international guideline on etiopathogenesis clinical features and complication with recent advances in ppt form
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"hypertensive disorders of pregnancy" AND guidelines
Searching the Web
hypertensive disorders pregnancy international guidelines 2024 2025 etiopathogenesis preeclampsia
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Reading Web Page
https://www.aafp.org/afp/2024/0300/hypertensive-disorders-of…
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Running Command
mkdir -p /home/daytona/workspace/hdp-presentation && ls /home/daytona/workspace/hdp-presentation/
Writing File
~/hdp-presentation/build.js
const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3" x 7.5"
pres.author = "Medical Education";
pres.title = "Hypertensive Disorders of Pregnancy";
// ─── COLOR PALETTE ──────────────────────────────────────────────
const DARK_NAVY = "0D1B2A"; // dominant dark bg
const MED_BLUE = "1B4F72"; // supporting
const ACCENT_TEAL = "1ABC9C"; // sharp accent
const LIGHT_BG = "EAF2F8"; // light slide bg
const WHITE = "FFFFFF";
const LIGHT_GRAY = "D5D8DC";
const WARN_RED = "C0392B";
const GOLD = "F1C40F";
const TEXT_DARK = "1A252F";
const TEXT_MID = "2C3E50";
// ─── HELPER: Section header bar ──────────────────────────────────
function addSectionBar(slide, color, text) {
slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.7, fill: { color } });
slide.addText(text, { x: 0.3, y: 0, w: 12.7, h: 0.7, fontSize: 20, bold: true, color: WHITE, valign: "middle", margin: 0 });
}
// ─── HELPER: Bullet block ────────────────────────────────────────
function addBullets(slide, items, opts) {
const { x, y, w, h, fontSize = 14, color = TEXT_DARK, indent = 0.3 } = opts;
const textArr = items.map((item, i) => ({
text: item,
options: {
bullet: { type: "bullet", indent },
breakLine: i < items.length - 1,
fontSize,
color,
}
}));
slide.addText(textArr, { x, y, w, h, valign: "top" });
}
// ─── HELPER: Colored box ─────────────────────────────────────────
function addBox(slide, { x, y, w, h, fill, text, titleFill, title, fontSize = 13, textColor = WHITE }) {
if (title) {
slide.addShape(pres.ShapeType.rect, { x, y, w, h: 0.38, fill: { color: titleFill || fill }, rectRadius: 0 });
slide.addText(title, { x, y, w, h: 0.38, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
slide.addShape(pres.ShapeType.rect, { x, y: y + 0.38, w, h: h - 0.38, fill: { color: fill }, rectRadius: 0 });
const textArr = (Array.isArray(text) ? text : [text]).map((t, i, arr) => ({
text: t, options: { bullet: { type: "bullet" }, breakLine: i < arr.length - 1, fontSize, color: textColor }
}));
slide.addText(textArr, { x: x + 0.1, y: y + 0.42, w: w - 0.2, h: h - 0.5, valign: "top", fontSize });
} else {
slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: fill } });
const textArr = (Array.isArray(text) ? text : [text]).map((t, i, arr) => ({
text: t, options: { bullet: { type: "bullet" }, breakLine: i < arr.length - 1, fontSize, color: textColor }
}));
slide.addText(textArr, { x: x + 0.1, y: y + 0.1, w: w - 0.2, h: h - 0.2, valign: "top", fontSize });
}
}
// =================================================================
// SLIDE 1 — TITLE SLIDE
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK_NAVY } });
// Accent stripe
s.addShape(pres.ShapeType.rect, { x: 0, y: 2.8, w: 13.3, h: 0.08, fill: { color: ACCENT_TEAL } });
// Large title
s.addText("Hypertensive Disorders\nof Pregnancy", {
x: 1, y: 1.1, w: 11.3, h: 1.7, fontSize: 44, bold: true, color: WHITE, align: "center", valign: "middle"
});
s.addText("International Guidelines | Etiopathogenesis | Clinical Features | Complications | Recent Advances", {
x: 1, y: 3.1, w: 11.3, h: 0.55, fontSize: 17, color: ACCENT_TEAL, align: "center", italic: true
});
// Stats boxes
const stats = [
{ label: "Prevalence", val: "3-8%\nof pregnancies" },
{ label: "Maternal Deaths", val: "~16%\nglobally" },
{ label: "Annual Deaths", val: "~42,000\nper year (2023)" },
{ label: "US Hospital\nDeliveries", val: "1 in 7\naffected" }
];
stats.forEach((st, i) => {
const x = 1.2 + i * 2.85;
s.addShape(pres.ShapeType.rect, { x, y: 4.0, w: 2.5, h: 1.3, fill: { color: MED_BLUE }, line: { color: ACCENT_TEAL, width: 1.5 } });
s.addText(st.val, { x, y: 4.05, w: 2.5, h: 0.7, fontSize: 18, bold: true, color: GOLD, align: "center", valign: "middle" });
s.addText(st.label, { x, y: 4.75, w: 2.5, h: 0.5, fontSize: 12, color: LIGHT_GRAY, align: "center" });
});
s.addText("Sources: WHO Factsheet Dec 2025 | ISSHP 2021 | ACOG 2020 | AFP 2024", {
x: 1, y: 6.8, w: 11.3, h: 0.4, fontSize: 10, color: LIGHT_GRAY, align: "center", italic: true
});
}
// =================================================================
// SLIDE 2 — TABLE OF CONTENTS
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK_NAVY } });
s.addText("Contents", { x: 0.5, y: 0.3, w: 12.3, h: 0.7, fontSize: 28, bold: true, color: WHITE });
s.addShape(pres.ShapeType.rect, { x: 0.5, y: 1.05, w: 3, h: 0.05, fill: { color: ACCENT_TEAL } });
const items = [
["01", "Definitions & ISSHP 2021 Classification"],
["02", "Epidemiology & Risk Factors"],
["03", "Etiopathogenesis – Two-Stage Model"],
["04", "Angiogenic Imbalance (sFlt-1 / PlGF)"],
["05", "Immunologic & Genetic Mechanisms"],
["06", "Diagnostic Criteria"],
["07", "Clinical Features & Organ Systems"],
["08", "Complications – Maternal"],
["09", "Complications – Fetal/Neonatal"],
["10", "HELLP Syndrome"],
["11", "Management Overview"],
["12", "Antihypertensive Therapy"],
["13", "Prevention & Prophylaxis"],
["14", "Recent Advances 2023-2026"],
["15", "Long-term Consequences"],
];
items.forEach((item, i) => {
const col = i < 8 ? 0 : 1;
const row = col === 0 ? i : i - 8;
const x = col === 0 ? 0.5 : 7.0;
const y = 1.3 + row * 0.67;
s.addShape(pres.ShapeType.rect, { x, y: y - 0.02, w: 0.55, h: 0.45, fill: { color: ACCENT_TEAL } });
s.addText(item[0], { x, y: y - 0.02, w: 0.55, h: 0.45, fontSize: 14, bold: true, color: DARK_NAVY, align: "center", valign: "middle", margin: 0 });
s.addText(item[1], { x: x + 0.65, y: y - 0.02, w: 5.7, h: 0.45, fontSize: 13.5, color: WHITE, valign: "middle" });
});
}
// =================================================================
// SLIDE 3 — DEFINITIONS & ISSHP 2021 CLASSIFICATION
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: LIGHT_BG } });
addSectionBar(s, MED_BLUE, "01 | Definitions & ISSHP 2021 Classification");
const cats = [
{
title: "CHRONIC HYPERTENSION",
fill: "1B4F72",
items: [
"BP ≥140/90 mmHg before 20 weeks' gestation",
"OR pre-existing hypertension before pregnancy",
"Includes essential & secondary hypertension",
"Persists >12 weeks postpartum"
]
},
{
title: "GESTATIONAL HYPERTENSION",
fill: "21618C",
items: [
"New BP ≥140/90 mmHg after 20 weeks",
"No proteinuria, no end-organ damage",
"Resolves within 12 weeks postpartum",
"If severe: ≥160/110 mmHg (severe feature)"
]
},
{
title: "PREECLAMPSIA",
fill: "1E8449",
items: [
"Gestational HTN + proteinuria (≥300 mg/24h)",
"OR gestational HTN + end-organ damage",
"After 20 weeks (can occur without proteinuria)",
"Early-onset (<34 wks) vs Late-onset (≥34 wks)"
]
},
{
title: "ECLAMPSIA",
fill: "922B21",
items: [
"New-onset generalized seizures in preeclampsia",
"No other cause for seizure",
"Can occur antepartum, intrapartum, or postpartum",
"Medical emergency requiring MgSO4"
]
},
{
title: "SUPERIMPOSED PREECLAMPSIA",
fill: "784212",
items: [
"Chronic HTN + new proteinuria after 20 wks",
"OR sudden worsening of existing HTN",
"OR new end-organ dysfunction in chronic HTN",
"Higher risk than either condition alone"
]
},
];
cats.forEach((cat, i) => {
const col = i < 3 ? i : i - 3;
const row = i < 3 ? 0 : 1;
const x = i < 3 ? 0.2 + i * 4.3 : 2.35 + col * 4.3;
const y = i < 3 ? 0.9 : 4.1;
const w = 3.9;
const h = i < 3 ? 2.9 : 3.0;
s.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: cat.fill } });
s.addText(cat.title, { x: x + 0.05, y: y + 0.05, w: w - 0.1, h: 0.5, fontSize: 11.5, bold: true, color: GOLD, valign: "middle", align: "center", margin: 0 });
s.addShape(pres.ShapeType.line, { x: x + 0.15, y: y + 0.58, w: w - 0.3, h: 0, line: { color: GOLD, width: 0.8 } });
const textArr = cat.items.map((t, idx) => ({
text: t,
options: { bullet: { type: "bullet" }, breakLine: idx < cat.items.length - 1, fontSize: 11, color: WHITE }
}));
s.addText(textArr, { x: x + 0.08, y: y + 0.65, w: w - 0.16, h: h - 0.75, valign: "top" });
});
s.addText("ISSHP 2021 Classification (Magee et al, Pregnancy Hypertens. 2022;27:148-169) | ACOG 2020", {
x: 0.3, y: 7.2, w: 12.7, h: 0.25, fontSize: 9, color: MED_BLUE, italic: true
});
}
// =================================================================
// SLIDE 4 — EPIDEMIOLOGY & RISK FACTORS
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: LIGHT_BG } });
addSectionBar(s, MED_BLUE, "02 | Epidemiology & Risk Factors");
// Epi panel
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 0.85, w: 4.0, h: 6.3, fill: { color: MED_BLUE } });
s.addText("EPIDEMIOLOGY", { x: 0.2, y: 0.85, w: 4.0, h: 0.45, fontSize: 13, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
const epiItems = [
"Affects 3-8% of pregnancies worldwide",
"Increased prevalence 2017-2019 in US",
"Accounts for 7% of US pregnancy-related deaths",
"Responsible for ~16% of all maternal deaths globally (~42,000/year)",
"Higher prevalence in LMICs",
"Preeclampsia: 5-8% of pregnancies globally",
"Eclampsia: 1-2% of preeclampsia cases",
"Higher risk with multiple gestations:\n- Twins: 10-20%\n- Triplets: 25-60%\n- Quadruplets: up to 90%",
"44% of maternal deaths in 1st 6 days post-delivery attributable to HDP",
];
const epiArr = epiItems.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: i < epiItems.length - 1, fontSize: 11.5, color: WHITE } }));
s.addText(epiArr, { x: 0.3, y: 1.35, w: 3.8, h: 5.7, valign: "top" });
// Risk factor columns
const rfCols = [
{
title: "Non-Modifiable", color: "1A5276",
items: [
"Nulliparity (primigravida)",
"Age >35 or <18 years",
"Prior preeclampsia history",
"Family history (mother/sister)",
"Multiple gestation",
"ART/IVF conception",
"Hydatidiform mole",
"New paternity (partner change)",
"Born small for gestational age",
"Father born of PE pregnancy",
"ICSI conception",
"Black race / African descent"
]
},
{
title: "Modifiable", color: "1E8449",
items: [
"Obesity / BMI >30 kg/m²",
"Chronic hypertension",
"Diabetes mellitus (T1 or T2)",
"Chronic kidney disease",
"Dyslipidemia",
"Thrombophilia / APS",
"Sleep-disordered breathing",
"Autoimmune diseases (SLE, RA)",
"High-salt diet",
"Physical inactivity",
"Anxiety / stress",
"Low calcium/vitamin D intake"
]
}
];
rfCols.forEach((col, i) => {
const x = 4.4 + i * 4.5;
s.addShape(pres.ShapeType.rect, { x, y: 0.85, w: 4.1, h: 6.3, fill: { color: col.color } });
s.addText(col.title.toUpperCase() + " RISK FACTORS", { x, y: 0.85, w: 4.1, h: 0.45, fontSize: 12, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
const arr = col.items.map((t, idx) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: idx < col.items.length - 1, fontSize: 11.5, color: WHITE } }));
s.addText(arr, { x: x + 0.1, y: 1.35, w: 3.9, h: 5.7, valign: "top" });
});
}
// =================================================================
// SLIDE 5 — ETIOPATHOGENESIS: TWO-STAGE MODEL
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK_NAVY } });
addSectionBar(s, ACCENT_TEAL, "03 | Etiopathogenesis – Two-Stage Model");
// Stage 1 box
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 0.85, w: 6.0, h: 6.3, fill: { color: "163A52" } });
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 0.85, w: 6.0, h: 0.5, fill: { color: "1ABC9C" } });
s.addText("STAGE 1 — Impaired Placentation (1st trimester)", {
x: 0.2, y: 0.85, w: 6.0, h: 0.5, fontSize: 13, bold: true, color: DARK_NAVY, align: "center", valign: "middle", margin: 0
});
const stage1 = [
"Occurs at 8-18 weeks gestation",
"Extravillous trophoblasts (EVTs) invade decidua & myometrium",
"Normal: EVTs remodel spiral arteries → low-resistance, high-flow vessels",
"In preeclampsia: Shallow trophoblast invasion & incomplete spiral artery remodeling",
"Myometrial segments remain muscular & vasoactive",
"Results in uteroplacental ischemia and relative hypoxia",
"Mechanism: Defective immune tolerance (NK cell / HLA-C mismatch)",
"Genetic, immunologic & environmental factors contribute",
"Hypoxia triggers HIF-1α → sFlt-1 upregulation",
"Oxidative stress → NFkB activation → proinflammatory cytokines",
"Pathologic acute atherosis in 10% of PE placentas",
"Placental microparticle shedding → systemic inflammation",
"This stage is clinically silent — no symptoms yet"
];
const st1arr = stage1.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: i < stage1.length - 1, fontSize: 11.5, color: WHITE } }));
s.addText(st1arr, { x: 0.35, y: 1.42, w: 5.7, h: 5.65, valign: "top" });
// Arrow
s.addShape(pres.ShapeType.rect, { x: 6.3, y: 3.5, w: 0.7, h: 0.5, fill: { color: GOLD } });
s.addText("→", { x: 6.3, y: 3.5, w: 0.7, h: 0.5, fontSize: 22, bold: true, color: DARK_NAVY, align: "center", valign: "middle", margin: 0 });
// Stage 2 box
s.addShape(pres.ShapeType.rect, { x: 7.1, y: 0.85, w: 6.0, h: 6.3, fill: { color: "4A0E0E" } });
s.addShape(pres.ShapeType.rect, { x: 7.1, y: 0.85, w: 6.0, h: 0.5, fill: { color: WARN_RED } });
s.addText("STAGE 2 — Maternal Syndrome (2nd/3rd trimester)", {
x: 7.1, y: 0.85, w: 6.0, h: 0.5, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0
});
const stage2 = [
"Release of antiangiogenic factors from diseased placenta",
"sFlt-1 (soluble fms-like tyrosine kinase-1) markedly elevated",
"Soluble endoglin (sEng) elevated — inhibits TGF-β signaling",
"PlGF (placental growth factor) markedly reduced",
"sFlt-1/PlGF ratio >38 predictive of PE (sensitivity >80%)",
"Systemic endothelial dysfunction → widespread vasoconstriction",
"Increased sensitivity to angiotensin II & vasopressors",
"Decreased PGI2 (prostacyclin) / increased TXA2 (thromboxane)",
"Disruption of NO-mediated vasodilation",
"Proteinuria: glomerular endotheliosis (podocyte injury)",
"3 mechanisms summarized (Creasy & Resnik):",
" 1. Abnormal placentation → excess sFlt-1/sEng",
" 2. Preexisting endothelial sensitization (e.g., obesity)",
" 3. Excess placental mass (multiple gestation)"
];
const st2arr = stage2.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: i < stage2.length - 1, fontSize: 11.5, color: WHITE } }));
s.addText(st2arr, { x: 7.25, y: 1.42, w: 5.7, h: 5.65, valign: "top" });
}
// =================================================================
// SLIDE 6 — ANGIOGENIC IMBALANCE
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: LIGHT_BG } });
addSectionBar(s, MED_BLUE, "04 | Angiogenic Imbalance – sFlt-1, PlGF & Soluble Endoglin");
// Normal pregnancy panel
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 0.85, w: 5.9, h: 3.2, fill: { color: "D5F5E3" } });
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 0.85, w: 5.9, h: 0.45, fill: { color: "1E8449" } });
s.addText("NORMAL PREGNANCY", { x: 0.2, y: 0.85, w: 5.9, h: 0.45, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
const normalItems = [
"Balanced proangiogenic environment",
"VEGF & PlGF bind VEGFR-1/2 on endothelium",
"TGF-β1 signaling via endoglin promotes vessel stability",
"Low circulating sFlt-1, low sEng",
"Adequate uteroplacental perfusion",
"Endothelial NO production preserved",
"Peripheral vascular resistance falls by 25%"
];
const narr = normalItems.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: i < normalItems.length - 1, fontSize: 12, color: TEXT_DARK } }));
s.addText(narr, { x: 0.35, y: 1.35, w: 5.6, h: 2.65, valign: "top" });
// Preeclampsia panel
s.addShape(pres.ShapeType.rect, { x: 6.4, y: 0.85, w: 6.7, h: 3.2, fill: { color: "FDEDEC" } });
s.addShape(pres.ShapeType.rect, { x: 6.4, y: 0.85, w: 6.7, h: 0.45, fill: { color: WARN_RED } });
s.addText("PREECLAMPSIA", { x: 6.4, y: 0.85, w: 6.7, h: 0.45, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
const peItems = [
"↑ sFlt-1: sequesters free VEGF and PlGF → prevents endothelial receptor binding",
"↑ sEng: blocks TGF-β1 signaling → impaired NO/PGI2 production",
"↓ Free PlGF: marker detectable weeks before clinical disease",
"sFlt-1/PlGF ratio >38 → preeclampsia within 4 weeks (Zeisler et al 2016)",
"Ratio >85 = severe disease; correlates with fetal outcomes",
"DELPHI study: ratio predicts PE 1-4 weeks in advance (NEJM 2016)",
"Exogenous VEGF administration reverses PE in animal models"
];
const pearr = peItems.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: i < peItems.length - 1, fontSize: 12, color: TEXT_DARK } }));
s.addText(pearr, { x: 6.55, y: 1.35, w: 6.4, h: 2.65, valign: "top" });
// Bottom row: Clinical utility
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 4.2, w: 12.9, h: 3.05, fill: { color: MED_BLUE } });
s.addText("CLINICAL UTILITY OF BIOMARKERS (Recent Advances)", {
x: 0.2, y: 4.2, w: 12.9, h: 0.45, fontSize: 13, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0
});
const bioItems = [
["sFlt-1/PlGF Ratio", "Rule-in/rule-out preeclampsia in symptomatic women (ISSHP 2021 & FIGO 2019 endorsed)", "FDA cleared 2023 for US use"],
["PlGF alone", "Low PlGF (<12 pg/mL at 19-23 wks) predicts severe early-onset PE; PlGF-based testing reduces NICU admissions (PARROT trial)", ""],
["Large-scale proteomics", "2024 JAMA Cardiol study: early pregnancy proteomics predicts HDP weeks before clinical onset (Greenland et al 2024)", ""],
["Polygenic risk score", "Honigberg et al Nat Med 2023: polygenic prediction improves pre-pregnancy risk stratification", ""]
];
bioItems.forEach((bi, i) => {
const x = 0.3 + i * 3.2;
s.addShape(pres.ShapeType.rect, { x, y: 4.72, w: 3.0, h: 2.38, fill: { color: "163A52" } });
s.addText(bi[0], { x, y: 4.72, w: 3.0, h: 0.42, fontSize: 11.5, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
s.addText(bi[1] + (bi[2] ? " " + bi[2] : ""), { x: x + 0.05, y: 5.14, w: 2.9, h: 1.9, fontSize: 10.5, color: WHITE, valign: "top" });
});
}
// =================================================================
// SLIDE 7 — IMMUNOLOGIC & GENETIC MECHANISMS
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK_NAVY } });
addSectionBar(s, ACCENT_TEAL, "05 | Immunologic, Genetic & Oxidative Stress Mechanisms");
const panels = [
{
title: "IMMUNOLOGIC MECHANISMS",
color: "1A5276",
items: [
"Fetal antigens trigger immune recognition",
"Abnormal NK cell activity (uterine NK cells promote trophoblast invasion)",
"KIR/HLA-C polymorphism mismatch: genetic evidence for immune dysregulation",
"Increased dendritic cell & macrophage infiltration in PE placentas",
"Chronic villitis & pathologic inflammation",
"Angiotensin receptor autoantibodies (AT1R-AAs) activate renin-angiotensin axis",
"Systemic neutrophil activation → vascular injury",
"Placental microparticle shedding drives oxidative stress",
"New partner / primipaternity: reduced immune tolerance to paternal antigens",
"IVF & donor oocyte: diminished tolerance to foreign antigens"
]
},
{
title: "GENETIC FACTORS",
color: "1E5631",
items: [
"4x increased risk in sisters of affected women",
"15% incidence in mothers of PE women vs 4% in mothers-in-law",
"Multifactorial inheritance (no single gene identified)",
"FinnGen 2023 (JAMA Cardiol): multiple genetic loci associated with HDP",
"Polygenic risk scoring (Honigberg et al, Nat Med 2023)",
"STAT3 signaling pathway implicated (Marzioni et al, 2025)",
"Gene variants: COMT, heme oxygenase, corin",
"These pathways converge to increase placental sFlt-1 production",
"Mitochondrial variants: emerging evidence",
"Epigenetic modifications of placental gene expression"
]
},
{
title: "OXIDATIVE STRESS",
color: "6E2F0C",
items: [
"Excess reactive oxygen species (ROS) beyond antioxidant capacity",
"Lipid peroxidation products elevated in PE women",
"Nitrotyrosine, protein carbonyls elevated in blood/placenta",
"Reduced antioxidants (Vit C, E, glutathione)",
"Antibodies to oxidized LDL excess",
"Changes precede clinical preeclampsia",
"However: Vit C + Vit E supplementation RCTs failed to prevent PE",
"Oxidative stress likely a consequence rather than primary cause",
"Interaction with antiangiogenic factors: complementary damage",
"Endothelial mitochondrial dysfunction a key target"
]
}
];
panels.forEach((p, i) => {
const x = 0.2 + i * 4.35;
s.addShape(pres.ShapeType.rect, { x, y: 0.85, w: 4.1, h: 6.35, fill: { color: p.color } });
s.addText(p.title, { x, y: 0.85, w: 4.1, h: 0.48, fontSize: 12, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
s.addShape(pres.ShapeType.line, { x: x + 0.1, y: 1.36, w: 3.9, h: 0, line: { color: GOLD, width: 0.8 } });
const arr = p.items.map((t, idx) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: idx < p.items.length - 1, fontSize: 11.2, color: WHITE } }));
s.addText(arr, { x: x + 0.08, y: 1.42, w: 3.94, h: 5.7, valign: "top" });
});
}
// =================================================================
// SLIDE 8 — DIAGNOSTIC CRITERIA
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: LIGHT_BG } });
addSectionBar(s, MED_BLUE, "06 | Diagnostic Criteria (ISSHP 2021 / ACOG 2020)");
// BP criteria box
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 0.85, w: 6.0, h: 2.8, fill: { color: MED_BLUE } });
s.addText("BLOOD PRESSURE THRESHOLDS", { x: 0.2, y: 0.85, w: 6.0, h: 0.45, fontSize: 13, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
const bpItems = [
"Hypertension: ≥140 mmHg systolic AND/OR ≥90 mmHg diastolic",
"Severe hypertension: ≥160 mmHg systolic OR ≥110 mmHg diastolic",
"Minimum 2 readings at least 4 hours apart (or 15 min if severe)",
"Measured after at least 5 minutes of seated rest",
"Confirm with 24-hr ambulatory or home BP monitoring if borderline",
"Target for treatment: <140/90 mmHg (ACOG/ISSHP consensus)"
];
const bparr = bpItems.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: i < bpItems.length - 1, fontSize: 12, color: WHITE } }));
s.addText(bparr, { x: 0.35, y: 1.35, w: 5.7, h: 2.25, valign: "top" });
// Proteinuria box
s.addShape(pres.ShapeType.rect, { x: 6.5, y: 0.85, w: 6.6, h: 2.8, fill: { color: "154360" } });
s.addText("PROTEINURIA CRITERIA", { x: 6.5, y: 0.85, w: 6.6, h: 0.45, fontSize: 13, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
const protItems = [
"24-hour urine protein: ≥300 mg (gold standard)",
"Protein:creatinine ratio (PCR): ≥30 mg/mmol (0.3 mg/mg)",
"Urine dipstick 2+ (only if other methods unavailable)",
"NOTE: Proteinuria is NO LONGER required for PE diagnosis if end-organ damage present",
"End-organ criteria sufficient: thrombocytopenia, AKI, impaired liver, pulmonary edema, new-onset headache/visual symptoms"
];
const protarr = protItems.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: i < protItems.length - 1, fontSize: 12, color: WHITE } }));
s.addText(protarr, { x: 6.65, y: 1.35, w: 6.3, h: 2.25, valign: "top" });
// Severe features row
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 3.8, w: 12.9, h: 0.45, fill: { color: WARN_RED } });
s.addText("SEVERE FEATURES OF PREECLAMPSIA (any one = severe disease)", {
x: 0.2, y: 3.8, w: 12.9, h: 0.45, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0
});
const sevFeats = [
["Neurologic", "Severe headache unresponsive to medication\nVisual disturbances (scotomata, photophobia)\nAltered mental status / seizure"],
["Hematologic", "Platelets <100,000/µL\nHemolysis\nDIC"],
["Hepatic", "AST/ALT >2× ULN\nSevere RUQ/epigastric pain\nSubcapsular hematoma"],
["Renal", "Creatinine >1.1 mg/dL or doubling\nOliguria <500 mL/24h"],
["Pulmonary", "Pulmonary edema\nO2 sat <94% on room air"],
["Vascular", "BP ≥160/110 mmHg\nFetal growth restriction\nReverse end-diastolic flow"]
];
sevFeats.forEach((sf, i) => {
const col = i % 3;
const row = Math.floor(i / 3);
const x = 0.2 + col * 4.3;
const y = 4.32 + row * 1.48;
s.addShape(pres.ShapeType.rect, { x, y, w: 4.05, h: 1.4, fill: { color: "4A0E0E" } });
s.addText(sf[0], { x, y, w: 4.05, h: 0.38, fontSize: 12, bold: true, color: WARN_RED, align: "center", valign: "middle", margin: 0 });
s.addText(sf[1], { x: x + 0.08, y: y + 0.4, w: 3.89, h: 0.95, fontSize: 10.5, color: WHITE, valign: "top" });
});
}
// =================================================================
// SLIDE 9 — CLINICAL FEATURES
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK_NAVY } });
addSectionBar(s, ACCENT_TEAL, "07 | Clinical Features – Organ System Involvement");
const systems = [
{
sys: "CARDIOVASCULAR",
color: "6E1010",
items: [
"Hypertension (may be labile)",
"High systemic vascular resistance",
"Low cardiac output (vs normal pregnancy)",
"Increased sensitivity to angiotensin II",
"Peripheral vasospasm",
"Peripheral edema (non-dependent)"
]
},
{
sys: "RENAL",
color: "0E4D6E",
items: [
"Proteinuria (hallmark)",
"Glomerular endotheliosis (pathognomonic)",
"Oliguria (<500 mL/24h in severe disease)",
"Raised serum creatinine & uric acid",
"GFR reduction up to 30%",
"Sodium and water retention"
]
},
{
sys: "NEUROLOGIC",
color: "4A1067",
items: [
"Severe frontal headache",
"Visual disturbances (scotomata, blurring, photophobia)",
"Hyperreflexia & clonus",
"Cortical blindness (rare)",
"Cerebral edema / PRES",
"Eclamptic seizures (tonic-clonic)"
]
},
{
sys: "HEPATIC",
color: "765400",
items: [
"RUQ / epigastric pain (Glisson capsule distension)",
"Elevated AST, ALT (2× ULN)",
"Nausea and vomiting",
"Subcapsular hematoma (rare)",
"Liver rupture (rare, life-threatening)",
"Component of HELLP syndrome"
]
},
{
sys: "HEMATOLOGIC",
color: "1E5631",
items: [
"Thrombocytopenia (<100,000/µL)",
"Microangiopathic hemolytic anemia (MAHA)",
"DIC (in severe cases)",
"Elevated LDH (>600 U/L)",
"Schistocytes on peripheral smear",
"Reduced fibrinogen in severe cases"
]
},
{
sys: "PLACENTAL/FETAL",
color: "2E4057",
items: [
"Placental insufficiency / infarcts",
"Fetal growth restriction (FGR)",
"Oligohydramnios",
"Abnormal umbilical artery Doppler",
"Non-reassuring fetal status",
"Increased perinatal mortality"
]
}
];
systems.forEach((sys, i) => {
const col = i % 3;
const row = Math.floor(i / 3);
const x = 0.2 + col * 4.35;
const y = 0.85 + row * 3.2;
s.addShape(pres.ShapeType.rect, { x, y, w: 4.1, h: 3.1, fill: { color: sys.color } });
s.addText(sys.sys, { x, y, w: 4.1, h: 0.45, fontSize: 12.5, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
s.addShape(pres.ShapeType.line, { x: x + 0.1, y: y + 0.47, w: 3.9, h: 0, line: { color: GOLD, width: 0.8 } });
const arr = sys.items.map((t, idx) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: idx < sys.items.length - 1, fontSize: 11.5, color: WHITE } }));
s.addText(arr, { x: x + 0.1, y: y + 0.52, w: 3.9, h: 2.5, valign: "top" });
});
}
// =================================================================
// SLIDE 10 — MATERNAL COMPLICATIONS
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: LIGHT_BG } });
addSectionBar(s, WARN_RED, "08 | Maternal Complications");
const acuteCx = [
"Eclampsia (seizures)",
"HELLP syndrome",
"Acute pulmonary edema",
"Acute kidney injury (AKI)",
"Placental abruption",
"DIC / coagulopathy",
"Stroke / intracranial hemorrhage",
"Liver rupture / subcapsular hematoma",
"Myocardial infarction / heart failure",
"Retinal detachment",
"Maternal death"
];
const acutearr = acuteCx.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: i < acuteCx.length - 1, fontSize: 12.5, color: WHITE } }));
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 0.85, w: 5.9, h: 6.35, fill: { color: "6E1010" } });
s.addText("ACUTE / IMMEDIATE", { x: 0.2, y: 0.85, w: 5.9, h: 0.48, fontSize: 13, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
s.addText(acutearr, { x: 0.35, y: 1.38, w: 5.6, h: 5.75, valign: "top" });
const longCx = [
"Hypertension (4.6× risk within 14 years)",
"Cardiovascular disease (2× lifetime risk of MI, stroke)",
"Chronic kidney disease (CKD)",
"Increased dementia risk (meta-analysis 2024)",
"Increased stroke risk (meta-analysis 2023)",
"Type 2 diabetes mellitus",
"Metabolic syndrome",
"Subclinical cardiac dysfunction",
"Risk of recurrence in subsequent pregnancies (15-25%)",
"Increased all-cause mortality long-term"
];
const longarr = longCx.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: i < longCx.length - 1, fontSize: 12.5, color: WHITE } }));
s.addShape(pres.ShapeType.rect, { x: 7.2, y: 0.85, w: 5.9, h: 6.35, fill: { color: "4A1067" } });
s.addText("LONG-TERM / REMOTE", { x: 7.2, y: 0.85, w: 5.9, h: 0.48, fontSize: 13, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
s.addText(longarr, { x: 7.35, y: 1.38, w: 5.6, h: 5.75, valign: "top" });
// Arrow / divider
s.addShape(pres.ShapeType.rect, { x: 6.25, y: 3.2, w: 0.8, h: 0.7, fill: { color: WARN_RED } });
s.addText("⟹", { x: 6.25, y: 3.2, w: 0.8, h: 0.7, fontSize: 20, color: WHITE, align: "center", valign: "middle", margin: 0 });
}
// =================================================================
// SLIDE 11 — FETAL/NEONATAL COMPLICATIONS
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK_NAVY } });
addSectionBar(s, ACCENT_TEAL, "09 | Fetal & Neonatal Complications");
const fetalCx = [
{ cat: "GROWTH", items: ["Fetal growth restriction (FGR)", "Small for gestational age (SGA)", "Low birth weight (<2500g)", "Oligohydramnios"] },
{ cat: "DELIVERY", items: ["Preterm birth (iatrogenic)", "Emergency cesarean section", "Low gestational age at birth", "Higher NICU admission rates"] },
{ cat: "PERFUSION", items: ["Uteroplacental insufficiency", "Abnormal umbilical artery Doppler (absent/reversed EDF)", "Perinatal asphyxia", "Stillbirth / fetal death"] },
{ cat: "NEONATAL", items: ["Respiratory distress syndrome", "Necrotizing enterocolitis", "Intraventricular hemorrhage", "Retinopathy of prematurity"] },
{ cat: "PLACENTA", items: ["Placental abruption (maternal hemorrhage)", "Placental infarcts", "Abnormal placental shape", "Abnormal insertion/abnormal cord"] },
{ cat: "LONG-TERM\n(OFFSPRING)", items: ["Hypertension in adult life", "Obesity risk", "Cardiovascular disease risk", "Cognitive development issues (maternal inflammation)"] }
];
fetalCx.forEach((fc, i) => {
const col = i % 3;
const row = Math.floor(i / 3);
const x = 0.2 + col * 4.35;
const y = 0.85 + row * 3.2;
s.addShape(pres.ShapeType.rect, { x, y, w: 4.1, h: 3.1, fill: { color: i < 3 ? "163A52" : "2E4057" } });
s.addText(fc.cat, { x, y, w: 4.1, h: 0.45, fontSize: 12.5, bold: true, color: ACCENT_TEAL, align: "center", valign: "middle", margin: 0 });
s.addShape(pres.ShapeType.line, { x: x + 0.1, y: y + 0.47, w: 3.9, h: 0, line: { color: ACCENT_TEAL, width: 0.8 } });
const arr = fc.items.map((t, idx) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: idx < fc.items.length - 1, fontSize: 12, color: WHITE } }));
s.addText(arr, { x: x + 0.1, y: y + 0.52, w: 3.9, h: 2.5, valign: "top" });
});
}
// =================================================================
// SLIDE 12 — HELLP SYNDROME
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: LIGHT_BG } });
addSectionBar(s, WARN_RED, "10 | HELLP Syndrome – Diagnosis & Management");
// HELLP acronym boxes
const hellp = [
{ letter: "H", full: "Hemolysis", details: "MAHA — LDH >600 U/L\nAbnormal peripheral smear (schistocytes)\nTotal bilirubin >1.2 mg/dL" },
{ letter: "EL", full: "Elevated Liver Enzymes", details: "AST/ALT >70 U/L\nAST/ALT >2× ULN\nRUQ/epigastric pain" },
{ letter: "LP", full: "Low Platelets", details: "Platelets <100,000/µL\nClass I: <50,000\nClass II: 50,000-100,000" }
];
hellp.forEach((h, i) => {
const x = 0.2 + i * 4.35;
s.addShape(pres.ShapeType.rect, { x, y: 0.85, w: 4.1, h: 1.5, fill: { color: WARN_RED } });
s.addText(h.letter, { x, y: 0.85, w: 1.2, h: 1.5, fontSize: 52, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
s.addText(h.full, { x: x + 1.25, y: 0.85, w: 2.75, h: 0.55, fontSize: 14, bold: true, color: GOLD, valign: "bottom" });
s.addText(h.details, { x: x + 1.25, y: 1.4, w: 2.75, h: 0.9, fontSize: 11, color: WHITE, valign: "top" });
});
// Tennessee vs Mississippi classification
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 2.5, w: 5.9, h: 1.8, fill: { color: "154360" } });
s.addText("TENNESSEE CLASSIFICATION", { x: 0.2, y: 2.5, w: 5.9, h: 0.4, fontSize: 12, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
s.addText("Complete HELLP: all 3 criteria present\nPartial (Incomplete) HELLP: 1-2 criteria", {
x: 0.3, y: 2.95, w: 5.7, h: 1.25, fontSize: 12.5, color: WHITE, valign: "top"
});
s.addShape(pres.ShapeType.rect, { x: 6.4, y: 2.5, w: 6.7, h: 1.8, fill: { color: "154360" } });
s.addText("MISSISSIPPI CLASSIFICATION", { x: 6.4, y: 2.5, w: 6.7, h: 0.4, fontSize: 12, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
s.addText("Class I: Plt <50,000 + LDH ≥600 + AST/ALT ≥70\nClass II: Plt 50-100,000 + LDH ≥600 + AST/ALT ≥70\nClass III: Plt 100-150,000 + LDH ≥600 + AST/ALT mildly elevated", {
x: 6.55, y: 2.95, w: 6.4, h: 1.25, fontSize: 12, color: WHITE, valign: "top"
});
// Management
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 4.45, w: 12.9, h: 0.42, fill: { color: MED_BLUE } });
s.addText("MANAGEMENT OF HELLP", { x: 0.2, y: 4.45, w: 12.9, h: 0.42, fontSize: 13, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
const mgtCols = [
{ title: "Immediate", items: ["IV MgSO4 for seizure prophylaxis", "Antihypertensives (BP ≥160/110)", "IV access, crossmatch, ICU criteria", "Expedite delivery if ≥34 weeks"] },
{ title: "Stabilization", items: ["Dexamethasone 10mg IV q12h (< 34 wks)", "Platelet transfusion if <50,000 + bleeding", "Correct coagulopathy (FFP, cryoprecipitate)", "Hepatology input if liver involvement"] },
{ title: "Delivery", items: ["Delivery is definitive treatment", "Vaginal delivery if feasible", "If <34 wks: steroids first, then deliver", "Postpartum worsening can occur 24-48h"] }
];
mgtCols.forEach((mc, i) => {
const x = 0.2 + i * 4.35;
s.addShape(pres.ShapeType.rect, { x, y: 4.92, w: 4.1, h: 2.35, fill: { color: "4A1A0E" } });
s.addText(mc.title, { x, y: 4.92, w: 4.1, h: 0.4, fontSize: 12, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
const arr = mc.items.map((t, idx) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: idx < mc.items.length - 1, fontSize: 11.5, color: WHITE } }));
s.addText(arr, { x: x + 0.1, y: 5.35, w: 3.9, h: 1.85, valign: "top" });
});
}
// =================================================================
// SLIDE 13 — MANAGEMENT OVERVIEW
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK_NAVY } });
addSectionBar(s, ACCENT_TEAL, "11 | Management Overview – by Severity & Gestational Age");
// Table header
const cols = ["Category", "Gestation", "BP Target", "Antihypertensive", "MgSO4", "Delivery Timing"];
const colW = [2.5, 1.6, 1.6, 2.3, 1.2, 3.7];
let startX = 0.15;
cols.forEach((c, i) => {
s.addShape(pres.ShapeType.rect, { x: startX, y: 0.85, w: colW[i], h: 0.5, fill: { color: MED_BLUE } });
s.addText(c, { x: startX, y: 0.85, w: colW[i], h: 0.5, fontSize: 11, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
startX += colW[i];
});
const rows = [
["Chronic HTN", "Any", "<140/90", "Labetalol, Nifedipine, Methyldopa", "No", "≥37 wks (uncomplicated)"],
["Gestational HTN\n(non-severe)", "≥20 wks", "<140/90", "Oral agents if sustained ≥140/90", "No", "37-38 wks"],
["Gestational HTN\n(severe)", "≥20 wks", "<160/110", "IV Labetalol / IV Hydralazine / oral Nifedipine", "Consider", "Deliver after stabilization"],
["Preeclampsia\nw/o severe features", "≥20 wks", "<140/90", "Oral agents as needed", "No", "37 wks"],
["Preeclampsia\nw/ severe features ≥34 wks", "≥34 wks", "<160/110", "IV agents within 30-60 min", "Yes", "Deliver after stabilization"],
["Preeclampsia\nw/ severe 24-34 wks", "24-34 wks", "<160/110", "IV agents + steroids", "Yes", "Expectant to 34 wks if stable"],
["Eclampsia", "Any", "<160/110", "IV agents urgently", "Yes — 4g IV bolus then 1-2g/h", "Deliver after seizure control"],
["HELLP", "Any", "<160/110", "IV agents urgently", "Yes", "Deliver if ≥34 wks or unstable"]
];
const rowColors = ["163A52", "163A52", "4A1A0E", "1E5631", "4A0E0E", "6E2F0C", "6E1010", "4A1067"];
rows.forEach((row, ri) => {
let rx = 0.15;
const y = 1.4 + ri * 0.73;
row.forEach((cell, ci) => {
s.addShape(pres.ShapeType.rect, { x: rx, y, w: colW[ci], h: 0.68, fill: { color: rowColors[ri] } });
s.addText(cell, { x: rx + 0.05, y, w: colW[ci] - 0.1, h: 0.68, fontSize: 10, color: WHITE, valign: "middle", align: ci === 0 ? "left" : "center" });
rx += colW[ci];
});
});
s.addText("Sources: ACOG Practice Bulletin 2020 | ISSHP 2021 | NICE 2023 | ESC 2018", {
x: 0.3, y: 7.2, w: 12.7, h: 0.25, fontSize: 9, color: LIGHT_GRAY, italic: true
});
}
// =================================================================
// SLIDE 14 — ANTIHYPERTENSIVE THERAPY
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: LIGHT_BG } });
addSectionBar(s, MED_BLUE, "12 | Antihypertensive Therapy in Pregnancy");
const drugs = [
{
name: "LABETALOL\n(α & β blocker)",
color: "1A5276",
acute: "20-40mg IV q10-15min\nMax 300mg total\nInfusion: 1-2 mg/min",
chronic: "100-400 mg BD-TID",
safe: "Yes",
avoid: "Asthma, heart block"
},
{
name: "HYDRALAZINE\n(Direct vasodilator)",
color: "1E5631",
acute: "5-10mg IV q20min\nMax 20mg per episode",
chronic: "10-50 mg TID-QID",
safe: "Yes",
avoid: "Tachycardia risk, lupus-like syndrome"
},
{
name: "NIFEDIPINE\n(CCB)",
color: "6E2F0C",
acute: "10-20mg oral (immediate)\nRepeat in 30 min if needed\nDo NOT use sublingual",
chronic: "30-60 mg XR OD",
safe: "Yes",
avoid: "With MgSO4: ↑ neuromuscular blockade"
},
{
name: "METHYLDOPA\n(Central α agonist)",
color: "154360",
acute: "Not used acutely",
chronic: "250-500 mg TID-QID\nMax 3g/day",
safe: "Yes (most experience)",
avoid: "Depression, sedation"
}
];
drugs.forEach((d, i) => {
const x = 0.15 + i * 3.28;
s.addShape(pres.ShapeType.rect, { x, y: 0.85, w: 3.1, h: 6.35, fill: { color: d.color } });
s.addText(d.name, { x, y: 0.85, w: 3.1, h: 0.7, fontSize: 13, bold: true, color: GOLD, align: "center", valign: "middle" });
s.addShape(pres.ShapeType.line, { x: x + 0.1, y: 1.57, w: 2.9, h: 0, line: { color: GOLD, width: 0.8 } });
const labels = ["Acute (IV/oral):", "Chronic use:", "Pregnancy safe:", "Cautions:"];
const vals = [d.acute, d.chronic, d.safe, d.avoid];
labels.forEach((l, li) => {
const ly = 1.65 + li * 1.35;
s.addText(l, { x: x + 0.1, y: ly, w: 2.9, h: 0.35, fontSize: 11, bold: true, color: ACCENT_TEAL, valign: "middle" });
s.addText(vals[li], { x: x + 0.1, y: ly + 0.35, w: 2.9, h: 0.9, fontSize: 10.5, color: WHITE, valign: "top" });
});
});
// Drugs to AVOID
s.addShape(pres.ShapeType.rect, { x: 0.15, y: 6.15, w: 12.9, h: 1.1, fill: { color: WARN_RED } });
s.addText("CONTRAINDICATED IN PREGNANCY:", {
x: 0.25, y: 6.15, w: 3.2, h: 1.1, fontSize: 12, bold: true, color: WHITE, valign: "middle"
});
s.addText("ACE Inhibitors (enalapril, lisinopril) | ARBs (losartan, valsartan) — teratogenic (renal agenesis, oligohydramnios) | Direct renin inhibitors (aliskiren) | Nitroprusside (fetal cyanide toxicity)", {
x: 3.55, y: 6.15, w: 9.4, h: 1.1, fontSize: 11.5, color: WHITE, valign: "middle"
});
}
// =================================================================
// SLIDE 15 — PREVENTION & PROPHYLAXIS
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK_NAVY } });
addSectionBar(s, ACCENT_TEAL, "13 | Prevention & Prophylaxis – International Recommendations");
const prevs = [
{
title: "LOW-DOSE ASPIRIN\n(LSAS — Grade A)",
color: "1ABC9C",
textColor: DARK_NAVY,
items: [
"Recommended for women with ≥1 HIGH risk factor or ≥2 moderate risk factors",
"Dose: 100-162 mg/day (ISSHP: 150 mg/day optimal)",
"Start: 11-16 weeks gestation (ideally 12 wks), continue to 36 wks",
"High risk: prior PE, CKD, autoimmune, diabetes, chronic HTN",
"ASPRE trial: 150 mg at night reduces early PE by 62%",
"First-trimester combined screening (FMF algorithm) identifies high-risk women",
"USPSTF 2023: Screening + aspirin recommendation reaffirmed"
]
},
{
title: "CALCIUM SUPPLEMENTATION",
color: "1B4F72",
textColor: WHITE,
items: [
"Dose: 1.5-2g/day elemental calcium",
"For women with LOW dietary calcium intake",
"WHO 2018 recommendation: reduces PE by ~50% in low-Ca populations",
"Mechanism: lowers PTH → reduces intracellular calcium → vasodilation",
"ISSHP 2021 endorses calcium for populations with low dietary intake",
"No benefit shown in populations with adequate dietary calcium",
"Safe, inexpensive, widely available"
]
},
{
title: "OTHER STRATEGIES",
color: "163A52",
textColor: WHITE,
items: [
"Weight optimization pre-pregnancy (BMI <30)",
"Treatment of underlying conditions (DM, CKD, autoimmune)",
"Folic acid 400 mcg/day (neural tube + vascular protection)",
"Vitamin D: emerging evidence but not yet standard",
"Pravastatin: under investigation (promising in RCTs — 2024/2025)",
"Antioxidants (Vit C + E): NOT recommended (failed in large RCTs)",
"Metformin: under investigation for obese/insulin-resistant women",
"Lifestyle: physical activity, low-salt diet, stress management",
"Vaginal microbiome optimization (L. crispatus — emerging evidence)"
]
}
];
prevs.forEach((p, i) => {
const x = 0.2 + i * 4.35;
s.addShape(pres.ShapeType.rect, { x, y: 0.85, w: 4.1, h: 6.35, fill: { color: p.color } });
s.addText(p.title, { x, y: 0.85, w: 4.1, h: 0.7, fontSize: 12.5, bold: true, color: i === 0 ? DARK_NAVY : GOLD, align: "center", valign: "middle" });
s.addShape(pres.ShapeType.line, { x: x + 0.1, y: 1.57, w: 3.9, h: 0, line: { color: i === 0 ? DARK_NAVY : GOLD, width: 0.8 } });
const arr = p.items.map((t, idx) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: idx < p.items.length - 1, fontSize: 11.5, color: p.textColor } }));
s.addText(arr, { x: x + 0.1, y: 1.65, w: 3.9, h: 5.65, valign: "top" });
});
}
// =================================================================
// SLIDE 16 — RECENT ADVANCES 2023-2026
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: LIGHT_BG } });
addSectionBar(s, MED_BLUE, "14 | Recent Advances 2023-2026");
const advances = [
{
title: "BIOMARKER ADVANCES",
color: "1A5276",
year: "2023-2025",
items: [
"sFlt-1/PlGF ratio: FDA cleared in US 2023 (Elecsys BRAHMS)",
"PlGF-based management reduces NICU admissions (PARROT trial)",
"Large-scale proteomics predicts HDP weeks before onset (Greenland et al, JAMA Cardiol 2024)",
"Polygenic risk score for preeclampsia (Honigberg et al, Nat Med 2023)",
"Maternal serum PIGF at 11-13 wks combined with uterine artery Doppler + MAP → PE screening algorithm",
"Cell-free DNA: low fetal fraction → adverse outcomes including HDP (2024 meta-analysis)"
]
},
{
title: "GENETICS & MOLECULAR",
color: "1E5631",
year: "2023-2025",
items: [
"FinnGen/Estonian Biobank GWAS: multiple HDP genetic loci (Tyrmi et al, JAMA Cardiol 2023)",
"STAT3 signaling pathway in preeclampsia (Marzioni et al, Int J Mol Med 2025)",
"Mitochondrial dysfunction as therapeutic target",
"Epigenetic modifications: placental DNA methylation patterns",
"Complement pathway activation in atypical HDP",
"Microbiome studies: vaginal L. crispatus reduces HDP risk (Li et al, 2024)"
]
},
{
title: "NOVEL THERAPEUTICS",
color: "6E2F0C",
year: "2024-2026",
items: [
"Pravastatin: statin therapy trials for PE prevention (ongoing RCTs — promising safety/efficacy 2024)",
"Recombinant PlGF (VEGF-mimetics): investigational",
"Dextran sulfate apheresis to reduce sFlt-1: pilot trials show promise (NKF Primer 2023)",
"Metformin for PE prevention in obese/insulin-resistant women: meta-analyses ongoing",
"SGLT2 inhibitors: safety not established, under study",
"Anti-sFlt-1 aptamers: preclinical stage"
]
},
{
title: "GUIDELINES UPDATES",
color: "154360",
year: "2021-2025",
items: [
"ISSHP 2021: revised classification, endorsed sFlt-1/PlGF for diagnosis",
"ACOG 2020 (reaffirmed 2023): recommends antihypertensives for all BP ≥140/90",
"NICE 2023 UK: recommends aspirin 75-150mg for high-risk women",
"ESC 2018/2022: cardiovascular management during pregnancy",
"WHO 2025 Factsheet: updated global burden (~42,000 deaths/year)",
"AHA 2025: new high BP guidelines emphasizing pregnancy health",
"USPSTF 2023: screening for HDP recommendation statement"
]
}
];
advances.forEach((a, i) => {
const col = i % 2;
const row = Math.floor(i / 2);
const x = 0.2 + col * 6.55;
const y = 0.85 + row * 3.2;
s.addShape(pres.ShapeType.rect, { x, y, w: 6.25, h: 3.1, fill: { color: a.color } });
s.addShape(pres.ShapeType.rect, { x: x + 4.65, y, w: 1.55, h: 0.45, fill: { color: GOLD } });
s.addText(a.year, { x: x + 4.65, y, w: 1.55, h: 0.45, fontSize: 11, bold: true, color: DARK_NAVY, align: "center", valign: "middle", margin: 0 });
s.addText(a.title, { x, y, w: 4.6, h: 0.45, fontSize: 12, bold: true, color: GOLD, valign: "middle" });
s.addShape(pres.ShapeType.line, { x: x + 0.1, y: y + 0.47, w: 6.05, h: 0, line: { color: GOLD, width: 0.8 } });
const arr = a.items.map((t, idx) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: idx < a.items.length - 1, fontSize: 11.5, color: WHITE } }));
s.addText(arr, { x: x + 0.1, y: y + 0.55, w: 6.05, h: 2.48, valign: "top" });
});
}
// =================================================================
// SLIDE 17 — LONG-TERM CONSEQUENCES & POSTPARTUM CARE
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK_NAVY } });
addSectionBar(s, ACCENT_TEAL, "15 | Long-Term Consequences & Postpartum Surveillance");
// Left: long-term consequences timeline
s.addShape(pres.ShapeType.rect, { x: 0.2, y: 0.85, w: 6.6, h: 6.35, fill: { color: "163A52" } });
s.addText("LONG-TERM MATERNAL RISKS", { x: 0.2, y: 0.85, w: 6.6, h: 0.45, fontSize: 13, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
const ltRisks = [
["Hypertension", "4.6× higher risk within 14 years post-PE (BMJ 2017 cohort)"],
["CVD", "2× lifetime risk of MI and ischemic heart disease"],
["Stroke", "Meta-analysis 2023 (PMID 36990309): significant long-term stroke risk"],
["Dementia", "Meta-analysis 2024 (PMID 38278201): increased cognitive decline risk"],
["CKD", "Proteinuria, microalbuminuria, impaired renal function"],
["Metabolic syndrome", "Insulin resistance, dyslipidemia, obesity cluster"],
["Recurrence", "15-25% risk in subsequent pregnancies"],
["Offspring", "Increased lifetime CVD/HTN/obesity risk in children born of PE pregnancies"]
];
ltRisks.forEach((r, i) => {
const y = 1.37 + i * 0.73;
s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 1.8, h: 0.62, fill: { color: WARN_RED } });
s.addText(r[0], { x: 0.3, y, w: 1.8, h: 0.62, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
s.addText(r[1], { x: 2.2, y, w: 4.5, h: 0.62, fontSize: 11, color: WHITE, valign: "middle" });
});
// Right: postpartum surveillance
s.addShape(pres.ShapeType.rect, { x: 7.0, y: 0.85, w: 6.1, h: 6.35, fill: { color: "1E5631" } });
s.addText("POSTPARTUM SURVEILLANCE", { x: 7.0, y: 0.85, w: 6.1, h: 0.45, fontSize: 13, bold: true, color: GOLD, align: "center", valign: "middle", margin: 0 });
const ppItems = [
"BP monitoring: every 15 min for 1h postpartum, then 4-hourly",
"Continue antihypertensives if BP remains ≥150/100 postpartum",
"MgSO4: continue for 24-48h after delivery",
"Assess for HELLP: LFTs, CBC 24-48h post delivery",
"6-week postpartum: check BP, urine PCR, renal function",
"Echocardiography if postpartum pulmonary edema",
"Annual CVD screening thereafter: BP, lipids, glucose",
"Advise lifestyle modification: diet, exercise, weight",
"Aspirin pre-conception in future pregnancies if prior PE",
"Inform GP of future cardiovascular risk",
"Offer preconception counseling before next pregnancy",
"Consider cardiology/nephrology referral if persistent dysfunction"
];
const ppArr = ppItems.map((t, i) => ({ text: t, options: { bullet: { type: "bullet" }, breakLine: i < ppItems.length - 1, fontSize: 11.5, color: WHITE } }));
s.addText(ppArr, { x: 7.1, y: 1.35, w: 5.9, h: 5.75, valign: "top" });
}
// =================================================================
// SLIDE 18 — SUMMARY / CONCLUSION
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DARK_NAVY } });
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 0.08, fill: { color: ACCENT_TEAL } });
s.addShape(pres.ShapeType.rect, { x: 0, y: 7.42, w: 13.3, h: 0.08, fill: { color: ACCENT_TEAL } });
s.addText("Key Takeaways", { x: 0.5, y: 0.25, w: 12.3, h: 0.65, fontSize: 30, bold: true, color: WHITE });
const keyPoints = [
"HDP affects 3-8% of pregnancies globally and causes ~16% of all maternal deaths — a major public health crisis.",
"ISSHP 2021 classifies HDP into: Chronic HTN, Gestational HTN, Preeclampsia (with/without severe features), Eclampsia, and Superimposed PE.",
"Pathogenesis follows a Two-Stage Model: Stage 1 (silent impaired placentation at 8-18 wks) → Stage 2 (clinical maternal syndrome driven by sFlt-1/sEng release causing endothelial dysfunction).",
"Proteinuria is NO LONGER required for PE diagnosis — end-organ damage alone is sufficient (ISSHP 2021).",
"sFlt-1/PlGF ratio is the best validated biomarker for diagnosis and risk stratification; now FDA-cleared in the US (2023).",
"MgSO4 is the drug of choice for seizure prophylaxis and treatment; reduces eclampsia by >50%.",
"Antihypertensives of choice: IV Labetalol / IV Hydralazine / oral Nifedipine for acute; Labetalol / Nifedipine XR / Methyldopa for maintenance.",
"ACE inhibitors and ARBs are CONTRAINDICATED in pregnancy.",
"Aspirin 100-150 mg/day from 12-16 weeks is recommended for high-risk women (Grade A evidence; ASPRE trial: 62% reduction in early-onset PE).",
"Delivery is the only definitive treatment; timing depends on severity and gestational age.",
"HDP confers significant long-term CVD, hypertension, stroke, dementia, and CKD risks — lifelong surveillance is essential.",
"Recent advances: biomarker-guided management, genetic risk scoring, statin trials, and apheresis therapy are transforming the field."
];
keyPoints.forEach((kp, i) => {
const col = i < 6 ? 0 : 1;
const row = col === 0 ? i : i - 6;
const x = col === 0 ? 0.3 : 6.85;
const y = 1.1 + row * 1.02;
s.addShape(pres.ShapeType.rect, { x, y, w: 0.38, h: 0.38, fill: { color: ACCENT_TEAL } });
s.addText(String(i + 1), { x, y, w: 0.38, h: 0.38, fontSize: 12, bold: true, color: DARK_NAVY, align: "center", valign: "middle", margin: 0 });
s.addText(kp, { x: x + 0.45, y, w: 6.0, h: 0.95, fontSize: 10.5, color: WHITE, valign: "top" });
});
}
// =================================================================
// WRITE FILE
// =================================================================
pres.writeFile({ fileName: "/home/daytona/workspace/hdp-presentation/HDP_Presentation.pptx" })
.then(() => console.log("SUCCESS: /home/daytona/workspace/hdp-presentation/HDP_Presentation.pptx"))
.catch(err => { console.error("ERROR:", err); process.exit(1); });
Reading File
PLEASE DO MAKE PPT
Running Command
ls /home/daytona/workspace/hdp-presentation/
Writing File
~/hdp-presentation/build_new.js
const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3" x 7.5"
pres.author = "Medical Education";
pres.title = "Hypertensive Disorders of Pregnancy";
// ─── COLOR PALETTE ───────────────────────────────────────────────
const DARK_NAVY = "0D1B2A";
const MED_BLUE = "1B4F72";
const ACCENT_TEAL = "1ABC9C";
const LIGHT_BG = "EAF2F8";
const WHITE = "FFFFFF";
const LIGHT_GRAY = "D5D8DC";
const WARN_RED = "C0392B";
const GOLD = "F1C40F";
const TEXT_DARK = "1A252F";
// ─── HELPERS ────────────────────────────────────────────────────
function sectionBar(slide, color, text) {
slide.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:0.72, fill:{color} });
slide.addText(text, { x:0.3, y:0, w:12.7, h:0.72, fontSize:20, bold:true, color:WHITE, valign:"middle", margin:0 });
}
function bullets(slide, items, opts) {
const {x,y,w,h,fontSize=13,color=TEXT_DARK} = opts;
slide.addText(
items.map((t,i)=>({ text:t, options:{ bullet:true, breakLine: i<items.length-1, fontSize, color } })),
{x,y,w,h,valign:"top"}
);
}
// =================================================================
// SLIDE 1 — TITLE
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, {x:0,y:0,w:13.3,h:7.5,fill:{color:DARK_NAVY}});
// gradient stripe
s.addShape(pres.ShapeType.rect, {x:0,y:2.75,w:13.3,h:0.07,fill:{color:ACCENT_TEAL}});
s.addShape(pres.ShapeType.rect, {x:0,y:2.83,w:13.3,h:0.05,fill:{color:"16A085"}});
s.addText("Hypertensive Disorders\nof Pregnancy", {
x:0.8, y:0.8, w:11.7, h:1.85,
fontSize:46, bold:true, color:WHITE, align:"center", valign:"middle"
});
s.addText("International Guidelines | Etiopathogenesis | Clinical Features | Complications | Recent Advances 2023–2026", {
x:0.8, y:3.0, w:11.7, h:0.5,
fontSize:15, italic:true, color:ACCENT_TEAL, align:"center"
});
const stats = [
{v:"3–8%", l:"of all pregnancies"},
{v:"~16%", l:"of maternal deaths"},
{v:"~42,000", l:"deaths/year (2023)"},
{v:"1 in 7", l:"US hospital deliveries"}
];
stats.forEach((st,i)=>{
const x = 0.9 + i*2.9;
s.addShape(pres.ShapeType.rect, {x, y:3.75, w:2.6, h:1.45, fill:{color:MED_BLUE}, line:{color:ACCENT_TEAL,width:1.5}});
s.addText(st.v, {x, y:3.78, w:2.6, h:0.75, fontSize:22, bold:true, color:GOLD, align:"center", valign:"middle"});
s.addText(st.l, {x, y:4.5, w:2.6, h:0.6, fontSize:11, color:LIGHT_GRAY, align:"center"});
});
s.addText("WHO Dec 2025 | ISSHP 2021 | ACOG 2020 | AFP 2024 | Creasy & Resnik MFM", {
x:0.5,y:6.95,w:12.3,h:0.35, fontSize:9.5, color:LIGHT_GRAY, align:"center", italic:true
});
}
// =================================================================
// SLIDE 2 — TABLE OF CONTENTS
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, {x:0,y:0,w:13.3,h:7.5,fill:{color:DARK_NAVY}});
s.addText("Contents", {x:0.5,y:0.25,w:8,h:0.65, fontSize:28, bold:true, color:WHITE});
s.addShape(pres.ShapeType.rect, {x:0.5,y:0.95,w:2.5,h:0.06,fill:{color:ACCENT_TEAL}});
const items = [
["01","Definitions & ISSHP 2021 Classification"],
["02","Epidemiology & Risk Factors"],
["03","Etiopathogenesis — Two-Stage Model"],
["04","Angiogenic Imbalance (sFlt-1 / PlGF)"],
["05","Immunologic, Genetic & Oxidative Stress"],
["06","Diagnostic Criteria"],
["07","Clinical Features — Organ Systems"],
["08","Maternal Complications"],
["09","Fetal & Neonatal Complications"],
["10","HELLP Syndrome"],
["11","Management Overview"],
["12","Antihypertensive Therapy"],
["13","Prevention & Prophylaxis"],
["14","Recent Advances 2023–2026"],
["15","Long-term Consequences & Postpartum Care"],
];
items.forEach((it,i)=>{
const col = i<8?0:1;
const row = col===0?i:i-8;
const x = col===0 ? 0.5 : 7.0;
const y = 1.1 + row*0.77;
s.addShape(pres.ShapeType.rect, {x, y, w:0.58, h:0.55, fill:{color:ACCENT_TEAL}});
s.addText(it[0], {x, y, w:0.58, h:0.55, fontSize:14, bold:true, color:DARK_NAVY, align:"center", valign:"middle", margin:0});
s.addText(it[1], {x:x+0.68, y, w:5.8, h:0.55, fontSize:13.5, color:WHITE, valign:"middle"});
});
}
// =================================================================
// SLIDE 3 — CLASSIFICATION
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, {x:0,y:0,w:13.3,h:7.5,fill:{color:LIGHT_BG}});
sectionBar(s, MED_BLUE, "01 | Definitions & ISSHP 2021 Classification");
const cats = [
{ title:"CHRONIC\nHYPERTENSION", fill:"1B4F72",
items:["BP ≥140/90 mmHg before 20 wks gestation","Pre-existing hypertension before pregnancy","Includes essential & secondary hypertension","Persists >12 weeks postpartum"] },
{ title:"GESTATIONAL\nHYPERTENSION", fill:"21618C",
items:["New BP ≥140/90 after 20 weeks' gestation","No proteinuria, no end-organ damage","Resolves within 12 weeks postpartum","Severe if ≥160/110 mmHg"] },
{ title:"PREECLAMPSIA", fill:"117A65",
items:["Gestational HTN + proteinuria (≥300 mg/24h)","OR Gestational HTN + end-organ damage","Proteinuria no longer mandatory (ISSHP 2021)","Early-onset (<34 wks) vs Late-onset (≥34 wks)"] },
{ title:"ECLAMPSIA", fill:"922B21",
items:["New-onset generalised seizures in preeclampsia","No other attributable cause","Antepartum / intrapartum / postpartum","Medical emergency — MgSO₄ treatment"] },
{ title:"SUPERIMPOSED\nPREECLAMPSIA", fill:"784212",
items:["Chronic HTN + new proteinuria after 20 wks","Sudden worsening of pre-existing HTN","New end-organ dysfunction on chronic HTN","Higher risk than either condition alone"] },
];
cats.forEach((c,i)=>{
const col = i<3?i:i-3;
const x = i<3 ? 0.15+i*4.35 : 2.35+col*4.35;
const y = i<3 ? 0.9 : 4.05;
const w=4.1, h=i<3?2.9:3.0;
s.addShape(pres.ShapeType.rect, {x,y,w,h,fill:{color:c.fill}});
s.addText(c.title, {x,y:y+0.05,w,h:0.65,fontSize:12.5,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
s.addShape(pres.ShapeType.line,{x:x+0.15,y:y+0.73,w:w-0.3,h:0,line:{color:GOLD,width:0.8}});
bullets(s, c.items, {x:x+0.1,y:y+0.78,w:w-0.2,h:h-0.88,fontSize:11.5,color:WHITE});
});
s.addText("Magee et al. Pregnancy Hypertens. 2022;27:148–169 (ISSHP 2021) | ACOG Practice Bulletin 2020",
{x:0.3,y:7.22,w:12.7,h:0.24,fontSize:8.5,color:MED_BLUE,italic:true});
}
// =================================================================
// SLIDE 4 — EPIDEMIOLOGY & RISK FACTORS
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, {x:0,y:0,w:13.3,h:7.5,fill:{color:LIGHT_BG}});
sectionBar(s, MED_BLUE, "02 | Epidemiology & Risk Factors");
// Epi panel
s.addShape(pres.ShapeType.rect, {x:0.15,y:0.85,w:4.1,h:6.4,fill:{color:MED_BLUE}});
s.addText("EPIDEMIOLOGY", {x:0.15,y:0.85,w:4.1,h:0.45,fontSize:13,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
bullets(s,[
"3–8% of all pregnancies worldwide",
"Prevalence rising in USA (2017–2019)",
"7% of US pregnancy-related deaths",
"~16% of global maternal deaths",
"~42,000 deaths/year (WHO 2023)",
"HDP: leading maternal cause in Indiana (2025)",
"Preeclampsia: 5–8% globally",
"Eclampsia: 1–2% of PE cases",
"Twins: 10–20% PE incidence",
"Triplets: 25–60% PE incidence",
"Quadruplets: up to 90% PE incidence",
"44% of maternal deaths in 1st 6 days post-delivery linked to HDP",
],{x:0.28,y:1.35,w:3.85,h:5.8,fontSize:11.5,color:WHITE});
// Risk factor columns
const rfCols=[
{title:"NON-MODIFIABLE", fill:"1A5276", items:[
"Nulliparity (primigravida)","Age >35 or <18 years",
"Prior preeclampsia history","Family history (mother/sister)",
"Multiple gestation","IVF / ART conception",
"Hydatidiform mole","New paternity / primipaternity",
"Born small for gestational age","Father born of PE pregnancy",
"ICSI conception","Black/African-descent ethnicity"
]},
{title:"MODIFIABLE", fill:"1E5631", items:[
"Obesity / BMI >30 kg/m²","Chronic hypertension",
"Diabetes mellitus (T1 or T2)","Chronic kidney disease",
"Dyslipidemia","Thrombophilia / APS",
"Sleep-disordered breathing","Autoimmune disease (SLE, RA)",
"High-sodium diet","Physical inactivity",
"Chronic psychosocial stress","Low calcium / vitamin D intake"
]},
];
rfCols.forEach((col,i)=>{
const x=4.4+i*4.5;
s.addShape(pres.ShapeType.rect,{x,y:0.85,w:4.2,h:6.4,fill:{color:col.fill}});
s.addText(col.title+" RISK FACTORS",{x,y:0.85,w:4.2,h:0.45,fontSize:12,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
bullets(s,col.items,{x:x+0.12,y:1.35,w:3.96,h:5.8,fontSize:11.5,color:WHITE});
});
}
// =================================================================
// SLIDE 5 — ETIOPATHOGENESIS: TWO-STAGE MODEL
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect, {x:0,y:0,w:13.3,h:7.5,fill:{color:DARK_NAVY}});
sectionBar(s, ACCENT_TEAL, "03 | Etiopathogenesis — Two-Stage Model (Roberts & Hubel)");
// Stage 1
s.addShape(pres.ShapeType.rect, {x:0.15,y:0.85,w:6.05,h:6.4,fill:{color:"163A52"}});
s.addShape(pres.ShapeType.rect, {x:0.15,y:0.85,w:6.05,h:0.52,fill:{color:ACCENT_TEAL}});
s.addText("STAGE 1 — Impaired Placentation (8–18 weeks, clinically silent)", {
x:0.15,y:0.85,w:6.05,h:0.52,fontSize:12.5,bold:true,color:DARK_NAVY,align:"center",valign:"middle",margin:0
});
bullets(s,[
"Extravillous trophoblasts (EVTs) invade decidua & myometrium",
"Normal: EVTs remodel spiral arteries → low-resistance, high-flow vessels",
"In PE: Shallow trophoblast invasion — incomplete spiral artery remodeling",
"Myometrial segments remain muscular & vasoactive",
"Results in uteroplacental ischaemia & placental hypoxia",
"Hypoxia triggers HIF-1α → upregulates sFlt-1 production",
"NFkB activation → proinflammatory cytokine cascade",
"Pathologic acute atherosis in 10% of PE placentas",
"Defective immune tolerance: NK cell/HLA-C mismatch",
"AT1R autoantibodies activate renin-angiotensin axis",
"Increased necrotic trophoblast shedding → systemic inflammation",
"Placental microparticle shedding → oxidative stress",
"This stage is clinically SILENT — no symptoms"
],{x:0.28,y:1.42,w:5.78,h:5.75,fontSize:11.5,color:WHITE});
// Arrow
s.addShape(pres.ShapeType.rect,{x:6.35,y:3.55,w:0.7,h:0.55,fill:{color:GOLD}});
s.addText("→",{x:6.35,y:3.55,w:0.7,h:0.55,fontSize:24,bold:true,color:DARK_NAVY,align:"center",valign:"middle",margin:0});
// Stage 2
s.addShape(pres.ShapeType.rect,{x:7.1,y:0.85,w:6.05,h:6.4,fill:{color:"4A0E0E"}});
s.addShape(pres.ShapeType.rect,{x:7.1,y:0.85,w:6.05,h:0.52,fill:{color:WARN_RED}});
s.addText("STAGE 2 — Maternal Syndrome (clinical disease, 2nd/3rd trimester)",{
x:7.1,y:0.85,w:6.05,h:0.52,fontSize:12.5,bold:true,color:WHITE,align:"center",valign:"middle",margin:0
});
bullets(s,[
"Diseased placenta releases antiangiogenic factors systemically",
"↑ sFlt-1 (soluble fms-like tyrosine kinase-1) — markedly elevated",
"↑ Soluble endoglin (sEng) — inhibits TGF-β signaling",
"↓ Free PlGF (placental growth factor) — markedly reduced",
"sFlt-1 sequesters free VEGF and PlGF → endothelial receptor blockade",
"Systemic endothelial dysfunction → vasoconstriction",
"↑ Sensitivity to angiotensin II, vasopressin, norepinephrine",
"↓ Prostacyclin (PGI₂) / ↑ Thromboxane A₂ (TXA₂) imbalance",
"Disrupted NO-mediated vasodilation",
"Glomerular endotheliosis → proteinuria (pathognomonic on biopsy)",
"3 mechanisms (Creasy & Resnik): (1) Abnormal placentation → excess sFlt-1/sEng; (2) Preexisting endothelial sensitization (e.g., obesity); (3) Excess placental mass (multiple gestation)",
],{x:7.22,y:1.42,w:5.78,h:5.75,fontSize:11.5,color:WHITE});
}
// =================================================================
// SLIDE 6 — ANGIOGENIC IMBALANCE
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect,{x:0,y:0,w:13.3,h:7.5,fill:{color:LIGHT_BG}});
sectionBar(s, MED_BLUE, "04 | Angiogenic Imbalance — sFlt-1, PlGF & Soluble Endoglin");
// Normal
s.addShape(pres.ShapeType.rect,{x:0.15,y:0.85,w:6.1,h:3.0,fill:{color:"D5F5E3"}});
s.addShape(pres.ShapeType.rect,{x:0.15,y:0.85,w:6.1,h:0.45,fill:{color:"1E8449"}});
s.addText("NORMAL PREGNANCY",{x:0.15,y:0.85,w:6.1,h:0.45,fontSize:13,bold:true,color:WHITE,align:"center",valign:"middle",margin:0});
bullets(s,[
"Balanced proangiogenic environment",
"VEGF & PlGF bind VEGFR-1/2 on endothelium freely",
"TGF-β1 signalling via endoglin → vessel stability",
"Low circulating sFlt-1 and sEng",
"Adequate uteroplacental perfusion maintained",
"Endothelial NO production preserved → vasodilation",
"Peripheral vascular resistance falls ~25% in normal pregnancy",
],{x:0.28,y:1.35,w:5.84,h:2.42,fontSize:12,color:TEXT_DARK});
// PE
s.addShape(pres.ShapeType.rect,{x:6.55,y:0.85,w:6.6,h:3.0,fill:{color:"FDEDEC"}});
s.addShape(pres.ShapeType.rect,{x:6.55,y:0.85,w:6.6,h:0.45,fill:{color:WARN_RED}});
s.addText("PREECLAMPSIA",{x:6.55,y:0.85,w:6.6,h:0.45,fontSize:13,bold:true,color:WHITE,align:"center",valign:"middle",margin:0});
bullets(s,[
"↑↑ sFlt-1: sequesters free VEGF + PlGF → endothelial receptor blockade",
"↑ sEng: blocks TGF-β1 → impaired NO/PGI₂ production",
"↓↓ Free PlGF: marker detectable weeks before clinical disease",
"sFlt-1/PlGF ratio >38 predicts PE within 4 weeks (Zeisler et al, NEJM 2016)",
"Ratio >85 = severe disease; correlates with adverse outcomes",
"Exogenous VEGF administration reverses PE in animal models",
],{x:6.68,y:1.35,w:6.34,h:2.42,fontSize:12,color:TEXT_DARK});
// Biomarker utility strip
s.addShape(pres.ShapeType.rect,{x:0.15,y:4.0,w:12.95,h:0.45,fill:{color:MED_BLUE}});
s.addText("CLINICAL UTILITY OF BIOMARKERS — Recent Advances",
{x:0.15,y:4.0,w:12.95,h:0.45,fontSize:13,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
const bio=[
{t:"sFlt-1/PlGF Ratio",d:"FDA-cleared in USA 2023 (Elecsys BRAHMS). ISSHP 2021 & FIGO 2019 endorsed for rule-in/rule-out of PE in symptomatic women."},
{t:"PlGF-based mgmt",d:"PARROT RCT: PlGF-based testing reduces NICU admissions. Low PlGF (<12 pg/mL at 19–23 wks) predicts severe early-onset PE."},
{t:"Early-pregnancy proteomics",d:"Greenland et al, JAMA Cardiol 2024: large-scale proteomics in early pregnancy predicts HDP weeks before clinical onset."},
{t:"Polygenic risk score",d:"Honigberg et al, Nat Med 2023: polygenic prediction improves preconception risk stratification for PE and gestational HTN."},
];
bio.forEach((b,i)=>{
const x=0.22+i*3.25;
s.addShape(pres.ShapeType.rect,{x,y:4.5,w:3.1,h:2.75,fill:{color:"163A52"}});
s.addText(b.t,{x,y:4.5,w:3.1,h:0.45,fontSize:12,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
s.addText(b.d,{x:x+0.08,y:4.98,w:2.94,h:2.2,fontSize:11,color:WHITE,valign:"top"});
});
}
// =================================================================
// SLIDE 7 — IMMUNOLOGIC & GENETIC
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect,{x:0,y:0,w:13.3,h:7.5,fill:{color:DARK_NAVY}});
sectionBar(s, ACCENT_TEAL, "05 | Immunologic, Genetic & Oxidative Stress Mechanisms");
const panels=[
{title:"IMMUNOLOGIC\nMECHANISMS", fill:"1A5276", items:[
"Fetal antigens trigger immune recognition in mother",
"Abnormal uterine NK cell activity",
"KIR/HLA-C polymorphism: molecular evidence for immune dysregulation",
"Increased dendritic cells & macrophage infiltration in PE placentas",
"Chronic villitis and pathologic inflammation",
"AT1R autoantibodies activate renin-angiotensin system",
"Systemic neutrophil activation → vascular injury",
"Primipaternity / new partner: reduced immune tolerance",
"IVF/donor oocyte: diminished tolerance to foreign antigens",
"NK/macrophage ratio alteration in decidua"
]},
{title:"GENETIC\nFACTORS", fill:"1E5631", items:[
"4× increased risk in sisters of preeclamptic women",
"15% incidence in mothers vs 4% in mothers-in-law",
"Multifactorial inheritance — no single causative gene",
"FinnGen/Estonian GWAS: multiple HDP loci (Tyrmi et al, JAMA Cardiol 2023)",
"Polygenic risk scoring (Honigberg et al, Nat Med 2023)",
"STAT3 signalling pathway (Marzioni et al, Int J Mol Med 2025)",
"COMT, heme oxygenase, corin gene variants → ↑ sFlt-1",
"Mitochondrial genetic variants: emerging evidence",
"Epigenetic modifications of placental gene expression",
"Complement pathway activation in atypical HDP"
]},
{title:"OXIDATIVE\nSTRESS", fill:"6E2F0C", items:[
"Excess reactive oxygen species (ROS) beyond antioxidant capacity",
"Lipid peroxidation products elevated in PE serum",
"Nitrotyrosine, protein carbonyls in blood/vessels/placenta",
"Reduced antioxidants: Vit C, Vit E, glutathione",
"Antibodies to oxidised LDL in excess",
"Changes precede clinical preeclampsia onset",
"Large RCTs: Vit C + Vit E failed to prevent PE",
"Oxidative stress likely consequence rather than primary cause",
"Endothelial mitochondrial dysfunction: key emerging target",
"Interacts with antiangiogenic factors in vascular damage"
]},
];
panels.forEach((p,i)=>{
const x=0.15+i*4.38;
s.addShape(pres.ShapeType.rect,{x,y:0.85,w:4.15,h:6.4,fill:{color:p.fill}});
s.addText(p.title,{x,y:0.85,w:4.15,h:0.65,fontSize:13,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
s.addShape(pres.ShapeType.line,{x:x+0.1,y:1.52,w:3.95,h:0,line:{color:GOLD,width:0.8}});
bullets(s,p.items,{x:x+0.1,y:1.58,w:3.95,h:5.6,fontSize:11.5,color:WHITE});
});
}
// =================================================================
// SLIDE 8 — DIAGNOSTIC CRITERIA
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect,{x:0,y:0,w:13.3,h:7.5,fill:{color:LIGHT_BG}});
sectionBar(s, MED_BLUE, "06 | Diagnostic Criteria (ISSHP 2021 / ACOG 2020)");
s.addShape(pres.ShapeType.rect,{x:0.15,y:0.85,w:6.15,h:2.85,fill:{color:MED_BLUE}});
s.addText("BLOOD PRESSURE THRESHOLDS",{x:0.15,y:0.85,w:6.15,h:0.45,fontSize:13,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
bullets(s,[
"Hypertension: ≥140 mmHg systolic AND/OR ≥90 mmHg diastolic",
"Severe HTN: ≥160 mmHg systolic OR ≥110 mmHg diastolic",
"Minimum 2 readings at least 4 hours apart (15 min if severe)",
"Measured after ≥5 min rest in seated position",
"Confirm with ABPM or home monitoring if borderline",
"Treatment target: <140/90 mmHg (ACOG/ISSHP consensus)"
],{x:0.28,y:1.35,w:5.9,h:2.25,fontSize:12,color:WHITE});
s.addShape(pres.ShapeType.rect,{x:6.5,y:0.85,w:6.65,h:2.85,fill:{color:"154360"}});
s.addText("PROTEINURIA CRITERIA",{x:6.5,y:0.85,w:6.65,h:0.45,fontSize:13,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
bullets(s,[
"24-hour urine protein: ≥300 mg (gold standard)",
"Protein:creatinine ratio (PCR): ≥30 mg/mmol (0.3 mg/mg)",
"Dipstick 2+ only if other methods unavailable",
"Proteinuria is NOT mandatory for PE diagnosis (ISSHP 2021)",
"End-organ damage alone is sufficient: thrombocytopenia, AKI, liver injury, pulmonary oedema, new neurologic symptoms"
],{x:6.65,y:1.35,w:6.38,h:2.25,fontSize:12,color:WHITE});
// Severe features table
s.addShape(pres.ShapeType.rect,{x:0.15,y:3.82,w:12.95,h:0.45,fill:{color:WARN_RED}});
s.addText("SEVERE FEATURES OF PREECLAMPSIA — any one criterion = severe disease",
{x:0.15,y:3.82,w:12.95,h:0.45,fontSize:13,bold:true,color:WHITE,align:"center",valign:"middle",margin:0});
const sev=[
{cat:"Neurologic", items:["Severe unresponsive headache","Visual disturbances (scotomata)","Altered consciousness / seizure"]},
{cat:"Hematologic", items:["Platelets <100,000/µL","Hemolysis (MAHA)","DIC / coagulopathy"]},
{cat:"Hepatic", items:["AST/ALT >2× ULN","Severe RUQ/epigastric pain","Subcapsular hematoma"]},
{cat:"Renal", items:["Creatinine >1.1 mg/dL","Oliguria <500 mL/24 h","GFR significantly reduced"]},
{cat:"Pulmonary", items:["Pulmonary oedema","O₂ sat <94% on room air","Dyspnoea at rest"]},
{cat:"BP / Fetal", items:["BP ≥160/110 mmHg","Fetal growth restriction","Reverse end-diastolic flow"]},
];
sev.forEach((sf,i)=>{
const col=i%3, row=Math.floor(i/3);
const x=0.15+col*4.32, y=4.35+row*1.55;
s.addShape(pres.ShapeType.rect,{x,y,w:4.1,h:1.48,fill:{color:"4A0E0E"}});
s.addText(sf.cat,{x,y,w:4.1,h:0.38,fontSize:12,bold:true,color:WARN_RED,align:"center",valign:"middle",margin:0});
bullets(s,sf.items,{x:x+0.08,y:y+0.4,w:3.94,h:1.02,fontSize:11,color:WHITE});
});
}
// =================================================================
// SLIDE 9 — CLINICAL FEATURES
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect,{x:0,y:0,w:13.3,h:7.5,fill:{color:DARK_NAVY}});
sectionBar(s, ACCENT_TEAL, "07 | Clinical Features — Organ System Involvement");
const sys=[
{name:"CARDIOVASCULAR",fill:"6E1010",items:["Hypertension (may be labile)","↑ Systemic vascular resistance","↓ Cardiac output vs normal pregnancy","Exaggerated response to vasopressors","Peripheral vasospasm","Non-dependent peripheral oedema"]},
{name:"RENAL", fill:"0E4D6E",items:["Proteinuria (hallmark of PE)","Glomerular endotheliosis (pathognomonic)","Oliguria (<500 mL/24h in severe PE)","↑ Serum creatinine & uric acid","GFR reduction up to 30%","Sodium and water retention"]},
{name:"NEUROLOGIC", fill:"4A1067",items:["Severe frontal headache","Visual disturbances (scotomata, blurring)","Hyperreflexia and clonus","Cortical blindness (rare)","Cerebral oedema / PRES syndrome","Tonic-clonic seizures (eclampsia)"]},
{name:"HEPATIC", fill:"765400",items:["RUQ / epigastric pain","Elevated AST, ALT (>2× ULN)","Nausea and vomiting","Subcapsular hematoma (rare)","Liver rupture (life-threatening)","Component of HELLP syndrome"]},
{name:"HEMATOLOGIC", fill:"1E5631",items:["Thrombocytopenia (<100,000/µL)","Microangiopathic haemolytic anaemia","DIC in severe cases","↑ LDH (>600 U/L)","Schistocytes on peripheral smear","Reduced fibrinogen (severe)"]},
{name:"PLACENTA/FETAL", fill:"2E4057",items:["Placental insufficiency / infarcts","Fetal growth restriction (FGR)","Oligohydramnios","Absent/reversed umbilical Doppler","Non-reassuring fetal status","↑ Perinatal mortality"]},
];
sys.forEach((sy,i)=>{
const col=i%3, row=Math.floor(i/3);
const x=0.15+col*4.38, y=0.85+row*3.27;
s.addShape(pres.ShapeType.rect,{x,y,w:4.15,h:3.15,fill:{color:sy.fill}});
s.addText(sy.name,{x,y,w:4.15,h:0.48,fontSize:12.5,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
s.addShape(pres.ShapeType.line,{x:x+0.1,y:y+0.5,w:3.95,h:0,line:{color:GOLD,width:0.8}});
bullets(s,sy.items,{x:x+0.1,y:y+0.56,w:3.95,h:2.52,fontSize:11.5,color:WHITE});
});
}
// =================================================================
// SLIDE 10 — MATERNAL COMPLICATIONS
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect,{x:0,y:0,w:13.3,h:7.5,fill:{color:LIGHT_BG}});
sectionBar(s, WARN_RED, "08 | Maternal Complications");
s.addShape(pres.ShapeType.rect,{x:0.15,y:0.85,w:6.05,h:6.4,fill:{color:"6E1010"}});
s.addText("ACUTE / IMMEDIATE",{x:0.15,y:0.85,w:6.05,h:0.45,fontSize:13,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
bullets(s,[
"Eclampsia (generalised seizures)",
"HELLP syndrome (haemolysis, ↑LFTs, ↓platelets)",
"Acute pulmonary oedema",
"Acute kidney injury (AKI)",
"Placental abruption",
"Disseminated intravascular coagulation (DIC)",
"Stroke / intracranial haemorrhage",
"Liver rupture / subcapsular haematoma",
"Myocardial infarction / acute heart failure",
"Retinal detachment / cortical blindness",
"Hypertensive encephalopathy",
"Maternal death"
],{x:0.28,y:1.35,w:5.8,h:5.8,fontSize:12.5,color:WHITE});
s.addShape(pres.ShapeType.rect,{x:7.1,y:0.85,w:6.05,h:6.4,fill:{color:"4A1067"}});
s.addText("LONG-TERM / REMOTE",{x:7.1,y:0.85,w:6.05,h:0.45,fontSize:13,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
bullets(s,[
"Hypertension: 4.6× risk within 14 years (BMJ 2017)",
"Cardiovascular disease: 2× lifetime risk of MI/stroke",
"Chronic kidney disease (CKD) and proteinuria",
"Increased dementia risk (meta-analysis, PMID 38278201, 2024)",
"Increased stroke risk (meta-analysis, PMID 36990309, 2023)",
"Type 2 diabetes mellitus",
"Metabolic syndrome (obesity, dyslipidaemia, insulin resistance)",
"Subclinical cardiac dysfunction",
"Risk of recurrence in subsequent pregnancies: 15–25%",
"Offspring: ↑ lifetime CVD, HTN, obesity risk",
"Increased all-cause mortality (long-term studies)"
],{x:7.22,y:1.35,w:5.8,h:5.8,fontSize:12.5,color:WHITE});
s.addShape(pres.ShapeType.rect,{x:6.25,y:3.3,w:0.8,h:0.7,fill:{color:WARN_RED}});
s.addText("⟹",{x:6.25,y:3.3,w:0.8,h:0.7,fontSize:24,color:WHITE,align:"center",valign:"middle",margin:0});
}
// =================================================================
// SLIDE 11 — FETAL COMPLICATIONS
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect,{x:0,y:0,w:13.3,h:7.5,fill:{color:DARK_NAVY}});
sectionBar(s, ACCENT_TEAL, "09 | Fetal & Neonatal Complications");
const fc=[
{cat:"FETAL GROWTH", fill:"163A52", items:["Fetal growth restriction (FGR)","Small for gestational age (SGA)","Low birth weight (<2500 g)","Oligohydramnios"]},
{cat:"DELIVERY OUTCOMES",fill:"1A5276", items:["Iatrogenic preterm birth","Emergency caesarean section","Low gestational age at delivery","High NICU admission rates"]},
{cat:"PERFUSION", fill:"0E4D6E", items:["Uteroplacental insufficiency","Absent/reversed end-diastolic flow","Perinatal asphyxia","Stillbirth / fetal death"]},
{cat:"NEONATAL", fill:"2E4057", items:["Respiratory distress syndrome","Necrotising enterocolitis","Intraventricular haemorrhage","Retinopathy of prematurity"]},
{cat:"PLACENTAL", fill:"4A1A0E", items:["Placental abruption","Placental infarcts","Abnormal placental morphology","Abnormal cord insertion"]},
{cat:"LONG-TERM\nOFFSPRING",fill:"1E5631",items:["Hypertension in adult life","Obesity and metabolic syndrome","Cardiovascular disease risk","Cognitive/neurodevelopmental issues (maternal inflammation — Maher et al 2019)"]},
];
fc.forEach((f,i)=>{
const col=i%3, row=Math.floor(i/3);
const x=0.15+col*4.38, y=0.85+row*3.27;
s.addShape(pres.ShapeType.rect,{x,y,w:4.15,h:3.15,fill:{color:f.fill}});
s.addText(f.cat,{x,y,w:4.15,h:0.48,fontSize:12.5,bold:true,color:ACCENT_TEAL,align:"center",valign:"middle",margin:0});
s.addShape(pres.ShapeType.line,{x:x+0.1,y:y+0.5,w:3.95,h:0,line:{color:ACCENT_TEAL,width:0.8}});
bullets(s,f.items,{x:x+0.1,y:y+0.56,w:3.95,h:2.52,fontSize:12,color:WHITE});
});
}
// =================================================================
// SLIDE 12 — HELLP SYNDROME
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect,{x:0,y:0,w:13.3,h:7.5,fill:{color:LIGHT_BG}});
sectionBar(s, WARN_RED, "10 | HELLP Syndrome — Classification, Diagnosis & Management");
const hellp=[
{letter:"H", full:"Haemolysis", detail:"LDH >600 U/L\nTotal bilirubin >1.2 mg/dL\nSchistocytes on peripheral smear"},
{letter:"EL", full:"Elevated Liver Enzymes", detail:"AST/ALT >70 U/L (>2× ULN)\nRUQ / epigastric pain\nNausea and vomiting"},
{letter:"LP", full:"Low Platelets", detail:"Plt <100,000/µL\nClass I: <50,000\nClass II: 50,000–100,000"},
];
hellp.forEach((h,i)=>{
const x=0.15+i*4.38;
s.addShape(pres.ShapeType.rect,{x,y:0.85,w:4.15,h:1.6,fill:{color:WARN_RED}});
s.addText(h.letter,{x,y:0.85,w:1.1,h:1.6,fontSize:56,bold:true,color:WHITE,align:"center",valign:"middle",margin:0});
s.addText(h.full,{x:x+1.12,y:0.85,w:2.95,h:0.55,fontSize:14,bold:true,color:GOLD,valign:"bottom"});
s.addText(h.detail,{x:x+1.12,y:1.42,w:2.95,h:0.95,fontSize:11,color:WHITE,valign:"top"});
});
// Classification boxes
s.addShape(pres.ShapeType.rect,{x:0.15,y:2.6,w:6.1,h:2.0,fill:{color:"154360"}});
s.addText("TENNESSEE CLASSIFICATION",{x:0.15,y:2.6,w:6.1,h:0.42,fontSize:12.5,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
s.addText("Complete HELLP: All 3 criteria present\nPartial (Incomplete) HELLP: 1 or 2 criteria\nHigher risk with complete HELLP",
{x:0.28,y:3.05,w:5.86,h:1.45,fontSize:13,color:WHITE,valign:"top"});
s.addShape(pres.ShapeType.rect,{x:6.5,y:2.6,w:6.65,h:2.0,fill:{color:"154360"}});
s.addText("MISSISSIPPI CLASSIFICATION (Martin et al)",{x:6.5,y:2.6,w:6.65,h:0.42,fontSize:12.5,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
s.addText("Class I: Plt <50,000 + LDH ≥600 + AST/ALT ≥70 — worst prognosis\nClass II: Plt 50,000–100,000 + LDH ≥600 + AST/ALT ≥70\nClass III: Plt 100,000–150,000 + mild enzyme elevation",
{x:6.65,y:3.05,w:6.4,h:1.45,fontSize:12.5,color:WHITE,valign:"top"});
// Management
s.addShape(pres.ShapeType.rect,{x:0.15,y:4.72,w:12.95,h:0.42,fill:{color:MED_BLUE}});
s.addText("MANAGEMENT",{x:0.15,y:4.72,w:12.95,h:0.42,fontSize:13,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
const mgt=[
{t:"Immediate", items:["IV MgSO₄ for seizure prophylaxis","IV antihypertensives (BP ≥160/110)","IV access, crossmatch, ICU criteria","Expedite delivery if ≥34 weeks"]},
{t:"Stabilise", items:["Dexamethasone 10 mg IV q12h (<34 wks)","Platelet transfusion if <50,000 + bleeding","Correct coagulopathy: FFP, cryoprecipitate","Hepatology input if liver involvement"]},
{t:"Delivery", items:["Delivery is DEFINITIVE treatment","Vaginal delivery if feasible","<34 wks: steroids first, then deliver","Postpartum worsening: watch 24–48h"]},
];
mgt.forEach((m,i)=>{
const x=0.15+i*4.38;
s.addShape(pres.ShapeType.rect,{x,y:5.18,w:4.15,h:2.2,fill:{color:"4A1A0E"}});
s.addText(m.t,{x,y:5.18,w:4.15,h:0.4,fontSize:12.5,bold:true,color:GOLD,align:"center",valign:"middle",margin:0});
bullets(s,m.items,{x:x+0.1,y:5.62,w:3.95,h:1.7,fontSize:11.5,color:WHITE});
});
}
// =================================================================
// SLIDE 13 — MANAGEMENT OVERVIEW TABLE
// =================================================================
{
const s = pres.addSlide();
s.addShape(pres.ShapeType.rect,{x:0,y:0,w:13.3,h:7.5,fill:{color:DARK_NAVY}});
sectionBar(s, ACCENT_TEAL, "11 | Management Overview — by Severity & Gestational Age");
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["Preeclampsia\nw/ severe ≥34 wks","≥34 wks","<160/110","IV agents within 30–60 min","Yes","After stabilisation"],
["Preeclampsia\nw/ severe 24–34 wks","24–34 wks","<160/110","IV agents + corticosteroids","Yes","Expectant to 34 wks if stable"],
["Eclampsia","Any","<160/110","IV agents urgently","Yes — 4g bolus, 1–2g/h","After seizure control"],
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// =================================================================
// SLIDE 14 — ANTIHYPERTENSIVE THERAPY
// =================================================================
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// =================================================================
// SLIDE 15 — PREVENTION
// =================================================================
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"Recommended for women with ≥1 HIGH-risk or ≥2 moderate-risk factors",
"Dose: 100–162 mg/day (ISSHP: 150 mg nightly — optimal)",
"Start: 11–16 weeks gestation (ideally by 12 wks)",
"Continue until 36 weeks of gestation",
"High-risk factors: prior PE, CKD, autoimmune disease, DM, chronic HTN, multiple gestation",
"ASPRE trial: 150 mg at night → 62% reduction in early-onset PE",
"First-trimester combined screening (FMF algorithm) identifies high-risk women",
"USPSTF 2023: reaffirmed screening + aspirin recommendation",
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"Recommended for women with LOW dietary calcium intake",
"WHO 2018: reduces PE risk by ~50% in low-calcium populations",
"Mechanism: lowers PTH → reduces intracellular calcium → vasodilation",
"ISSHP 2021 endorses calcium supplementation",
"No benefit in populations with adequate dietary calcium",
"Safe, inexpensive and widely available globally",
"Beneficial in LMICs where calcium intake is often deficient",
]},
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"Folic acid 400 mcg/day (neural tube + vascular protection)",
"Weight optimisation pre-pregnancy (BMI <30 kg/m²)",
"Treat underlying conditions: DM, CKD, autoimmune disease",
"Pravastatin: promising in 2024–25 RCTs for PE prevention",
"Vitamin D: growing evidence but not yet standard recommendation",
"Metformin: under investigation for obese/insulin-resistant women",
"Antioxidants (Vit C+E): NOT recommended — failed RCTs",
"Vaginal microbiome: L. crispatus dominance may reduce HDP risk (2024)",
"Lifestyle: physical activity, low-salt diet, stress reduction",
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// =================================================================
// SLIDE 16 — RECENT ADVANCES 2023-2026
// =================================================================
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"sFlt-1/PlGF ratio: FDA-cleared in USA 2023 (Elecsys BRAHMS) for PE rule-in/rule-out",
"PlGF-based management reduces NICU admissions (PARROT RCT, UK)",
"Large-scale proteomics in early pregnancy predicts HDP weeks before onset (Greenland et al, JAMA Cardiol 2024)",
"Polygenic risk score: improved preconception risk stratification (Honigberg et al, Nat Med 2023)",
"Low fetal fraction (cfDNA) associated with adverse outcomes including HDP (meta-analysis 2024)",
"First-trimester PE screening: MAP + uterine artery PI + PIGF algorithm (Nicolaides/FMF)",
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"FinnGen + Estonian Biobank GWAS: multiple HDP genetic loci identified (Tyrmi et al, JAMA Cardiol 2023)",
"STAT3 signalling pathway confirmed in preeclampsia pathogenesis (Marzioni et al, 2025)",
"Mitochondrial dysfunction and maternal endothelial senescence: emerging targets",
"Epigenetic modifications of placental DNA methylation patterns",
"Complement pathway activation in atypical HDP presentations",
"Vaginal microbiome: L. crispatus dominant community reduces HDP risk (Li et al, 2024)",
]},
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"Pravastatin: RCT evidence for PE prevention — promising safety + efficacy in 2024 studies",
"Recombinant PlGF / VEGF-mimetics: investigational Phase II trials underway",
"Dextran sulfate apheresis to reduce sFlt-1: pilot data shows benefit in early-onset PE",
"Metformin for PE prevention in obese women: ongoing meta-analyses",
"SGLT2 inhibitors: safety profile in pregnancy under active investigation",
"Anti-sFlt-1 aptamers and RNA-based therapies: preclinical development",
]},
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"NICE 2023 (UK): aspirin 75–150 mg for high-risk women; sFlt-1/PlGF endorsed",
"ESC 2018/2022: cardiovascular management framework during pregnancy",
"WHO Dec 2025: updated global burden data (~42,000 maternal deaths/year)",
"AHA Aug 2025: new high BP guidelines emphasising pregnancy health and prevention",
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// =================================================================
// SLIDE 17 — LONG-TERM CONSEQUENCES
// =================================================================
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"Annual CVD screening: BP, lipids, fasting glucose",
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// =================================================================
// SLIDE 18 — KEY TAKEAWAYS
// =================================================================
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"HDP affects 3–8% of pregnancies globally, causing ~16% of all maternal deaths (~42,000/year in 2023) — a major public health emergency.",
"ISSHP 2021 classification: Chronic HTN | Gestational HTN | Preeclampsia (with/without severe features) | Eclampsia | Superimposed PE.",
"Pathogenesis follows a Two-Stage Model: Stage 1 (silent impaired placentation at 8–18 wks) → Stage 2 (clinical maternal endothelial dysfunction driven by sFlt-1/sEng release).",
"Proteinuria is NO LONGER required for PE diagnosis — end-organ damage alone is sufficient per ISSHP 2021.",
"sFlt-1/PlGF ratio is the best-validated biomarker for diagnosis and risk stratification; FDA-cleared in USA (2023).",
"MgSO₄ is the drug of choice for eclampsia seizure prophylaxis and treatment, reducing eclampsia by >50%.",
"Acute antihypertensives of choice: IV Labetalol / IV Hydralazine / oral Nifedipine (treat BP ≥160/110 within 30–60 min).",
"ACE inhibitors, ARBs, and direct renin inhibitors are ABSOLUTELY CONTRAINDICATED in pregnancy.",
"Low-dose aspirin 100–150 mg/day from 12–16 weeks is Grade A evidence for high-risk women (ASPRE trial: 62% reduction).",
"Delivery is the ONLY definitive treatment; timing depends on severity and gestational age.",
"HDP confers significant long-term CVD, hypertension, stroke, and dementia risks — lifelong surveillance is essential.",
"Recent advances: FDA-cleared biomarkers, genetic risk scoring, pravastatin trials, and apheresis therapy are reshaping management.",
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// =================================================================
// SLIDE 19 — REFERENCES
// =================================================================
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const refs=[
"1. Magee LA, Brown MA, Hall DR, et al. The 2021 ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2022;27:148–169.",
"2. ACOG Practice Bulletin No. 222. Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2020;135(6):e237–e260.",
"3. WHO. Pre-eclampsia fact sheet. December 2025. who.int",
"4. Creasy RK, Resnik R et al. Maternal-Fetal Medicine: Principles and Practice, 8th edition. Elsevier/Saunders. 2019.",
"5. Brenner BM. Brenner and Rector's The Kidney, 11th edition. Elsevier. 2020.",
"6. Zeisler H, Llurba E, Chantraine F, et al. Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia. NEJM. 2016;374(1):13–22.",
"7. Rolnik DL, Wright D, Poon LC, et al. Aspirin versus placebo in pregnancies at high risk for preterm PE (ASPRE). NEJM. 2017;377:613–622.",
"8. Brohan MP, Daly FP, Kelly L. HDP and long-term risk of maternal stroke — systematic review & meta-analysis. Am J Obstet Gynecol. 2023 (PMID 36990309).",
"9. Carey C, Mulcahy E, McCarthy FP. HDP and risk of maternal dementia. Am J Obstet Gynecol. 2024 (PMID 38278201).",
"10. Honigberg MC, Truong B, Khan RR, et al. Polygenic prediction of preeclampsia and gestational hypertension. Nat Med. 2023;29(6):1540–1549.",
"11. Greenland P, Segal MR, McNeil RB, et al. Large-scale proteomics in early pregnancy and HDP. JAMA Cardiol. 2024;9(9):791–799.",
"12. Tyrmi JS, Kaartokallio T, Lokki AI, et al. Genetic risk factors associated with PE and HDP. JAMA Cardiol. 2023;8(7):674–683.",
"13. Marzioni D, Piani F, Di Simone N, et al. Importance of STAT3 signaling in preeclampsia. Int J Mol Med. 2025;55(4):58.",
"14. USPSTF. Screening for HDP: Final Recommendation Statement. JAMA. 2023 Sep 19 (PMID 37721605).",
"15. Brown MA, Magee LA, Kenny LC, et al. ISSHP 2018 Classification. Hypertension. 2018;72(1):24–43.",
];
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// WRITE
pres.writeFile({fileName:"/home/daytona/workspace/hdp-presentation/HDP_Presentation_v2.pptx"})
.then(()=>console.log("SUCCESS"))
.catch(e=>{console.error(e);process.exit(1);});
Running Command
cd /home/daytona/workspace/hdp-presentation && node build_new.js 2>&1
Running Command
ls -lh /home/daytona/workspace/hdp-presentation/HDP_Presentation_v2.pptx
Your PowerPoint is ready! Here's your download link:
HDP Presentation v2
Presentation · PPTX
What's Inside — 19 Slides
| # | Slide |
|---|---|
| 1 | Title Slide - with 4 key global statistics |
| 2 | Table of Contents |
| 3 | ISSHP 2021 Classification - all 5 categories with criteria |
| 4 | Epidemiology & Risk Factors - modifiable vs non-modifiable |
| 5 | Etiopathogenesis — Two-Stage Model - Stage 1 (silent placentation) → Stage 2 (maternal syndrome) |
| 6 | Angiogenic Imbalance - sFlt-1, PlGF, sEng with clinical biomarker utility |
| 7 | Immunologic, Genetic & Oxidative Stress Mechanisms |
| 8 | Diagnostic Criteria - BP thresholds, proteinuria, severe features table |
| 9 | Clinical Features - 6 organ systems (CV, renal, neuro, hepatic, hematologic, placental) |
| 10 | Maternal Complications - acute + long-term |
| 11 | Fetal & Neonatal Complications |
| 12 | HELLP Syndrome - Tennessee/Mississippi classification + management |
| 13 | Management Table - all HDP categories by gestational age & severity |
| 14 | Antihypertensive Therapy - doses, contraindications |
| 15 | Prevention & Prophylaxis - aspirin, calcium, emerging strategies |
| 16 | Recent Advances 2023-2026 - biomarkers, genetics, novel therapeutics, guideline updates |
| 17 | Long-term Consequences & Postpartum Care |
| 18 | Key Takeaways - 12 summary points |
| 19 | References - 15 primary sources |
Design: Dark navy/teal color scheme with gold accents, wide (13.3" × 7.5") format, suitable for academic/CME presentations.
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