sidePanel(s, C.red);
  accentBar(s);
  slideTitle(s, "MANAGEMENT — Antihypertensive Therapy in Pre-eclampsia", 0.18, C.textDark);
  sectionLabel(s, "Goal: prevent acute complications (stroke, eclampsia) — does NOT treat the underlying disease", C.red);

  const items = [
    { text: "When to Treat:", bold: true, color: C.red, size: 14 },
    { text: "Threshold: SBP ≥150–160 mmHg OR DBP ≥100–110 mmHg → initiate antihypertensives to prevent cerebral hemorrhage", size: 13 },
    { text: "Avoid acute aggressive BP reduction (↓ uteroplacental perfusion → fetal distress)", size: 13 },
    { text: "Target BP: 130–155 / 80–105 mmHg (avoid hypotension)", size: 13 },
    { text: "ACUTE (Hypertensive Emergency — IV options):", bold: true, color: C.red, size: 14 },
    { text: "Labetalol IV: 20 mg bolus → repeat 40–80 mg q10 min (max 300 mg); also as infusion", size: 13 },
    { text: "Hydralazine IV: 5–10 mg q20 min; risk of maternal hypotension, reflex tachycardia", size: 13 },
    { text: "Nifedipine (oral immediate-release): 10–20 mg q20–30 min (max 50 mg/hr); convenient, effective", size: 13 },
    { text: "CHRONIC / MAINTENANCE (oral):", bold: true, color: C.red, size: 14 },
    { text: "Labetalol: 200–400 mg BD–TDS (first choice in many guidelines)", size: 13 },
    { text: "Methyldopa: 250–750 mg TDS–QDS (most safety data in pregnancy)", size: 13 },
    { text: "Nifedipine XL: 20–60 mg OD/BD — good for chronic BP control", size: 13 },
    { text: "CONTRAINDICATED: ACE inhibitors, ARBs, direct renin inhibitors (teratogenic — causes oligohydramnios, fetal renal failure)", bold: true, color: C.red, size: 12 },
  ];
  bulletBox(s, items, 0.38, 1.0, 9.2, 4.2, 13);
  footer(s, 19);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 20 — MAGNESIUM SULFATE
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  sidePanel(s, C.teal);
  s.addText("MANAGEMENT — Magnesium Sulfate: Seizure Prophylaxis & Eclampsia Treatment", {
    x: 0.38, y: 0.15, w: 9.3, h: 0.55,
    fontSize: 18, bold: true, color: C.white, fontFace: "Calibri",
  });
  accentBar(s, 0.72);

  const items = [
    { text: "Indications for MgSO4:", bold: true, color: C.accentLight, size: 14 },
    { text: "Seizure prophylaxis: Pre-eclampsia with severe features (SBP ≥160, symptoms, thrombocytopenia, hepatic/renal dysfunction)", size: 13 },
    { text: "Treatment of eclamptic seizures (drug of choice, superior to diazepam and phenytoin — Magpie Trial)", size: 13 },
    { text: "Dose Regimen (Pritchard / WHO / Zuspan):", bold: true, color: C.accentLight, size: 14 },
    { text: "Loading dose: MgSO4 4–6 g IV over 15–20 minutes", size: 13 },
    { text: "Maintenance: 1–2 g/hour IV infusion; continue for 24 hours post-delivery", size: 13 },
    { text: "For eclampsia recurrence: additional 2–4 g IV bolus over 5 min", size: 13 },
    { text: "Monitoring for Toxicity:", bold: true, color: C.red, size: 14 },
    { text: "Urinary output ≥25–30 mL/hour (oliguria → toxicity accumulates)", size: 13 },
    { text: "Respiratory rate >12/min (respiratory depression occurs at 9–12 mEq/L)", size: 13 },
    { text: "Patellar reflexes present (loss of reflexes at 7–10 mEq/L = early toxicity sign)", size: 13 },
    { text: "Antidote: Calcium gluconate 1 g IV (10 mL of 10% solution) over 10 minutes", bold: true, color: C.accentLight, size: 13 },
    { text: "Mechanism: Antagonizes NMDA receptors → central anticonvulsant; causes vasodilation (↓BP) and bronchodilation", size: 12, italic: true },
  ];
  bulletBox(s, items, 0.38, 0.85, 9.2, 4.4, 13, C.white);
  footer(s, 20);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 21 — HELLP SYNDROME
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightBg(s);
  sidePanel(s, C.red);
  accentBar(s);
  slideTitle(s, "HELLP SYNDROME — A Severe Variant of Pre-eclampsia", 0.18, C.textDark);
  sectionLabel(s, "H = Hemolysis   EL = Elevated Liver enzymes   LP = Low Platelets", C.red);

  const left = [
    { text: "Incidence:", bold: true, size: 14, color: C.red },
    { text: "0.5–0.9% of all pregnancies; 10–20% of severe PE cases", size: 13 },
    { text: "70% antepartum (usually 27–37 weeks); 30% within 48h postpartum", size: 13 },
    { text: "Diagnostic Criteria (Tennessee):", bold: true, size: 14, color: C.red },
    { text: "Hemolysis: LDH >600 IU/L; abnormal peripheral smear (schistocytes)", size: 13 },
    { text: "Elevated Liver enzymes: AST >70 IU/L", size: 13 },
    { text: "Low Platelets: <100,000/mm³", size: 13 },
    { text: "Mississippi Classification:", bold: true, size: 13, color: C.midBlue },
    { text: "Class I: PLT <50,000 | Class II: 50–100,000 | Class III: 100–150,000", size: 12 },
  ];
  const right = [
    { text: "Clinical Features:", bold: true, size: 14, color: C.red },
    { text: "Epigastric / RUQ pain (90%), Nausea/vomiting, Malaise, Headache", size: 13 },
    { text: "15% may have NO hypertension / proteinuria at presentation", size: 13 },
    { text: "Management:", bold: true, size: 14, color: C.red },
    { text: "Stabilize: MgSO4 + antihypertensives; correct coagulopathy", size: 13 },
    { text: "Steroids (dexamethasone/betamethasone) for fetal lung maturity if <34 weeks AND may temporarily improve platelet count", size: 13 },
    { text: "Definitive treatment: DELIVERY (regardless of GA if maternal condition deteriorates)", size: 13, bold: true },
    { text: "Complications: DIC, liver rupture, ARF, ARDS, pulmonary edema, placental abruption, IUFD", size: 12, color: C.red },
  ];
  bulletBox(s, left, 0.38, 1.05, 4.5, 4.2, 13);
  bulletBox(s, right, 5.1, 1.05, 4.5, 4.2, 13);
  s.addShape(pres.ShapeType.line, { x: 5.02, y: 1.05, w: 0, h: 4.1, line: { color: C.lightGray, width: 1 } });
  footer(s, 21);
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 22 — ECLAMPSIA MANAGEMENT
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkBg(s);
  sidePanel(s, C.red);
  s.addText("ECLAMPSIA — Management Protocol", {
    x: 0.38, y: 0.15, w: 9.3, h: 0.55,
    fontSize: 22, bold: true, color: C.white, fontFace: "Calibri",
  });
  accentBar(s, 0.72);

  const steps = [
    ["1. ABC", "Airway, Breathing, Circulation\nPosition left lateral; O2 by mask; IV access × 2; pulse oximetry", C.midBlue],
    ["2. MgSO4", "Loading dose 4–6 g IV over 15–20 min\nMaintenance 1–2 g/hr; recurrent seizure → 2–4 g IV bolus", C.teal],
    ["3. BP Control", "If SBP ≥160 or DBP ≥110: Labetalol IV / Hydralazine IV / Nifedipine PO\nTarget BP: 140–150 / 90–100 mmHg", C.accent],
    ["4. Fetal Assessment", "Continuous CTG monitoring\nMaternal stabilization takes priority; fetal bradycardia common post-seizure (usually resolves 3–5 min)", C.midBlue],
    ["5. Delivery", "Plan delivery once maternal condition is stabilized\nCS not mandatory — vaginal delivery if favorable cervix + no fetal compromise", C.red],
  ];

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// ═══════════════════════════════════════════════════════════════════
// SLIDE 23 — POSTPARTUM MANAGEMENT
// ═══════════════════════════════════════════════════════════════════
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  sidePanel(s, C.teal);
  accentBar(s);
  slideTitle(s, "MANAGEMENT — Postpartum Care & Long-Term Follow-up", 0.18, C.textDark);
  sectionLabel(s, "Pre-eclampsia does NOT always resolve immediately after delivery", C.teal);

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    { text: "Postpartum Monitoring:", bold: true, color: C.teal, size: 14 },
    { text: "BP monitoring: every 4–6 hours for first 48–72 h; PE may first manifest or WORSEN postpartum in 30% of cases", size: 13 },
    { text: "Continue MgSO4 for 24–48 hours postpartum in severe PE / eclampsia", size: 13 },
    { text: "BP may rise further 3–5 days postpartum (fluid mobilization) — watch for late postpartum eclampsia (up to 6 weeks)", size: 13 },
    { text: "Postpartum Antihypertensives:", bold: true, color: C.teal, size: 14 },
    { text: "Labetalol, nifedipine (calcium channel blocker) — safe during breastfeeding", size: 13 },
    { text: "Methyldopa: safe but associated with postpartum depression — use alternatives if possible", size: 13 },
    { text: "Avoid NSAIDs postpartum in pre-eclampsia (worsens hypertension and renal function)", size: 13 },
    { text: "Long-Term Cardiovascular Risk:", bold: true, color: C.red, size: 14 },
    { text: "PE is an independent risk factor for future cardiovascular disease: HTN (×4 risk), IHD (×2), stroke (×2), cardiomyopathy", size: 13 },
    { text: "Annual BP check; cardiovascular risk factor screening; lifestyle counseling", size: 13 },
    { text: "Recurrence Counseling:", bold: true, color: C.teal, size: 14 },
    { text: "Recurrence risk ~20% in subsequent pregnancy; higher with severe/early-onset PE", size: 13 },
    { text: "Aspirin prophylaxis in next pregnancy; preconception BP optimization", size: 13 },
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// ═══════════════════════════════════════════════════════════════════
// SLIDE 24 — FETAL & PERINATAL CONSIDERATIONS
// ═══════════════════════════════════════════════════════════════════
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    { text: "Fetal Growth Restriction (FGR):", bold: true, color: C.accentLight, size: 14 },
    { text: "Reduced uteroplacental blood flow → asymmetric IUGR (brain-sparing pattern); EFW <10th centile", size: 13 },
    { text: "Doppler surveillance: Umbilical artery PI/RI/S:D ratio; absent or reversed EDF → immediate delivery consideration", size: 13 },
    { text: "Middle cerebral artery (MCA) Doppler: brain sparing (↑ MCA PI) — indicates redistribution of fetal blood flow", size: 13 },
    { text: "Antenatal Corticosteroids:", bold: true, color: C.accentLight, size: 14 },
    { text: "Betamethasone 12 mg IM × 2 doses 24 h apart if delivery anticipated before 34 weeks", size: 13 },
    { text: "Reduces RDS, IVH, necrotizing enterocolitis in preterm neonates", size: 13 },
    { text: "Fetal Monitoring:", bold: true, color: C.accentLight, size: 14 },
    { text: "Non-stress test (NST) — reactive pattern reassuring; biophysical profile score (BPS) ≥8/10 reassuring", size: 13 },
    { text: "Oligohydramnios (AFI <5 cm / MVP <2 cm) → indicator of uteroplacental insufficiency", size: 13 },
    { text: "Neonatal complications:", bold: true, color: C.accentLight, size: 14 },
    { text: "Prematurity, RDS, IVH, sepsis (preterm delivery), hypoglycemia, polycythemia; IUFD in severe/untreated cases", size: 13 },
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  footer(s, 24);
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// ═══════════════════════════════════════════════════════════════════
// SLIDE 25 — SUMMARY & KEY TAKEAWAYS
// ═══════════════════════════════════════════════════════════════════
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    { text: "Two-stage model: abnormal placentation (Stage 1) → angiogenic imbalance/endothelial dysfunction (Stage 2)", size: 12, color: C.lightGray },
    { text: "sFlt-1 ↑ and PlGF ↓ are central mediators; sFlt-1/PlGF ratio is a validated diagnostic/predictive biomarker", size: 12, color: C.lightGray },
    { text: "1st trimester FMF algorithm (MAP + UtA-PI + PAPP-A + PlGF) detects 75–90% of preterm PE", size: 12, color: C.lightGray },
    { text: "Low-dose aspirin (75–150 mg/day from <16 weeks) is the only proven prevention in high-risk women", size: 12, bold: true, color: C.accentLight },
    { text: "Delivery is the ONLY cure — timing balanced between maternal safety and fetal maturity", size: 12, color: C.lightGray },
    { text: "MgSO4 is the drug of choice for seizure prophylaxis and eclampsia treatment (monitor reflexes, RR, UO)", size: 12, color: C.lightGray },
    { text: "HELLP: Hemolysis + elevated liver enzymes + low platelets — severe PE variant; delivery is definitive treatment", size: 12, color: C.lightGray },
    { text: "Pre-eclampsia is a cardiovascular risk marker — lifelong surveillance for HTN, IHD, stroke recommended", size: 12, bold: true, color: C.tealLight },
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// ─── WRITE FILE ──────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/preeclampsia-pptx/Hypertensive_Disorders_Pregnancy_PE.pptx" })
  .then(() => console.log("DONE: file written successfully"))
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