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pres.title = 'SGA vs FGR: Small for Gestational Age vs Fetal Growth Restriction';

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// ════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ════════════════════════════════════════════════════════════════════════════
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  "Small for Gestational Age (SGA)\nvs Fetal Growth Restriction (FGR)",
  "Definitions · Distinctions · Diagnosis · Management · Recent Guidelines 2023–2025"
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// ════════════════════════════════════════════════════════════════════════════
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  ["2.", "Definitions: SGA, FGR, AGA, IUGR"],
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  ["5.", "Classification: Symmetric vs Asymmetric FGR"],
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  ["7.", "Etiology & Risk Factors"],
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  ["10.", "Diagnosis: Ultrasound & Biometry"],
  ["11.", "Doppler Velocimetry in FGR"],
  ["12.", "Staging Systems (PORTO/Delphi)"],
  ["13.", "Biomarkers: sFlt-1/PlGF"],
  ["14.", "Management Overview: SGA vs FGR"],
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// ════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — HISTORICAL EVOLUTION
// ════════════════════════════════════════════════════════════════════════════
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contentSlide(s3,
  "Historical Evolution of Terminology",
  [
    { type:"header", text:"Early 20th Century" },
    "All small newborns were considered premature — no distinction existed",
    { type:"sub", text:"'Low birth weight' = any infant <2500 g (WHO classification)" },
    { type:"header", text:"1960s — The Lubchenco Era" },
    "Lubchenco et al. published birth weight percentile charts by gestational age",
    "Defined SGA (<10th percentile), AGA (10th–90th), LGA (>90th percentile)",
    { type:"sub", text:"These charts remain foundational but predate modern diverse populations" },
    { type:"header", text:"1970s–1990s — IUGR Concept" },
    "Term 'Intrauterine Growth Restriction (IUGR)' introduced to imply pathological causation",
    "Recognized that not all SGA fetuses are growth-restricted",
    { type:"header", text:"21st Century — FGR as distinct entity" },
    "FGR defined as failure to achieve growth potential — now distinct from SGA",
    "ISUOG (2020), SOGC (2023), RCOG (2024) provide formal differentiated guidelines",
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// ════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — DEFINITIONS (TWO COLUMN)
// ════════════════════════════════════════════════════════════════════════════
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  "Definitions: SGA vs FGR",
  "Small for Gestational Age (SGA)",
  [
    "Estimated fetal weight (EFW) or birth weight <10th percentile for gestational age",
    "A measure of SIZE — not necessarily pathological",
    "May be constitutionally small (healthy, appropriate for ethnicity/genetics)",
    "ACOG: SGA used for newborns; EFW <10th %ile on ultrasound",
    "FIGO: SGA as a preliminary diagnosis prompting FGR evaluation",
    "Incidence: 10–27% worldwide",
    {text:"Key: SGA is a phenotype, NOT a diagnosis"},
  ],
  "Fetal Growth Restriction (FGR)",
  [
    "Fetus that fails to achieve its biologically determined growth potential",
    "A measure of PROCESS — implies underlying pathology",
    "Most commonly due to placental insufficiency",
    "ISUOG Early FGR: EFW/AC <3rd %ile OR abnormal UA/UtA Doppler",
    "ISUOG Late FGR: EFW/AC <3rd %ile OR ≥2 of: EFW/AC <10th + UtA PI >95th + CPR <5th",
    "Incidence: 3–10% in developed; up to 25% in LMIC",
    {text:"Key: FGR is a clinical diagnosis with pathological basis"},
  ]
);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — EPIDEMIOLOGY
// ════════════════════════════════════════════════════════════════════════════
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contentSlide(s5,
  "Epidemiology & Incidence",
  [
    { type:"header", text:"Global Burden" },
    "SGA: 10–27% of all births worldwide",
    "FGR: 3–9% in developed countries; 25% in low/middle-income countries",
    "Early-onset FGR (<32 weeks): ~0.5–1% of pregnancies",
    "Late-onset FGR (≥32 weeks): ~5–10% of pregnancies",
    { type:"header", text:"Recurrence Risk" },
    "Prior FGR in singleton pregnancy: 20% recurrence risk (SOGC 2023)",
    "Prior SGA: recurrence ~20% in subsequent pregnancies",
    "PTB history is the highest predictor of FGR recurrence (Creasy & Resnik)",
    { type:"header", text:"Perinatal Impact" },
    "FGR accounts for ~50% of unexplained stillbirths",
    "Perinatal mortality increases exponentially below the 6th birth weight percentile",
    "FGR is the 2nd leading cause of perinatal morbidity and mortality after prematurity",
    "IUFD risk rises significantly in SGA fetuses at term (Pilliod et al., Am J Obstet Gynecol 2012)",
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);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — NORMAL FETAL GROWTH PHYSIOLOGY
// ════════════════════════════════════════════════════════════════════════════
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contentSlide(s6,
  "Normal Fetal Growth: Phases & Physiology",
  [
    { type:"header", text:"Three Phases of Fetal Growth (Creasy & Resnik)" },
    "Phase 1 — Early pregnancy: Cellular hyperplasia (cell division) — most growth by cell number",
    "Phase 2 — Mid-pregnancy: Combined hyperplasia AND hypertrophy (cell size increase)",
    "Phase 3 — Last 6–8 weeks: Predominantly hypertrophic growth — rapid weight gain",
    { type:"header", text:"Growth Rate Milestones" },
    "14–15 weeks: ~5 g/day",
    "20 weeks: ~10 g/day",
    "32–34 weeks: ~30–35 g/day (peak — 230–285 g/week)",
    "41–42 weeks: Growth may plateau or even decline",
    { type:"header", text:"Determinants of Fetal Growth" },
    "Maternal: Nutrition, BMI, disease, altitude, race",
    "Placental: Surface area, blood flow, transfer capacity",
    "Fetal: Genetics, sex, hormones (insulin, IGF-1, IGF-2), chromosomal integrity",
    "Growth velocity (>50-percentile drop, e.g., 70th to <20th %ile) = key FGR warning sign",
  ]
);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — CLASSIFICATION: SYMMETRIC vs ASYMMETRIC
// ════════════════════════════════════════════════════════════════════════════
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  "Classification: Symmetric vs Asymmetric FGR",
  "Symmetric FGR (~20–30%)",
  [
    "All body dimensions proportionally reduced (HC, AC, FL, weight)",
    "HC/AC and FL/HC ratios remain normal",
    "Results from early insult affecting hyperplastic growth phase",
    "Causes: Chromosomal anomalies (trisomy 13, 18, 21), congenital malformations, TORCH infections, teratogens",
    "Poorer prognosis — growth potential itself is reduced",
    "May be normal variant if familial/constitutional",
    {text:"Brain is NOT spared in symmetric FGR"},
  ],
  "Asymmetric FGR (~70–80%)",
  [
    "Normal skeletal dimensions & head size; reduced AC and subcutaneous fat",
    "Reduced HC/AC ratio — 'brain-sparing effect'",
    "Results from placental insufficiency in late 2nd or 3rd trimester",
    "Causes: Placental dysfunction, pre-eclampsia, maternal vascular disease, malnutrition",
    "Later onset — fetus redirects blood flow to brain, adrenals, heart",
    "Best detected by falling abdominal circumference on serial scans",
    {text:"Asymmetric pattern evolves to symmetric with prolonged insult"},
  ]
);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — EARLY vs LATE FGR
// ════════════════════════════════════════════════════════════════════════════
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twoColSlide(s8,
  "Early-Onset vs Late-Onset FGR",
  "Early-Onset FGR (<32 weeks)",
  [
    "Prevalence: ~0.5–1% of pregnancies",
    "Severe placental dysfunction — major Doppler abnormalities",
    "Associated with pre-eclampsia in 50–70% of cases",
    "High risk of perinatal mortality and prematurity-related morbidity",
    "Umbilical artery (UA) Doppler: absent/reversed end-diastolic flow",
    "Ductus venosus (DV) and middle cerebral artery (MCA) also evaluated",
    "Delivery often required in periviable or very preterm period",
    {text:"Periviable FGR (<25 wks): management individualized"},
  ],
  "Late-Onset FGR (≥32 weeks)",
  [
    "Prevalence: ~5–10% of pregnancies",
    "More subtle — mild or absent UA Doppler changes",
    "Often presents as SGA on routine third-trimester scan",
    "CPR (cerebroplacental ratio) <5th percentile is key marker",
    "UtA PI elevation common even with normal UA",
    "Higher risk of intrapartum fetal compromise and cesarean delivery",
    "Most stillbirths attributed to late-onset, undetected FGR",
    {text:"Delivery generally recommended by 37–38 weeks"},
  ]
);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — ETIOLOGY & RISK FACTORS
// ════════════════════════════════════════════════════════════════════════════
let s9 = pres.addSlide();
contentSlide(s9,
  "Etiology & Risk Factors",
  [
    { type:"header", text:"Maternal Factors" },
    "Medical: Pre-eclampsia, chronic hypertension, diabetes (with vascular disease), renal disease, thrombophilias (APS, Factor V Leiden), SLE, IBD",
    "Behavioral: Smoking (strongest modifiable risk), alcohol, substance abuse, malnutrition",
    "Demographic: Age <16 or >35, low BMI, high altitude, prior FGR/SGA",
    { type:"header", text:"Fetal Factors" },
    "Chromosomal anomalies: Trisomy 13, 18, 21; Turner syndrome, triploidy",
    "Structural malformations: Cardiac defects, gastroschisis",
    "Multiple gestation (twin-twin transfusion, selective FGR)",
    "TORCH infections: CMV (most common), rubella, toxoplasma, syphilis",
    { type:"header", text:"Placental Factors (most common overall cause)" },
    "Placental insufficiency — impaired trophoblast invasion and spiral artery remodeling",
    "Circumvallate/bilobed placenta, placenta previa, velamentous cord insertion",
    "Confined placental mosaicism, massive perivillous fibrin deposition",
    "Idiopathic: ~60% of FGR cases have no identifiable etiology (Creasy & Resnik)",
  ]
);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — PATHOPHYSIOLOGY
// ════════════════════════════════════════════════════════════════════════════
let s10 = pres.addSlide();
contentSlide(s10,
  "Pathophysiology & Placental Mechanisms",
  [
    { type:"header", text:"Core Placental Defect" },
    "Reduced placental mass → decreased terminal villi growth → reduced umbilical capillary bed expansion",
    "Umbilical pulsatility index elevated (reflects increased downstream resistance)",
    "Reduced vasosyncytial membranes → greater diffusion barrier for oxygen",
    "Placental oxygen permeability abnormally LOW → fetal hypoxemia",
    { type:"header", text:"Fetal Adaptive Responses (Brain Sparing)" },
    "Fetal hypoxemia → redistribution of cardiac output to brain, myocardium, adrenals",
    "Middle cerebral artery vasodilates → decreased MCA PI (CPR <5th %ile = brain sparing)",
    "Reduced oxygen delivery → slows fetal growth rate (adaptive, protective in short term)",
    "Cordocentesis data: umbilical venous PO₂ ~12 torr below normal; O₂ saturation drops from 81% to ~50%",
    { type:"header", text:"Progressive Deterioration Sequence" },
    "Stage 1: Elevated UtA/UA PI → Stage 2: Absent/reversed UA AEDF/REDF → Stage 3: Ductus venosus abnormalities → Stage 4: Fetal acidemia, bradycardia",
    "Chronic villitis, hemorrhagic endovasculitis, placental infarction found in 55% of FGR placentas",
    "Gene dysregulation: cell-cycle, oxidative phosphorylation, IGF axis",
  ]
);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — SCREENING & PREDICTION
// ════════════════════════════════════════════════════════════════════════════
let s11 = pres.addSlide();
contentSlide(s11,
  "Screening & Prediction of FGR",
  [
    { type:"header", text:"First Trimester Combined Screening (11–14 weeks)" },
    "Uterine artery (UtA) PI: elevated PI bilateral notching → placental dysfunction risk",
    "Serum PlGF (placental growth factor): low PlGF predicts early FGR and pre-eclampsia",
    "PAPP-A: low levels (<0.4 MoM) associated with placental disease and FGR",
    "Combined algorithm (UtA + MAP + PlGF + PAPP-A): detection rate ~75% for early FGR",
    { type:"header", text:"Risk Factor-Based Screening (ISUOG / RCOG)" },
    "Major risk factors: prior FGR/SGA/PE, antiphospholipid syndrome, heavy smoker, diabetes with vascular disease",
    "Minor risk factors: age >40, BMI >35, nulliparous, prior PE, cocaine use",
    "≥1 major OR ≥2 minor risk factors: offer 3rd trimester serial growth scans",
    { type:"header", text:"Second Trimester (18–24 weeks)" },
    "Uterine artery Doppler screening in high-risk pregnancies",
    "Low PIGF (<100 pg/mL at 19–23 wks) has >60% sensitivity for FGR",
    { type:"header", text:"SOGC 2023 Recommendation" },
    "Aspirin 81–162 mg/day from <16 weeks reduces FGR risk in high-risk patients (Grade 1A)",
  ]
);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — DIAGNOSIS: ULTRASOUND & BIOMETRY
// ════════════════════════════════════════════════════════════════════════════
let s12 = pres.addSlide();
contentSlide(s12,
  "Diagnosis: Ultrasound Biometry & Growth Assessment",
  [
    { type:"header", text:"Key Biometric Parameters" },
    "Biparietal diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC), Femur Length (FL)",
    "EFW calculated by Hadlock formula (HC+AC+FL) — errors ±10–15%",
    "AC alone is the most sensitive single parameter for FGR detection",
    "HC/AC ratio: differentiates symmetric (normal) vs asymmetric (elevated) FGR",
    { type:"header", text:"Diagnostic Thresholds" },
    "AC or EFW <3rd percentile = FGR (high probability, regardless of Doppler)",
    "AC or EFW 3rd–10th percentile = SGA or mild FGR — requires Doppler & velocity assessment",
    "EFW drop >50 percentiles (e.g., 70th → <20th) on serial scans → FGR alert (ISUOG Grade C)",
    { type:"header", text:"Growth Charts" },
    "Population-based charts (Hadlock, INTERGROWTH-21st, WHO): identify small fetuses",
    "Customized charts (GROW software): adjust for parity, maternal weight/height, ethnicity, gestational age",
    "INTERGROWTH-21st: international standard for optimal growth potential",
    { type:"header", text:"Serial Scans" },
    "Interval ≥2–3 weeks between growth scans (shorter intervals increase measurement error)",
    "Amniotic fluid assessment: oligohydramnios (AFI <5 cm or SDP <2 cm) supports FGR diagnosis",
  ]
);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — DOPPLER VELOCIMETRY
// ════════════════════════════════════════════════════════════════════════════
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  "Doppler Velocimetry in FGR Surveillance",
  [
    { type:"header", text:"Umbilical Artery (UA) Doppler — Primary Surveillance Tool" },
    "Elevated UA PI >95th %ile → increased placental resistance",
    "Absent End-Diastolic Flow (AEDF) → severe placental insufficiency, ~50% perinatal mortality",
    "Reversed End-Diastolic Flow (REDF) → imminent fetal compromise, ~70% perinatal mortality",
    "Normal UA Doppler in SGA/small fetus → likely constitutional SGA, can reduce frequency of monitoring",
    { type:"header", text:"Middle Cerebral Artery (MCA) Doppler" },
    "Decreased MCA PI → cerebral vasodilation = brain-sparing response",
    "Cerebroplacental Ratio (CPR) = MCA PI / UA PI: <5th percentile indicates redistribution",
    "CPR <5th %ile with normal UA Doppler = key marker for late-onset FGR (ISUOG)",
    { type:"header", text:"Uterine Artery (UtA) Doppler" },
    "UtA PI >95th %ile with bilateral notching → impaired spiral artery remodeling",
    "Present in both early and late FGR — helps distinguish FGR from SGA",
    { type:"header", text:"Ductus Venosus (DV) — Late Deterioration Marker" },
    "Absent or reversed DV a-wave → cardiac decompensation, acidemia",
    "ISUOG: Deliver if DV a-wave at/below baseline regardless of gestational age (>24 weeks)",
    "DV assessment combined with BPP/cCTG for delivery timing in early FGR",
  ]
);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — STAGING SYSTEMS
// ════════════════════════════════════════════════════════════════════════════
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    {text:"Estimated Perinatal Mortality", options:{bold:true, color:C.white, fill:{color:C.teal}, fontSize:14}},
    {text:"Action", options:{bold:true, color:C.white, fill:{color:C.teal}, fontSize:14}},
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    {text:"<5%", options:{color:C.green, bold:true, fontSize:13}},
    {text:"Intensive monitoring, no immediate delivery", options:{fontSize:12}},
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    {text:"Absent End-Diastolic Flow (AEDF) in UA", options:{fontSize:12}},
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    {text:"~25–50%", options:{color:C.red, bold:true, fontSize:13}},
    {text:"Delivery if viable; individualized if periviable", options:{fontSize:12}},
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    {text:"Abnormal CTG (late decelerations, STV <3.0ms) OR BPP ≤4", options:{fontSize:12}},
    {text:"~50–70%", options:{color:C.red, bold:true, fontSize:13}},
    {text:"Emergency delivery indicated", options:{fontSize:12}},
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// ════════════════════════════════════════════════════════════════════════════
// SLIDE 15 — BIOMARKERS
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  "Biomarkers in SGA/FGR Differentiation",
  [
    { type:"header", text:"sFlt-1 / PlGF Ratio" },
    "sFlt-1 (soluble fms-like tyrosine kinase-1): anti-angiogenic factor — elevated in placental disease",
    "PlGF (placental growth factor): pro-angiogenic — decreased in FGR and pre-eclampsia",
    "sFlt-1/PlGF ratio <38: rules out pre-eclampsia in next 7 days (high NPV)",
    "Ratio >38–85: intermediate risk; >85: high risk zone",
    "May help differentiate pathological SGA (FGR) from constitutional SGA — research ongoing",
    "ISUOG 2020: 'Lack of interventional trial data precludes routine recommendation'",
    { type:"header", text:"PAPP-A (Pregnancy-Associated Plasma Protein A)" },
    "Low PAPP-A <0.4 MoM at 11–14 weeks: 3-fold increased FGR risk",
    "Combined with UtA Doppler and PlGF for first-trimester FGR screening",
    { type:"header", text:"Other Biomarkers Under Investigation" },
    "Serum AFP (elevated in placental dysfunction)",
    "Cell-free fetal DNA: chromosomal aneuploidy screening",
    "Maternal serum hCG (elevated), inhibin A",
    "Placental mRNA transcriptomics: IGF axis, oxidative phosphorylation gene dysregulation",
    { type:"sub", text:"No single biomarker is sufficiently specific to replace ultrasound — multimodal approach required" },
  ]
);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 16 — MANAGEMENT OVERVIEW
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  "Management Overview: SGA vs FGR",
  [
    { type:"header", text:"Constitutional SGA (Normal Doppler, No Pathology)" },
    "Reassure — likely normal fetus, not at elevated risk",
    "Serial scans every 3–4 weeks; Doppler every 2–3 weeks if 3rd–10th percentile",
    "No specific intervention required unless growth velocity drops",
    "Delivery: Allow progression to ≥39 weeks if all surveillance remains normal",
    { type:"header", text:"Confirmed FGR — General Principles" },
    "Treat underlying cause where possible (optimize blood pressure, anticoagulation in APS)",
    "Low-dose aspirin: recommended if not already started (SOGC 2023 Grade 1A)",
    "Maternal rest — no proven benefit; hospitalization for close monitoring in severe FGR",
    "Corticosteroids (betamethasone 12 mg ×2): if delivery anticipated <34 weeks",
    "Magnesium sulfate: if delivery <32 weeks for neuroprotection",
    { type:"header", text:"Antenatal Surveillance Frequency (ISUOG 2020)" },
    "EFW/AC <3rd %ile: Doppler every 1–2 days; deliver by 34–37 weeks depending on Doppler",
    "EFW/AC 3rd–10th %ile + abnormal Doppler: Doppler + BPP/CTG every 2–3 days",
    "Aim: maximize gestational age while avoiding intrauterine demise",
  ]
);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 17 — DELIVERY TIMING TABLE
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    {text:"Severe FGR", options:{fontSize:12}},
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// ════════════════════════════════════════════════════════════════════════════
// SLIDE 18 — PERINATAL OUTCOMES
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  "Perinatal Outcomes & Complications",
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    { type:"header", text:"Short-Term Neonatal Complications" },
    "Stillbirth / IUFD: 50% of unexplained stillbirths attributed to FGR/placental insufficiency",
    "Neonatal asphyxia: Intrapartum fetal distress, low Apgar scores",
    "Hypothermia, hypoglycemia, hypocalcemia, polycythemia",
    "Respiratory distress syndrome (RDS): especially early-onset FGR requiring preterm delivery",
    "Necrotizing enterocolitis (NEC), sepsis, thrombocytopenia",
    { type:"header", text:"Neurological & Developmental Outcomes" },
    "Cognitive delay, poor academic performance in school-age children",
    "Behavioral problems: ADHD, attention deficit, fine/gross motor dysfunction",
    "Cerebral palsy (especially preterm FGR infants)",
    "Severity correlates with gestational age at delivery and degree of growth restriction",
    "Preterm FGR: highest neurodevelopmental risk (Creasy & Resnik)",
    { type:"header", text:"Barker Hypothesis — Programming" },
    "Intrauterine nutritional deprivation programs metabolic susceptibility",
    "Increased risk of adult-onset: obesity, type 2 diabetes, hypertension, cardiovascular disease",
    "FGR infants with rapid postnatal catch-up growth at highest risk",
  ]
);

// ════════════════════════════════════════════════════════════════════════════
// SLIDE 19 — GUIDELINE COMPARISON
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    {text:"EFW or AC <10th percentile", options:{fontSize:11}},
    {text:"EFW <10th %ile on serial scans with abnormal Doppler", options:{fontSize:11}},
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    {text:"UA primary; MCA, UtA secondary", options:{fontSize:11}},
    {text:"UA, UtA, CPR, DV", options:{fontSize:11}},
    {text:"UA, MCA, UtA, DV", options:{fontSize:11}},
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    {text:"Aspirin Prevention", options:{bold:true, fontSize:11}},
    {text:"Recommended high-risk", options:{fontSize:11}},
    {text:"81 mg/day from <16 wks (high-risk)", options:{fontSize:11}},
    {text:"81–162 mg from <16 wks (Grade 1A)", options:{fontSize:11}},
    {text:"75–150 mg/day from <16 wks", options:{fontSize:11}},
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    {text:"37–38 wks with abnormal Doppler", options:{fontSize:11}},
    {text:"37 wks if abnormal; 38 wks if SGA only", options:{fontSize:11}},
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// ════════════════════════════════════════════════════════════════════════════
// SLIDE 20 — KEY TAKEAWAYS / SUMMARY
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const takeaways = [
  "SGA is a SIZE description (<10th %ile); FGR is a PATHOLOGICAL PROCESS — the two overlap but are NOT synonymous",
  "The distinction between constitutional SGA and FGR requires Doppler velocimetry, growth velocity, and biophysical assessment",
  "FGR is classified as early (<32 wks, severe Doppler changes) vs late (≥32 wks, subtle, often CPR-based) — management differs significantly",
  "Doppler surveillance (UA → MCA/CPR → DV) is the cornerstone of FGR monitoring and delivery timing",
  "Symmetric FGR (chromosomal/infectious cause) vs Asymmetric FGR (placental; brain-sparing) — HC/AC ratio is key",
  "Staging (PORTO system) guides clinical decision-making: Stage I–IV based on Doppler and CTG findings",
  "Aspirin from <16 weeks significantly reduces FGR and pre-eclampsia risk in high-risk patients (all major guidelines)",
  "FGR fetuses face both immediate perinatal complications and long-term metabolic/cardiovascular programming (Barker hypothesis)",
  "ISUOG 2020, SOGC 2023, and RCOG 2024 provide harmonized but not identical frameworks — know your local guideline",
];
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