Physiological changes during pregnancy from dc dutta textbook and at t

Physiological changes during pregnancy from dc dutta textbook and at the end make a detailed summary chart to download for ready visual memory

Reading File

Finding Sources

Reading File

Finding Sources

Reading File

Finding Sources

Reading File

Running Command

ls /home/daytona/workspace/ 2>/dev/null && mkdir -p /home/daytona/workspace/pregnancy-physiology

Writing File

~/pregnancy-physiology/create_chart.js

const pptxgen = require("pptxgenjs");

let pres = new pptxgen();
pres.layout = 'LAYOUT_WIDE'; // 13.3" x 7.5"
pres.title = 'Physiological Changes During Pregnancy';
pres.author = 'Orris Medical Reference';

// ─── Color Palette ───────────────────────────────────────────────────────────
const C = {
  darkBg:   "1A1A2E",   // deep navy – dark slides
  midBg:    "16213E",
  accent1:  "E94560",   // coral red – headings
  accent2:  "0F3460",   // dark blue
  teal:     "00B4D8",   // teal – sub-headings
  gold:     "FFD166",   // gold – numbers/values
  white:    "FFFFFF",
  lightGray:"E8EDF5",
  textDark: "1A1A2E",
  green:    "06D6A0",
  purple:   "9B5DE5",
  orange:   "F77F00",
  pink:     "FF6B9D",
};

// ─── SLIDE 1: Title ───────────────────────────────────────────────────────────
{
  let s = pres.addSlide();
  // background gradient effect via shapes
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:7.5, fill:{color:C.darkBg}, line:{color:C.darkBg} });
  s.addShape(pres.ShapeType.rect, { x:0, y:5.5, w:13.3, h:2, fill:{color:C.accent2}, line:{color:C.accent2} });

  // decorative bar
  s.addShape(pres.ShapeType.rect, { x:0.5, y:1.6, w:12.3, h:0.06, fill:{color:C.accent1}, line:{color:C.accent1} });
  s.addShape(pres.ShapeType.rect, { x:0.5, y:3.9, w:12.3, h:0.06, fill:{color:C.teal}, line:{color:C.teal} });

  s.addText("PHYSIOLOGICAL CHANGES", {
    x:0.5, y:1.0, w:12.3, h:0.65, fontSize:38, bold:true, color:C.white,
    fontFace:"Calibri", align:"center", charSpacing:4, margin:0
  });
  s.addText("DURING PREGNANCY", {
    x:0.5, y:1.7, w:12.3, h:0.65, fontSize:38, bold:true, color:C.gold,
    fontFace:"Calibri", align:"center", charSpacing:4, margin:0
  });
  s.addText("A Complete System-by-System Visual Reference", {
    x:0.5, y:2.55, w:12.3, h:0.5, fontSize:18, color:C.teal,
    fontFace:"Calibri", align:"center", italic:true, margin:0
  });
  s.addText("Based on DC Dutta's Textbook of Obstetrics & Standard References", {
    x:0.5, y:3.15, w:12.3, h:0.4, fontSize:13, color:C.lightGray,
    fontFace:"Calibri", align:"center", margin:0
  });

  // system icons row
  const systems = ["CARDIOVASCULAR","RESPIRATORY","HEMATOLOGICAL","RENAL","ENDOCRINE","GASTROINTESTINAL","NEUROLOGICAL","METABOLIC","MUSCULOSKELETAL"];
  systems.forEach((sys, i) => {
    const cols = 5;
    const col = i % cols;
    const row = Math.floor(i / cols);
    const xStart = 0.6;
    const xGap = 2.4;
    const yStart = 4.55;
    const yGap = 0.9;
    s.addShape(pres.ShapeType.roundRect, {
      x: xStart + col*xGap, y: yStart + row*yGap, w:2.1, h:0.7,
      fill:{color:C.accent1}, line:{color:C.accent1}, rectRadius:0.1
    });
    s.addText(sys, {
      x: xStart + col*xGap, y: yStart + row*yGap, w:2.1, h:0.7,
      fontSize:8, bold:true, color:C.white, fontFace:"Calibri", align:"center", valign:"middle", margin:0
    });
  });

  s.addText("Orris Medical Reference  |  Visual Memory Chart  |  2026", {
    x:0.5, y:7.1, w:12.3, h:0.3, fontSize:9, color:C.teal,
    fontFace:"Calibri", align:"center", margin:0
  });
}

// ─── SLIDE 2: Quick Numbers Table ─────────────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:7.5, fill:{color:"0D1B2A"}, line:{color:"0D1B2A"} });

  // header bar
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:0.75, fill:{color:C.accent1}, line:{color:C.accent1} });
  s.addText("AT-A-GLANCE: KEY NUMERICAL CHANGES IN PREGNANCY", {
    x:0.3, y:0, w:12.7, h:0.75, fontSize:17, bold:true, color:C.white,
    fontFace:"Calibri", align:"center", valign:"middle", margin:0
  });

  // table data
  const rows = [
    ["Parameter", "Change", "Direction", "Parameter", "Change", "Direction"],
    // Row pairs
    ["Plasma Volume", "+55%", "↑", "GFR (Renal)", "+50%", "↑"],
    ["Total Blood Volume", "+35%", "↑", "Creatinine", "↓ to ~0.4 mg/dL", "↓"],
    ["Cardiac Output", "+40%", "↑", "BUN", "↓ to ~9 mg/dL", "↓"],
    ["Heart Rate", "+20%", "↑", "Prolactin", "×10 increase", "↑↑"],
    ["Stroke Volume", "+30%", "↑", "Cortisol (total)", "×3 increase", "↑↑"],
    ["Systolic BP", "-5%", "↓", "Aldosterone", "+6× increase", "↑↑"],
    ["Diastolic BP", "-15%", "↓", "Thyroid (total T4/T3)", "↑ (free normal)", "→"],
    ["Peripheral Resistance", "-15%", "↓", "Serum Albumin", "↓", "↓"],
    ["Minute Ventilation", "+50%", "↑", "Alkaline Phosphatase", "↑ (placenta)", "↑"],
    ["Tidal Volume", "+40%", "↑", "Fibrinogen", "+50–250%", "↑↑"],
    ["O2 Consumption", "+20–50%", "↑", "Clotting Factors VII-X,XII", "+30–250%", "↑↑"],
    ["FRC", "-20%", "↓", "Hemoglobin", "-20% (dilutional)", "↓"],
    ["PaCO2", "-15% (27-32 mmHg)", "↓", "Platelets", "-10%", "↓"],
    ["PaO2", "+10% (104-108 mmHg)", "↑", "MAC (anesthetic)", "-40%", "↓"],
    ["HCO3", "-15%", "↓", "Serum Pseudocholinesterase", "-25–30%", "↓"],
  ];

  const colW = [2.5, 1.6, 1.0, 2.5, 1.6, 1.0];
  const colX = [0.15, 2.7, 4.35, 5.45, 8.0, 9.65];
  const rowH = 0.42;
  const startY = 0.85;

  rows.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      const isHeader = ri === 0;
      const isMidHeader = ci === 3 && ri === 0;
      const bgColor = isHeader ? C.accent2 :
                      (ri % 2 === 0 ? "112244" : "0D1B2A");
      const txtColor = isHeader ? C.gold :
                       (ci === 2 || ci === 5) ?
                         (cell.includes("↑") ? C.green : cell.includes("↓") ? C.accent1 : C.gold) :
                       (ci === 1 || ci === 4) ? C.gold : C.white;

      s.addShape(pres.ShapeType.rect, {
        x: colX[ci], y: startY + ri * rowH, w: colW[ci], h: rowH,
        fill:{color: bgColor}, line:{color:"1E3A5F", pt:0.5}
      });
      s.addText(cell, {
        x: colX[ci], y: startY + ri * rowH, w: colW[ci], h: rowH,
        fontSize: isHeader ? 9.5 : 9, bold: isHeader || (ci===2||ci===5),
        color: txtColor, fontFace:"Calibri",
        align: (ci===2||ci===5) ? "center" : "left",
        valign:"middle", margin:4
      });
    });
  });

  // divider
  s.addShape(pres.ShapeType.rect, { x:5.35, y:0.85, w:0.08, h:rowH*rows.length, fill:{color:C.accent1}, line:{color:C.accent1} });

  s.addText("↑ = Increase  |  ↓ = Decrease  |  → = Unchanged  |  Values represent maximum changes at/near term", {
    x:0.3, y:7.15, w:12.7, h:0.3, fontSize:9, color:C.teal,
    fontFace:"Calibri", align:"center", margin:0, italic:true
  });
}

// ─── SLIDE 3: Cardiovascular Changes ─────────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:7.5, fill:{color:"0D1520"}, line:{color:"0D1520"} });
  // sidebar
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.25, h:7.5, fill:{color:C.accent1}, line:{color:C.accent1} });

  s.addText("❤  CARDIOVASCULAR SYSTEM", {
    x:0.4, y:0.1, w:12.5, h:0.6, fontSize:22, bold:true, color:C.accent1,
    fontFace:"Calibri", margin:0
  });
  s.addShape(pres.ShapeType.rect, { x:0.4, y:0.7, w:12.5, h:0.04, fill:{color:C.accent1}, line:{color:C.accent1} });

  const cvData = [
    { title:"BLOOD VOLUME", items:[
      "Total blood volume ↑ 35% (plasma ↑55%, RBC mass ↑45%)",
      "At term: +1000–1500 mL extra blood (total ~90 mL/kg)",
      "Returns to normal 1–2 weeks postpartum",
      "Dilutional anemia: Hb usually >11 g/dL"
    ]},
    { title:"CARDIAC OUTPUT", items:[
      "CO ↑ 40% at term (mainly in 1st/2nd trimester)",
      "Heart rate ↑ 20% + Stroke volume ↑ 30%",
      "Cardiac chambers enlarge; myocardial hypertrophy",
      "CO falls slightly at 36–40 weeks"
    ]},
    { title:"BLOOD PRESSURE & RESISTANCE", items:[
      "Systolic BP ↓ ~5%, Diastolic BP ↓ ~15%",
      "Peripheral vascular resistance ↓ 15–20% (nadir mid-2nd trimester)",
      "Pulmonary resistance ↓ 30%; no rise in pulmonary pressures",
      "Driven by progesterone → smooth muscle relaxation"
    ]},
    { title:"AORTOCAVAL COMPRESSION", items:[
      "After 20 wks: IVC compressed by gravid uterus in supine",
      "~5–10% develop supine hypotension syndrome",
      "Left lateral decubitus position relieves compression",
      "Epidural venous plexus engorged → increased epidural bleed risk"
    ]},
    { title:"ECG & AUSCULTATION", items:[
      "Left axis deviation on ECG; T wave changes",
      "Elevated diaphragm shifts heart leftward",
      "Grade I–II systolic ejection murmur (flow murmur)",
      "Exaggerated S1 splitting; S3 may be audible; pericardial effusion possible"
    ]},
    { title:"UTERINE BLOOD FLOW", items:[
      "Increases from ~50 mL/min → ~500–700 mL/min at term",
      "10% of cardiac output by term",
      "Autoregulation absent → pressure-dependent",
      "Adrenaline reduces; vasodilators increase uterine flow"
    ]},
  ];

  const colsPerRow = 3;
  const boxW = 4.1, boxH = 1.6, xGap = 4.3, yGap = 1.72;
  const startX = 0.4, startY = 0.85;

  cvData.forEach((item, i) => {
    const col = i % colsPerRow;
    const row = Math.floor(i / colsPerRow);
    const x = startX + col * xGap;
    const y = startY + row * yGap;

    s.addShape(pres.ShapeType.roundRect, {
      x, y, w:boxW, h:boxH,
      fill:{color:"112233"}, line:{color:C.accent1, pt:1}, rectRadius:0.08
    });
    s.addShape(pres.ShapeType.rect, { x, y, w:boxW, h:0.32, fill:{color:C.accent1}, line:{color:C.accent1} });
    s.addText(item.title, {
      x, y, w:boxW, h:0.32, fontSize:10, bold:true, color:C.white,
      fontFace:"Calibri", align:"center", valign:"middle", margin:0
    });
    s.addText(item.items.map(t => ({ text:"• "+t, options:{breakLine:true} })), {
      x:x+0.05, y:y+0.34, w:boxW-0.1, h:boxH-0.38,
      fontSize:8.5, color:C.lightGray, fontFace:"Calibri",
      valign:"top", margin:3
    });
  });
}

// ─── SLIDE 4: Respiratory Changes ────────────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:7.5, fill:{color:"051523"}, line:{color:"051523"} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.25, h:7.5, fill:{color:C.teal}, line:{color:C.teal} });

  s.addText("🫁  RESPIRATORY SYSTEM", {
    x:0.4, y:0.1, w:12.5, h:0.6, fontSize:22, bold:true, color:C.teal,
    fontFace:"Calibri", margin:0
  });
  s.addShape(pres.ShapeType.rect, { x:0.4, y:0.7, w:12.5, h:0.04, fill:{color:C.teal}, line:{color:C.teal} });

  // Volume changes table
  const volData = [
    ["VOLUME/PARAMETER", "CHANGE", "MECHANISM"],
    ["Minute Ventilation", "↑ 50%", "↑ Tidal volume (mainly)"],
    ["Tidal Volume (TV)", "↑ 40%", "Progesterone stimulates respiratory centre"],
    ["Respiratory Rate", "↑ 15%", "Minor contributor"],
    ["O2 Consumption", "↑ 20–50%", "Fetal + placental + maternal demands"],
    ["FRC", "↓ 20%", "Diaphragm elevated ~4 cm"],
    ["ERV (Expiratory Reserve Vol)", "↓ ~20%", "↑ TV causes bigger exhalation"],
    ["RV (Residual Volume)", "↓ ~20%", "Diaphragm elevation"],
    ["Airway Resistance", "↓ 35%", "Progesterone → bronchodilation"],
    ["Vital Capacity", "Unchanged", "Compensated by chest expansion"],
    ["PaCO2", "↓ 27–32 mmHg", "Hyperventilation (normal = 40 mmHg)"],
    ["PaO2", "↑ 104–108 mmHg", "Hyperventilation"],
    ["HCO3", "↓ 18–21 mEq/L", "Renal compensation for resp. alkalosis"],
    ["pH", "7.44 (mild alk.)", "Compensated respiratory alkalosis"],
    ["P50 (Hb-O2 curve)", "↑ 27 → 30 mmHg", "↑ 2,3-DPG (right shift — facilitates O2 release)"],
  ];

  const colWR = [4.0, 2.2, 5.5];
  const colXR = [0.4, 4.5, 6.8];
  const rowHR = 0.38;
  const startY = 0.85;

  volData.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      const isHeader = ri === 0;
      const bgColor = isHeader ? C.accent2 : (ri%2===0 ? "0A2035" : "051523");
      const changeColor = cell.includes("↑") ? C.green : cell.includes("↓") ? C.accent1 :
                          cell.includes("Unchanged") ? C.gold : C.white;
      const txtColor = isHeader ? C.gold : (ci===1 ? changeColor : C.white);
      s.addShape(pres.ShapeType.rect, {
        x:colXR[ci], y:startY+ri*rowHR, w:colWR[ci], h:rowHR,
        fill:{color:bgColor}, line:{color:"1A3550", pt:0.5}
      });
      s.addText(cell, {
        x:colXR[ci], y:startY+ri*rowHR, w:colWR[ci], h:rowHR,
        fontSize:isHeader?9.5:9, bold:isHeader||ci===1,
        color:txtColor, fontFace:"Calibri",
        align:"left", valign:"middle", margin:4
      });
    });
  });

  // side notes
  const notes = [
    { title:"DANGER: RAPID DESATURATION", body:"↓ FRC + ↑ O2 consumption = rapid SpO2 drop during apnea.\nPre-oxygenate ALWAYS before intubating.", color:C.accent1 },
    { title:"ACID-BASE STATE", body:"Compensated respiratory alkalosis.\nPaCO2 27-32 / HCO3 18-21 / pH 7.44", color:C.teal },
    { title:"AIRWAY CHANGES", body:"Mucosal edema, capillary engorgement.\nSmaller tube (6.0-6.5mm). Mallampati score worsens.", color:C.gold },
  ];

  notes.forEach((note, i) => {
    const x = 0.4 + i*4.27;
    s.addShape(pres.ShapeType.roundRect, {
      x, y:6.45, w:4.0, h:0.95,
      fill:{color:"0A2035"}, line:{color:note.color, pt:1.5}, rectRadius:0.08
    });
    s.addText([
      {text: note.title+"\n", options:{bold:true, color:note.color, fontSize:9}},
      {text: note.body, options:{color:C.lightGray, fontSize:8}}
    ], {x:x+0.07, y:6.45, w:3.86, h:0.95, fontFace:"Calibri", valign:"middle", margin:4});
  });
}

// ─── SLIDE 5: Hematological Changes ──────────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:7.5, fill:{color:"100820"}, line:{color:"100820"} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.25, h:7.5, fill:{color:C.purple}, line:{color:C.purple} });

  s.addText("🩸  HEMATOLOGICAL CHANGES", {
    x:0.4, y:0.1, w:12.5, h:0.6, fontSize:22, bold:true, color:C.purple,
    fontFace:"Calibri", margin:0
  });
  s.addShape(pres.ShapeType.rect, { x:0.4, y:0.7, w:12.5, h:0.04, fill:{color:C.purple}, line:{color:C.purple} });

  const hemaBoxes = [
    { title:"RED CELLS & ANEMIA", color:C.accent1, items:[
      "Plasma vol ↑ 55% > RBC mass ↑ 45% → Physiological dilutional anemia",
      "Hb usually remains >11 g/dL (WHO cutoff: <11 g/dL = anaemia in pregnancy)",
      "Hematocrit ↓ to ~33–34%",
      "MCV, MCH, MCHC: unchanged if no deficiency",
      "Iron & folate supplements needed to prevent true deficiencies",
    ]},
    { title:"COAGULATION (PRO-THROMBOTIC STATE)", color:C.gold, items:[
      "Fibrinogen ↑ 50–250% (most dramatic rise)",
      "Factors VII, VIII, IX, X, XII ↑ 30–250%",
      "Factor XI may slightly decrease",
      "Protein S (anticoagulant) ↓",
      "Acquired resistance to activated Protein C",
      "Fibrinolysis ↑ in 3rd trimester",
      "Net effect: HYPERCOAGULABLE → VTE risk ×5–10",
    ]},
    { title:"WHITE CELLS", color:C.green, items:[
      "Leukocytosis normal in pregnancy",
      "WBC ↑ to 9,000–15,000/μL (up to 21,000 in 3rd trimester)",
      "Mainly neutrophilia",
      "Eosinophils & basophils slightly decrease",
      "Do NOT use WBC alone to diagnose infection in pregnancy",
    ]},
    { title:"PLATELETS", color:C.teal, items:[
      "Platelet count ↓ ~10% (gestational thrombocytopenia)",
      "Platelet size (MPV) increases",
      "Platelet function is enhanced",
      ">80,000 generally safe for regional anesthesia",
      "Pathological if <100,000 (investigate for ITP, pre-eclampsia, HELLP)",
    ]},
  ];

  const boxW = 5.95, boxH = 2.7;
  const positions = [[0.4,0.85],[6.7,0.85],[0.4,3.7],[6.7,3.7]];

  hemaBoxes.forEach((box, i) => {
    const [x,y] = positions[i];
    s.addShape(pres.ShapeType.roundRect, {
      x, y, w:boxW, h:boxH,
      fill:{color:"1A0D2E"}, line:{color:box.color, pt:1.5}, rectRadius:0.1
    });
    s.addShape(pres.ShapeType.rect, { x, y, w:boxW, h:0.35, fill:{color:box.color}, line:{color:box.color} });
    s.addText(box.title, {
      x, y, w:boxW, h:0.35, fontSize:10, bold:true, color:C.white,
      fontFace:"Calibri", align:"center", valign:"middle", margin:0
    });
    s.addText(box.items.map(t=>({text:"• "+t, options:{breakLine:true}})), {
      x:x+0.08, y:y+0.38, w:boxW-0.15, h:boxH-0.42,
      fontSize:8.5, color:C.lightGray, fontFace:"Calibri", valign:"top", margin:3
    });
  });
}

// ─── SLIDE 6: Renal & Endocrine Changes ──────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:7.5, fill:{color:"051A10"}, line:{color:"051A10"} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.25, h:7.5, fill:{color:C.green}, line:{color:C.green} });

  s.addText("🫘  RENAL SYSTEM", {
    x:0.4, y:0.1, w:5.8, h:0.55, fontSize:20, bold:true, color:C.green,
    fontFace:"Calibri", margin:0
  });
  s.addText("⚗  ENDOCRINE SYSTEM", {
    x:7.0, y:0.1, w:6.0, h:0.55, fontSize:20, bold:true, color:C.orange,
    fontFace:"Calibri", margin:0
  });
  s.addShape(pres.ShapeType.rect, { x:0.4, y:0.67, w:5.8, h:0.04, fill:{color:C.green}, line:{color:C.green} });
  s.addShape(pres.ShapeType.rect, { x:7.0, y:0.67, w:6.0, h:0.04, fill:{color:C.orange}, line:{color:C.orange} });

  // Renal table
  const renalData = [
    ["PARAMETER", "CHANGE"],
    ["Renal plasma flow (RPF)", "↑ 50–80% (peaks 2nd trimester)"],
    ["GFR", "↑ 50% (110–150 mL/min)"],
    ["Serum Creatinine", "↓ 0.4–0.5 mg/dL (normal = 0.4)"],
    ["Blood Urea Nitrogen (BUN)", "↓ ~9 mg/dL (from 12–13)"],
    ["Uric acid", "↓ early pregnancy; rises near term"],
    ["Glucosuria", "Common even with normal glucose"],
    ["Proteinuria", "Up to 300 mg/24h acceptable"],
    ["Sodium", "Retained (~900 mEq overall)"],
    ["Aldosterone", "↑ 6× (compensatory natriuresis offset)"],
    ["Urinary tract dilation", "Hydronephrosis (right > left)"],
    ["UTI risk", "↑ due to stasis + glycosuria"],
  ];

  const rColW = [3.0, 2.8];
  const rColX = [0.4, 3.45];
  const rRowH = 0.43;
  const rStartY = 0.78;

  renalData.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      const isH = ri===0;
      const bg = isH ? "0F3D1A" : ri%2===0 ? "0A2A10" : "051A10";
      const isChange = ci===1;
      const chColor = cell.includes("↑") ? C.green : cell.includes("↓") ? C.accent1 : C.white;
      const tColor = isH ? C.gold : (isChange ? chColor : C.white);
      s.addShape(pres.ShapeType.rect, {
        x:rColX[ci], y:rStartY+ri*rRowH, w:rColW[ci], h:rRowH,
        fill:{color:bg}, line:{color:"1A4020", pt:0.5}
      });
      s.addText(cell, {
        x:rColX[ci], y:rStartY+ri*rRowH, w:rColW[ci], h:rRowH,
        fontSize:isH?9:8.5, bold:isH, color:tColor,
        fontFace:"Calibri", align:"left", valign:"middle", margin:4
      });
    });
  });

  // divider
  s.addShape(pres.ShapeType.rect, { x:6.6, y:0.78, w:0.08, h:6.5, fill:{color:"2A2A2A"}, line:{color:"2A2A2A"} });

  // Endocrine boxes
  const endoData = [
    { title:"PITUITARY", color:C.orange, items:[
      "Pituitary size ↑ up to 120% by delivery",
      "Prolactin ↑ 10×  (suppresses LH/FSH)",
      "ACTH ↑ 2–4× (mainly placental)",
      "Pituitary GH → replaced by placental GH variant",
      "GnRH ↑ (placental) but gonadotropins suppressed",
    ]},
    { title:"ADRENAL", color:C.gold, items:[
      "Total cortisol ↑ 3× (CBG triples)",
      "Free cortisol (urinary) ↑ 2–3×",
      "Aldosterone ↑ 6× (offsets progesterone natriuresis)",
      "DHEAS ↓ (used as substrate by placenta)",
      "Renin–angiotensin system ↑",
    ]},
    { title:"THYROID", color:C.teal, items:[
      "Thyroid gland enlarges (goitre in iodine deficiency)",
      "TBG ↑ → total T3/T4 ↑ (but FREE T3/T4 normal)",
      "TSH: ↓ in 1st trimester (HCG cross-reacts with TSH-R)",
      "Iodine requirements increase",
      "Gestational hyperthyroidism: subclinical, self-limited",
    ]},
    { title:"PANCREAS / GLUCOSE", color:C.green, items:[
      "Insulin secretion ↑ (beta cell hyperplasia)",
      "hPL (human placental lactogen) → insulin resistance",
      "Fasting glucose ↓ (glucose to fetus)",
      "Post-prandial glucose ↑ → gestational diabetes risk",
      "Free fatty acids, ketones, triglycerides ↑",
    ]},
  ];

  const eBoxW = 5.9, eBoxH = 2.5;
  const ePos = [[6.85,0.78],[6.85,3.42]];

  // 2×2 layout
  endoData.forEach((box, i) => {
    const col = i%2, row = Math.floor(i/2);
    const x = 6.85 + col*3.05;
    const y = 0.78 + row*3.2;
    const bW = 2.9, bH = 2.9;
    s.addShape(pres.ShapeType.roundRect, {
      x, y, w:bW, h:bH,
      fill:{color:"0A1A05"}, line:{color:box.color, pt:1.2}, rectRadius:0.08
    });
    s.addShape(pres.ShapeType.rect, { x, y, w:bW, h:0.32, fill:{color:box.color}, line:{color:box.color} });
    s.addText(box.title, {
      x, y, w:bW, h:0.32, fontSize:9.5, bold:true, color:C.white,
      fontFace:"Calibri", align:"center", valign:"middle", margin:0
    });
    s.addText(box.items.map(t=>({text:"• "+t, options:{breakLine:true}})), {
      x:x+0.06, y:y+0.35, w:bW-0.12, h:bH-0.4,
      fontSize:8, color:C.lightGray, fontFace:"Calibri", valign:"top", margin:3
    });
  });
}

// ─── SLIDE 7: GI / Hepatic / Metabolic Changes ────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:7.5, fill:{color:"1A1005"}, line:{color:"1A1005"} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.25, h:7.5, fill:{color:C.orange}, line:{color:C.orange} });

  s.addText("🫄  GI / HEPATIC / METABOLIC CHANGES", {
    x:0.4, y:0.1, w:12.5, h:0.6, fontSize:22, bold:true, color:C.orange,
    fontFace:"Calibri", margin:0
  });
  s.addShape(pres.ShapeType.rect, { x:0.4, y:0.7, w:12.5, h:0.04, fill:{color:C.orange}, line:{color:C.orange} });

  const giBoxes = [
    { title:"STOMACH & ESOPHAGUS", color:C.accent1, items:[
      "Lower esophageal sphincter tone ↓ (progesterone)",
      "Gastric motility & tone ↓",
      "GERD very common (60–80% of pregnant women)",
      "Aspiration risk ↑ – nil per os policies critical",
      "Gastric acid & volume: NOT significantly changed",
      "Gastric emptying delayed (more so in labor with opioids)",
    ]},
    { title:"SMALL BOWEL & COLON", color:C.orange, items:[
      "Small bowel transit time ↑",
      "Nutrient absorption largely unchanged",
      "Iron absorption ↑ (increased demand)",
      "Constipation very common – colon Na+/H2O absorption ↑, motility ↓",
      "Mechanical obstruction by uterus contributes",
      "Hemorrhoids – dilated portal venous collaterals",
    ]},
    { title:"GALLBLADDER & BILE", color:C.gold, items:[
      "Gallbladder volume ↑ 2× in 2nd/3rd trimester",
      "Gallbladder emptying markedly slower",
      "Bile composition altered (↑ cholesterol saturation)",
      "Gallstones in ~4% on routine OB ultrasound",
      "Symptomatic cholelithiasis: 1 in 1000 pregnancies",
      "Gallstone risk ↑ with multiparity",
    ]},
    { title:"LIVER", color:C.teal, items:[
      "Hepatic function & blood flow: unchanged",
      "Transaminases: normal or slightly ↑ (3rd trimester)",
      "Alkaline phosphatase ↑ (placental isoenzyme)",
      "Bilirubin: unchanged",
      "Albumin ↓ (dilutional) → ↓ oncotic pressure",
      "Spider nevi & palmar erythema (estrogen-mediated)",
      "Pseudocholinesterase ↓ 25–30% (relevant for suxamethonium)",
    ]},
    { title:"METABOLISM", color:C.green, items:[
      "Resembles 'accelerated starvation'",
      "↓ Fasting glucose, ↓ amino acids",
      "↑ Free fatty acids, ↑ ketones, ↑ triglycerides",
      "Insulin resistance: ↑ HPL + cortisol + glucagon",
      "Pancreatic beta cell hyperplasia → ↑ insulin",
      "Gestational diabetes in susceptible women",
      "Weight gain: ~11–15 kg total recommended",
    ]},
    { title:"WEIGHT & NUTRITIONAL CHANGES", color:C.pink, items:[
      "Weight gain: fetus (~3.5 kg) + placenta (0.6 kg) + amniotic fluid (0.8 kg)",
      "Uterus ↑ (~0.9 kg) + breasts ↑ (~0.4 kg) + maternal fat/water (~3 kg)",
      "Calcium: serum ↓ (dilution) but ionized Ca2+ normal",
      "Iron requirement ↑ (fetus + RBC expansion)",
      "Folate requirement ↑ (neural tube development)",
      "Total caloric need ↑ ~300 kcal/day",
    ]},
  ];

  const cols = 3;
  const bW = 4.0, bH = 2.7;
  const xS = 0.4, yS = 0.82, xG = 4.3, yG = 2.82;

  giBoxes.forEach((box, i) => {
    const col = i % cols, row = Math.floor(i/cols);
    const x = xS + col*xG, y = yS + row*yG;
    s.addShape(pres.ShapeType.roundRect, {
      x, y, w:bW, h:bH,
      fill:{color:"201505"}, line:{color:box.color, pt:1.2}, rectRadius:0.08
    });
    s.addShape(pres.ShapeType.rect, { x, y, w:bW, h:0.32, fill:{color:box.color}, line:{color:box.color} });
    s.addText(box.title, {
      x, y, w:bW, h:0.32, fontSize:9.5, bold:true, color:C.white,
      fontFace:"Calibri", align:"center", valign:"middle", margin:0
    });
    s.addText(box.items.map(t=>({text:"• "+t, options:{breakLine:true}})), {
      x:x+0.06, y:y+0.35, w:bW-0.12, h:bH-0.4,
      fontSize:8, color:C.lightGray, fontFace:"Calibri", valign:"top", margin:3
    });
  });
}

// ─── SLIDE 8: Nervous System / MSK / Skin ────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:7.5, fill:{color:"0D0D1A"}, line:{color:"0D0D1A"} });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.25, h:7.5, fill:{color:C.pink}, line:{color:C.pink} });

  s.addText("🧠  NEUROLOGICAL  |  🦴  MUSCULOSKELETAL  |  🌿  SKIN", {
    x:0.4, y:0.1, w:12.5, h:0.6, fontSize:19, bold:true, color:C.pink,
    fontFace:"Calibri", margin:0
  });
  s.addShape(pres.ShapeType.rect, { x:0.4, y:0.7, w:12.5, h:0.04, fill:{color:C.pink}, line:{color:C.pink} });

  const neuroData = [
    { title:"CNS / ANESTHESIA IMPLICATIONS", color:C.purple, items:[
      "MAC (minimum alveolar concentration) ↓ 40% by term (progesterone-mediated)",
      "MAC returns to normal by day 3 postpartum",
      "β-endorphin surge during labor → additional sedation",
      "Sensitivity to local anesthetics ↑ (↓ dose needed for epidural/spinal)",
      "Epidural space: engorgement of veins, ↓ volume → cephalad spread ↑",
      "Positive epidural pressure (normally negative) in parturients",
    ]},
    { title:"PERIPHERAL NERVOUS SYSTEM", color:C.teal, items:[
      "Carpal tunnel syndrome common (median nerve compression due to edema)",
      "Meralgia paresthetica: lateral femoral cutaneous nerve compression",
      "Bell's palsy slightly more common in 3rd trimester",
      "Restless leg syndrome common",
    ]},
    { title:"MUSCULOSKELETAL", color:C.gold, items:[
      "Relaxin (placental/endometrial hormone): cervical softening, ligament laxity",
      "Symphysis pubis diastasis (1–2 cm physiological)",
      "Lumbar lordosis increases → low back pain",
      "Ligamentous laxity → ↑ risk of ankle sprains, SI joint pain",
      "Centre of gravity shifts forward",
    ]},
    { title:"SKIN CHANGES", color:C.pink, items:[
      "Linea nigra: pigmentation of midline abdomen",
      "Chloasma (melasma): facial pigmentation ('mask of pregnancy')",
      "Striae gravidarum: stretch marks (irreversible)",
      "Spider nevi & palmar erythema (estrogen)",
      "Hyperhidrosis, hair growth changes (defluvium postpartum)",
      "Nail brittleness; nail growth often ↑ in pregnancy",
    ]},
    { title:"BREASTS", color:C.accent1, items:[
      "Breast size ↑; weight ↑ ~0.4 kg each",
      "Nipple & areola darken (↑ melanocyte-stimulating hormone)",
      "Montgomery tubercles enlarge",
      "Colostrum production from ~16 weeks onwards",
      "Prolactin → breast development; inhibited postpartum by progesterone fall",
    ]},
    { title:"UTERUS & CERVIX", color:C.green, items:[
      "Uterine weight: 60 g → 1000 g at term",
      "Uterine capacity: 10 mL → 5000–10,000 mL at term",
      "Uterine blood flow: 50 → 500–700 mL/min",
      "Cervix: Hegar's sign (softening), Goodell's sign (blue cervix)",
      "Braxton Hicks contractions from ~6 weeks (irregular, painless)",
      "Decidualization of endometrium",
    ]},
  ];

  const cols = 3;
  const bW = 4.0, bH = 2.7;
  const xS = 0.4, yS = 0.82, xG = 4.3, yG = 2.82;

  neuroData.forEach((box, i) => {
    const col = i%cols, row = Math.floor(i/cols);
    const x = xS + col*xG, y = yS + row*yG;
    s.addShape(pres.ShapeType.roundRect, {
      x, y, w:bW, h:bH,
      fill:{color:"0D0D20"}, line:{color:box.color, pt:1.2}, rectRadius:0.08
    });
    s.addShape(pres.ShapeType.rect, { x, y, w:bW, h:0.32, fill:{color:box.color}, line:{color:box.color} });
    s.addText(box.title, {
      x, y, w:bW, h:0.32, fontSize:9.5, bold:true, color:C.white,
      fontFace:"Calibri", align:"center", valign:"middle", margin:0
    });
    s.addText(box.items.map(t=>({text:"• "+t, options:{breakLine:true}})), {
      x:x+0.06, y:y+0.35, w:bW-0.12, h:bH-0.4,
      fontSize:8, color:C.lightGray, fontFace:"Calibri", valign:"top", margin:3
    });
  });
}

// ─── SLIDE 9: Master Summary Chart ───────────────────────────────────────────
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:7.5, fill:{color:"080810"}, line:{color:"080810"} });

  // top bar
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:13.3, h:0.65, fill:{color:C.accent1}, line:{color:C.accent1} });
  s.addText("MASTER SUMMARY: PHYSIOLOGICAL CHANGES IN PREGNANCY", {
    x:0.3, y:0, w:12.7, h:0.65, fontSize:16, bold:true, color:C.white,
    fontFace:"Calibri", align:"center", valign:"middle", charSpacing:1, margin:0
  });

  const summaryData = [
    { sys:"CARDIOVASCULAR", color:C.accent1, pts:[
      "CO ↑40% | HR ↑20% | SV ↑30%",
      "Blood vol ↑35% (plasma ↑55%)",
      "BP ↓ | PVR ↓15% | Dilutional anaemia",
      "Supine → IVC compression → ↓ CO",
    ]},
    { sys:"RESPIRATORY", color:C.teal, pts:[
      "MV ↑50% | TV ↑40% | FRC ↓20%",
      "PaCO2 ↓27-32 | PaO2 ↑104-108",
      "Compensated resp. alkalosis",
      "Rapid desaturation risk ↑↑",
    ]},
    { sys:"HEMATOLOGICAL", color:C.purple, pts:[
      "WBC ↑ to 15,000-21,000",
      "Fibrinogen + Factors ↑↑",
      "Hypercoagulable → VTE risk",
      "Platelets ↓10% | Factor XI ↓",
    ]},
    { sys:"RENAL", color:C.green, pts:[
      "GFR ↑50% | RPF ↑50-80%",
      "Creatinine ↓0.4 | BUN ↓9",
      "Glycosuria (normal glucose)",
      "Hydronephrosis (R>L)",
    ]},
    { sys:"ENDOCRINE", color:C.orange, pts:[
      "Prolactin ↑10× | Cortisol ↑3×",
      "Aldosterone ↑6× | Insulin ↑",
      "Pituitary ↑120% (size)",
      "Thyroid: total ↑, free = normal",
    ]},
    { sys:"GI / HEPATIC", color:C.gold, pts:[
      "LES tone ↓ → GERD ↑↑",
      "Gastric motility ↓ | Transit time ↑",
      "Albumin ↓ | Alk-phos ↑",
      "Gallbladder volume ↑2× → gallstones",
    ]},
    { sys:"NEUROLOGICAL", color:C.pink, pts:[
      "MAC ↓40% (inhaled agents)",
      "Local anaesthetic sensitivity ↑",
      "Epidural pressure positive",
      "β-endorphins ↑ in labor",
    ]},
    { sys:"METABOLIC", color:"FF8C00", pts:[
      "Insulin resistance (hPL)",
      "↑ FFA, ketones, triglycerides",
      "Ca2+ total ↓ | ionized normal",
      "Pseudocholinesterase ↓25-30%",
    ]},
    { sys:"MSK / SKIN / UTERUS", color:C.green, pts:[
      "Relaxin → ligament laxity, pelvic loosening",
      "Uterus: 60g → 1000g | blood flow ×10",
      "Linea nigra, chloasma, striae",
      "Lumbar lordosis ↑ → backache",
    ]},
  ];

  const cols = 3, rows = 3;
  const bW = 4.1, bH = 2.02;
  const xS = 0.15, yS = 0.72, xG = 4.35, yG = 2.22;

  summaryData.forEach((item, i) => {
    const col = i%cols, row = Math.floor(i/cols);
    const x = xS + col*xG, y = yS + row*yG;
    s.addShape(pres.ShapeType.roundRect, {
      x, y, w:bW, h:bH,
      fill:{color:"0F0F1E"}, line:{color:item.color, pt:1.5}, rectRadius:0.1
    });
    // sys label bar
    s.addShape(pres.ShapeType.rect, { x, y, w:bW, h:0.31, fill:{color:item.color}, line:{color:item.color} });
    s.addText(item.sys, {
      x, y, w:bW, h:0.31, fontSize:9.5, bold:true, color:"FFFFFF",
      fontFace:"Calibri", align:"center", valign:"middle", margin:0, charSpacing:1
    });
    s.addText(item.pts.map(t=>({text:"▸ "+t, options:{breakLine:true}})), {
      x:x+0.06, y:y+0.33, w:bW-0.12, h:bH-0.38,
      fontSize:8.5, color:C.lightGray, fontFace:"Calibri", valign:"top", margin:3
    });
  });

  s.addText("Visual Memory Summary  •  Based on Standard Obstetrics References  •  Orris Medical 2026", {
    x:0.3, y:7.2, w:12.7, h:0.25, fontSize:8, color:"555588",
    fontFace:"Calibri", align:"center", margin:0, italic:true
  });
}

// Write file
pres.writeFile({ fileName: "/home/daytona/workspace/pregnancy-physiology/Physiological_Changes_Pregnancy.pptx" })
  .then(() => console.log("DONE: /home/daytona/workspace/pregnancy-physiology/Physiological_Changes_Pregnancy.pptx"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

Running Command

cd /home/daytona/workspace/pregnancy-physiology && node create_chart.js

The file is ready. Here is the complete reference:

Physiological Changes During Pregnancy

Sourced from Morgan & Mikhail's Clinical Anesthesiology, Creasy & Resnik's Maternal-Fetal Medicine, and Sabiston's Surgery - representing the same standard content covered in DC Dutta's Textbook of Obstetrics.

1. CARDIOVASCULAR SYSTEM

Parameter	Change	Notes
Blood volume	+35%	Plasma +55%, RBC mass +45%
Cardiac output	+40% at term	Heart rate +20% + Stroke volume +30%
Heart rate	+20 bpm	Progressive from 1st trimester
Stroke volume	+30%	Due to increased preload
Systolic BP	-5%	Nadirs at mid-2nd trimester
Diastolic BP	-15%	More dramatic fall
Peripheral vascular resistance	-15 to -20%	Progesterone-mediated smooth muscle relaxation
Pulmonary resistance	-30%	Prevents pulmonary hypertension

Key clinical points:

Plasma volume increase exceeds RBC increase → physiological dilutional anaemia (Hb stays >11 g/dL)
At term: total blood volume +1000-1500 mL; total ~90 mL/kg
Aortocaval compression after 20 weeks in supine - 5-10% develop supine hypotension syndrome - always place in left lateral decubitus
ECG: left axis deviation, T-wave changes, flow murmur (grade I-II systolic)
Uterine blood flow: 50 mL/min → 500-700 mL/min at term (~10% of CO)

2. RESPIRATORY SYSTEM

Parameter	Change	Value at Term
Minute ventilation	+50%	~12 L/min
Tidal volume	+40%	Main driver of ventilation increase
Respiratory rate	+15%	Minor contributor
O2 consumption	+20-50%	Fetal + placental + maternal demand
FRC	-20%	Diaphragm elevated 4 cm
Airway resistance	-35%	Progesterone bronchodilation
PaCO2	-15%	27-32 mmHg (vs 40 normal)
PaO2	+10%	104-108 mmHg
HCO3	-15%	18-21 mEq/L (renal compensation)
pH	~7.44	Compensated respiratory alkalosis
P50 (Hb-O2 curve)	+3 mmHg	27 → 30 mmHg (right shift, +2,3-DPG)

Clinical pearls:

Rapid desaturation during apnea: ↓FRC + ↑O2 consumption - pre-oxygenation is mandatory before intubation
Mucosal edema + capillary engorgement → use smaller ET tube (6.0-6.5 mm), Mallampati worsens near term
↓PaCO2 increases CO2 gradient from fetus to mother, facilitating fetal CO2 transfer

3. HEMATOLOGICAL CHANGES

Red cells: Dilutional anaemia (WHO definition: Hb <11 g/dL = anaemia in pregnancy). Hematocrit falls to ~33-34%.

Coagulation - Hypercoagulable state:

Fibrinogen ↑ 50-250% (most dramatic)
Factors VII, VIII, IX, X, XII ↑ 30-250%
Factor XI may decrease; Protein S decreases
Acquired resistance to activated Protein C
Net: VTE risk ×5-10 compared to non-pregnant

White cells: Leukocytosis normal - WBC up to 21,000/μL (mainly neutrophilia). Don't use WBC alone to diagnose infection.

Platelets: ↓ 10% (gestational thrombocytopenia); >80,000 safe for regional anaesthesia.

4. RENAL SYSTEM

Parameter	Change
Renal plasma flow	↑ 50-80% (peaks 2nd trimester)
GFR	↑ 50% (110-150 mL/min)
Serum Creatinine	↓ to ~0.4-0.5 mg/dL
Blood Urea Nitrogen	↓ to ~9 mg/dL
Uric acid	↓ early; rises near term
Aldosterone	↑ 6×
Proteinuria	Up to 300 mg/24h = normal

Other renal changes: Glycosuria with normal blood glucose (↑ GFR exceeds tubular reabsorption); physiological hydronephrosis (right > left due to dextrorotation of uterus); ↑ UTI risk due to stasis + glycosuria.

5. ENDOCRINE SYSTEM

Gland	Key Change
Pituitary	Size ↑ 120% at delivery; Prolactin ↑ 10×; ACTH ↑ 2-4×
Adrenal cortex	Total cortisol ↑ 3× (CBG triples); Urinary free cortisol ↑ 2-3×; Aldosterone ↑ 6×
Thyroid	TBG ↑ → total T3/T4 ↑; Free T3/T4 and TSH = NORMAL; TSH ↓ slightly in 1st trimester (HCG cross-reactivity)
Pancreas	Insulin secretion ↑ (beta cell hyperplasia); hPL causes insulin resistance; Gestational diabetes risk

6. GASTROINTESTINAL / HEPATIC

Stomach: LES tone ↓ + gastric motility ↓ → GERD in 60-80%; aspiration risk ↑
Colon: Constipation (↑ Na+/H2O absorption, ↓ motility, uterine compression); hemorrhoids (dilated portal collaterals)
Gallbladder: Volume ↑ 2× in 2nd/3rd trimester; emptying slowed; cholesterol gallstones in ~4%
Liver: Function unchanged; albumin ↓ (dilutional); ALP ↑ (placental); spider nevi + palmar erythema (estrogen); pseudocholinesterase ↓ 25-30%

7. NEUROLOGICAL / ANAESTHESIA

MAC ↓ 40% for all volatile anaesthetics (progesterone-mediated); normalizes by day 3 postpartum
Local anaesthetic sensitivity ↑ - epidural/spinal dose requirements ↓ up to 30%
Epidural venous plexus engorged → ↑ cephalad spread, ↑ intravascular injection risk, positive epidural pressure
β-endorphin surge in labor contributes to analgesia

8. METABOLIC

State resembles accelerated starvation: ↓ fasting glucose, ↑ FFAs, ↑ ketones, ↑ triglycerides
hPL (human placental lactogen) = key insulin antagonist → diabetogenic state
Serum calcium ↓ (dilution) but ionized Ca²+ = normal
Thyroid hormone: total T3/T4 ↑, free fractions normal
Weight gain: ~11-15 kg total recommended

9. MUSCULOSKELETAL / SKIN / UTERUS

MSK: Relaxin → ligament laxity, pubic symphysis diastasis (1-2 cm), lumbar lordosis ↑, backache very common

Skin: Linea nigra, chloasma (melasma), striae gravidarum, spider nevi, palmar erythema

Uterus: Weight 60 g → 1000 g; capacity 10 mL → 5-10 L; blood flow ×10

Download the Visual Summary Chart

Physiological Changes Pregnancy

Presentation · PPTX

The PPTX contains 9 slides with a color-coded system-by-system layout:

Title slide with all 9 systems listed
At-a-glance numerical changes table (all key values at a glance)
Cardiovascular (6 detailed boxes)
Respiratory (full table with values + clinical notes)
Hematological (coagulation, RBC, WBC, platelets)
Renal + Endocrine (split slide)
GI / Hepatic / Metabolic (6 boxes)
Neurological / MSK / Skin / Uterus (6 boxes)
Master Summary Chart - all 9 systems on one slide for rapid visual revision

Each slide uses a distinct color per system so you can identify the topic at a glance during rapid review.

This is a shared conversation. Sign in to Orris to start your own chat.