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pres.title = "Hypertensive Disorders of Pregnancy";
pres.author = "Symposium Presentation";

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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ══════════════════════════════════════════════════════════════════════════════
{
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  slide.addText("Hypertensive Disorders\nof Pregnancy", {
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  slide.addText("Etiopathogenesis | Clinical Features | Complications", {
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – OUTLINE
// ══════════════════════════════════════════════════════════════════════════════
addContentSlide(pres, "Presentation Outline", [
  { text: "1.  Background & Global Burden", bold: true },
  { text: "2.  Classification of Hypertensive Disorders of Pregnancy", bold: true },
  { text: "3.  Etiopathogenesis – Two-Stage Model", bold: true },
  { text: "4.  Molecular Mechanisms & Biomarkers", bold: true },
  { text: "5.  Risk Factors", bold: true },
  { text: "6.  Clinical Features", bold: true },
  { text: "7.  Diagnostic Criteria (ACOG 2023 / ISSHP)", bold: true },
  { text: "8.  Complications – Maternal", bold: true },
  { text: "9.  Complications – Fetal / Neonatal", bold: true },
  { text: "10. HELLP Syndrome", bold: true },
  { text: "11. Long-term Sequelae", bold: true },
  { text: "12. References", bold: true }
], null);

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 – BACKGROUND & GLOBAL BURDEN
// ══════════════════════════════════════════════════════════════════════════════
addContentSlide(pres, "Background & Global Burden", [
  { text: "Hypertensive disorders of pregnancy (HDP) affect 5–10% of all pregnancies worldwide", bold: true },
  { text: "Leading cause of maternal and perinatal morbidity and mortality globally" },
  { text: "Account for ~16% of maternal deaths in developed countries and 7.4% in the US (Ohamadike et al., 2022)" },
  { text: "Rates of preeclampsia rose 25% between 1987 and 2004; severe PE increased 6.7-fold (1980–2003)" },
  { text: "Preeclampsia is the most studied HDP and a leading cause of preterm birth globally" },
  { text: "Women surviving preeclampsia have reduced life expectancy with elevated risk of stroke, CVD, and diabetes (Dimitriadis et al., 2023, Nature Rev Disease Primers)" },
  { text: "Neonatal impact: preterm birth, perinatal death, neurodevelopmental disability, metabolic disease later in life" },
  { text: "Significant diagnostic and management challenges persist, especially in low-resource settings" }
], "Refs: Ohamadike O et al. Obstet Gynecol Surv. 2022;77(4):241–254 | Dimitriadis E et al. Nat Rev Dis Primers. 2023;9:8");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – SECTION: CLASSIFICATION
// ══════════════════════════════════════════════════════════════════════════════
addSectionTitle(pres, "Section 1", "Classification of Hypertensive Disorders of Pregnancy");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – CLASSIFICATION TABLE
// ══════════════════════════════════════════════════════════════════════════════
addTableSlide(pres, "Classification of Hypertensive Disorders of Pregnancy (ACOG / ISSHP)",
  ["Category", "Definition", "Key Features"],
  [
    ["Gestational Hypertension", "New-onset BP ≥140/90 mmHg after 20 wks, no proteinuria", "Resolves within 6 wks postpartum; may precede PE"],
    ["Preeclampsia", "BP ≥140/90 + proteinuria or end-organ dysfunction after 20 wks", "Multisystem disorder; early-onset (<34 wks) vs late-onset (≥34 wks)"],
    ["Eclampsia", "New tonic-clonic / focal seizures in setting of PE", "20% have no prior BP >140; 38% no prior proteinuria"],
    ["Chronic Hypertension", "BP ≥140/90 diagnosed before 20 wks or pre-pregnancy", "Persists >6 wks postpartum"],
    ["Superimposed PE", "New proteinuria or end-organ damage in woman with chronic HTN", "Worse prognosis; harder to diagnose"],
    ["HELLP Syndrome", "Hemolysis + Elevated LFTs + Low Platelets (usually complicating PE)", "0.2–0.8% of pregnancies; 12% of severe PE"]
  ],
  "Refs: ACOG Practice Bulletin 2023 | Creasy & Resnik MFM 9e | Goldman-Cecil Medicine 2e"
);

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 – SECTION: ETIOPATHOGENESIS
// ══════════════════════════════════════════════════════════════════════════════
addSectionTitle(pres, "Section 2", "Etiopathogenesis of Preeclampsia");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – TWO-STAGE MODEL OVERVIEW
// ══════════════════════════════════════════════════════════════════════════════
addContentSlide(pres, "The Two-Stage Model of Preeclampsia Pathogenesis", [
  { text: "STAGE 1 – Placental Maldevelopment (Asymptomatic)", bold: true },
  { text: "Occurs in first trimester (8–18 weeks)", sub: true },
  { text: "Failure of trophoblast invasion into decidua and myometrium", sub: true },
  { text: "Inadequate remodeling of spiral arteries → remain narrow, high-resistance vessels", sub: true },
  { text: "Resulting uteroplacental hypoperfusion and relative ischemia", sub: true },
  { text: "STAGE 2 – Maternal Systemic Syndrome (Symptomatic, usually >20 wks)", bold: true },
  { text: "Ischemic placenta releases anti-angiogenic factors into maternal circulation", sub: true },
  { text: "Key mediators: sFlt-1 (soluble fms-like tyrosine kinase-1) and sEng (soluble endoglin)", sub: true },
  { text: "Widespread maternal endothelial dysfunction → hypertension, proteinuria, multi-organ injury", sub: true },
  { text: "Systemic inflammatory response amplifies the syndrome", sub: true },
  { text: "Only cure: delivery of dysfunctional placenta (Dimitriadis et al., 2023)" }
], "Refs: Torres-Torres J et al. Int J Mol Sci. 2024;25(14):7569 | Dimitriadis E et al. Nat Rev Dis Primers. 2023;9:8");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 – TROPHOBLAST INVASION & SPIRAL ARTERY REMODELING
// ══════════════════════════════════════════════════════════════════════════════
addTwoColSlide(pres, "Stage 1: Defective Placentation",
  [
    { text: "Normal Placentation", bold: true },
    "Extravillous trophoblasts (EVT) invade decidua and inner myometrium",
    "Spiral arteries undergo physiologic remodeling: become wide, low-resistance sinusoids",
    "High-flow, low-pressure uteroplacental circulation established",
    "Adequate oxygen and nutrient delivery to fetus"
  ],
  [
    { text: "Defective Placentation in PE", bold: true },
    "Shallow trophoblast invasion — limited to decidua only",
    "Spiral arteries retain muscular walls → narrow, high-resistance",
    "Uteroplacental hypoperfusion and oxidative stress",
    "Placental hypoxia triggers release of sFlt-1, sEng, inflammatory cytokines",
    "\"Two-hit\" model: impaired spiral artery remodeling + maternal predisposition"
  ],
  "Refs: Torres-Torres J et al. Int J Mol Sci. 2024 | Melchiorre K et al. Am J Obstet Gynecol. 2022;226:S904"
);

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – MOLECULAR MECHANISMS
// ══════════════════════════════════════════════════════════════════════════════
addContentSlide(pres, "Stage 2: Molecular Mechanisms – Anti-Angiogenic Cascade", [
  { text: "1. Anti-Angiogenic Imbalance", bold: true },
  { text: "sFlt-1 (VEGF receptor antagonist) ↑↑ → sequesters VEGF and PlGF → endothelial injury", sub: true },
  { text: "Soluble endoglin (sEng) ↑↑ → blocks TGF-β signalling → worsens endothelial dysfunction", sub: true },
  { text: "PlGF (placental growth factor) ↓ → validated early biomarker of preterm PE", sub: true },
  { text: "2. Oxidative Stress & Mitochondrial Dysfunction", bold: true },
  { text: "Placental ROS production exceeds antioxidant capacity", sub: true },
  { text: "Mitochondrial abnormalities fuel lipid peroxidation and inflammatory cascades", sub: true },
  { text: "3. Immune Dysregulation", bold: true },
  { text: "Impaired maternal immune tolerance to semi-allogeneic fetus / placenta", sub: true },
  { text: "Shift from regulatory T-cells (Tregs) to pro-inflammatory Th1/Th17 phenotype", sub: true },
  { text: "4. Genetic & Epigenetic Factors", bold: true },
  { text: "Polymorphisms in FLT1 gene, altered miRNA expression (e.g., miR-210)", sub: true },
  { text: "Familial clustering; HELLP shows strong familial tendency (Petca et al., 2022)", sub: true }
], "Refs: Torres-Torres J et al. Int J Mol Sci. 2024;25(14):7569 | Gardikioti A et al. Int J Mol Sci. 2022;23(7):3851");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 – vWF / ADAMTS-13 / COMPLEMENT
// ══════════════════════════════════════════════════════════════════════════════
addContentSlide(pres, "Advanced Molecular Pathways in PE / HELLP", [
  { text: "von Willebrand Factor (vWF) Dysregulation", bold: true },
  { text: "vWF antigen levels significantly elevated in PE/HELLP pregnancies", sub: true },
  { text: "ADAMTS-13 (cleaving protease) activity normal to decreased → ultra-large vWF multimers accumulate", sub: true },
  { text: "Promotes platelet aggregation, microvascular thrombosis (TMA-like picture)", sub: true },
  { text: "Complement System Activation", bold: true },
  { text: "↑ Urinary excretion of terminal complement complex C5b-9 in preeclamptic women", sub: true },
  { text: "Greater C5b-9 deposition on placental surface → complement-driven injury", sub: true },
  { text: "APS (antiphospholipid syndrome) activates complement; contributes to 10–15% of recurrent PE", sub: true },
  { text: "Pathogenesis of Goldman-Cecil (Goldman-Cecil Medicine, 2nd Ed):", bold: true },
  { text: "Faulty endovascular trophoblastic remodeling (Stage 1) → endothelial dysfunction + sFlt-1/sEng overproduction (Stage 2) → hemoconcentration, ↑ afterload, pulmonary edema risk", sub: true }
], "Refs: Gardikioti A et al. Int J Mol Sci. 2022;23:3851 | Goldman-Cecil Medicine International Ed., 2023");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 – RISK FACTORS
// ══════════════════════════════════════════════════════════════════════════════
addSectionTitle(pres, "Section 3", "Risk Factors for Hypertensive Disorders of Pregnancy");

addTwoColSlide(pres, "Risk Factors for Preeclampsia",
  [
    { text: "Strong / Established Risk Factors", bold: true },
    "Nulliparity (OR ~3)",
    "Prior history of preeclampsia (recurrence ~25–65%)",
    "Chronic hypertension — strongest single risk factor",
    "Pre-existing diabetes mellitus (type 1 or 2)",
    "Chronic renal disease / CKD",
    "Antiphospholipid syndrome (APS)",
    "Multifetal gestation (10–20% in twins; 25–60% in triplets)",
    "Obesity (BMI >30)",
    "Assisted reproductive technology (esp. donor oocyte / IVF)"
  ],
  [
    { text: "Moderate / Controversial Risk Factors", bold: true },
    "Advanced maternal age (>35 years)",
    "Thrombophilia (controversial — inconsistent data)",
    "Race: African-American race (confounded by ↑ prevalence of chronic HTN)",
    "Family history (first-degree relative with PE)",
    "Autoimmune conditions (SLE)",
    "Short inter-pregnancy interval (<2 years) or very long interval (>10 years)",
    "Male fetal sex (modest effect)",
    "Teen pregnancy (meta-analysis inconclusive)",
    "Socioeconomic deprivation / inadequate prenatal care"
  ],
  "Refs: Brenner & Rector's The Kidney 11e | Creasy & Resnik MFM 9e | Ohamadike O et al. Obstet Gynecol Surv 2022"
);

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 – SECTION: CLINICAL FEATURES
// ══════════════════════════════════════════════════════════════════════════════
addSectionTitle(pres, "Section 4", "Clinical Features of Hypertensive Disorders of Pregnancy");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 – CLINICAL FEATURES (Maternal)
// ══════════════════════════════════════════════════════════════════════════════
addContentSlide(pres, "Clinical Features — Maternal Presentation", [
  { text: "Hypertension (Key Diagnostic Feature)", bold: true },
  { text: "Systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg on two readings ≥4 hours apart", sub: true },
  { text: "Signs usually antedate symptoms; can be subtly elevated", sub: true },
  { text: "20% of eclamptic women had no prior systolic BP >140 mmHg (Creasy & Resnik, 9e)", sub: true },
  { text: "Proteinuria", bold: true },
  { text: "≥300 mg/24-h urine, or PCR ≥0.3, or dipstick ≥2+ (if no other quantitative test)", sub: true },
  { text: "Marker of glomerular endothelial injury; not required if end-organ damage present", sub: true },
  { text: "Neurological Symptoms", bold: true },
  { text: "Severe persistent headache (frontal/occipital), visual disturbances (scotomata, blurring, diplopia)", sub: true },
  { text: "Hyperreflexia, clonus — premonitory signs of eclampsia", sub: true },
  { text: "Hepatic / GI Symptoms", bold: true },
  { text: "Epigastric or right upper quadrant pain (hepatic capsule distension / subcapsular hematoma)", sub: true },
  { text: "Nausea, vomiting — may mimic viral syndrome or gastroenteritis", sub: true }
], "Refs: Creasy & Resnik MFM 9e, Chapter 40 | Goldman-Cecil Medicine 2e");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 – CLINICAL FEATURES continued
// ══════════════════════════════════════════════════════════════════════════════
addContentSlide(pres, "Clinical Features — Continued", [
  { text: "Edema", bold: true },
  { text: "Pathological edema: facial puffiness, rapid weight gain (>2 lb/week)", sub: true },
  { text: "No longer a diagnostic criterion (present in 80% of normal pregnancies)", sub: true },
  { text: "Pulmonary Features", bold: true },
  { text: "Dyspnoea / pulmonary edema — from hemoconcentration and ↑ cardiac afterload", sub: true },
  { text: "Risk compounded in multiple gestation when tocolytics + corticosteroids used concomitantly", sub: true },
  { text: "Renal Features", bold: true },
  { text: "Oliguria (<0.5 mL/kg/h) reflecting renal vasoconstriction", sub: true },
  { text: "Glomeruloendotheliosis: pathognomonic renal lesion (70% of primigravidas, 14% multigravidas on biopsy)", sub: true },
  { text: "Cardiovascular Features", bold: true },
  { text: "Increased afterload → impaired systolic & diastolic function", sub: true },
  { text: "Peripartum cardiomyopathy (PPCM) associated with HDP (Huang W et al., 2025)", sub: true },
  { text: "Hemoconcentration", bold: true },
  { text: "Hallmark of preeclampsia; reflects capillary leak and endothelial damage", sub: true }
], "Refs: Creasy & Resnik MFM 9e | Huang W et al. Curr Cardiol Rev. 2025 [PMID 39949098]");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 – DIAGNOSTIC CRITERIA TABLE
// ══════════════════════════════════════════════════════════════════════════════
addSectionTitle(pres, "Section 5", "Diagnostic Criteria — ACOG 2023 & ISSHP");

addTableSlide(pres, "Diagnostic Criteria for Preeclampsia (ACOG 2023)",
  ["Feature", "Criterion", "Significance"],
  [
    ["Blood Pressure", "≥140 mmHg systolic OR ≥90 mmHg diastolic on ≥2 readings, ≥4 hours apart, after 20 wks gestation", "Required for all subtypes"],
    ["Proteinuria", "≥300 mg/24-h, PCR ≥0.3, or sustained 2+ dipstick", "Marker of glomerular endothelial injury"],
    ["Thrombocytopenia", "Platelet count <100,000/μL", "Indicates PE with severe features"],
    ["Renal Insufficiency", "Creatinine >1.1 mg/dL OR doubling of creatinine", "In absence of other renal disease"],
    ["Liver Dysfunction", "Transaminases >2× upper limit of normal", "OR RUQ/epigastric pain unresponsive to meds"],
    ["Pulmonary Edema", "New-onset — not attributable to other cause", "Severe feature"],
    ["Neurological Symptoms", "New-onset headache unresponsive to analgesia, or visual disturbances", "Premonitory of eclampsia"],
    ["Eclampsia", "New tonic-clonic or focal seizures without other cause", "Can occur WITHOUT prior BP/proteinuria in ~38%"]
  ],
  "Ref: ACOG Practice Bulletin No. 222, 2023 | Goldman-Cecil Medicine International Ed. 2023"
);

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 18 – SECTION: MATERNAL COMPLICATIONS
// ══════════════════════════════════════════════════════════════════════════════
addSectionTitle(pres, "Section 6", "Complications of Hypertensive Disorders of Pregnancy");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 19 – MATERNAL COMPLICATIONS
// ══════════════════════════════════════════════════════════════════════════════
addContentSlide(pres, "Maternal Complications", [
  { text: "Eclampsia", bold: true },
  { text: "Generalised tonic-clonic seizures; 77% were hospitalised before seizure onset", sub: true },
  { text: "Risk of cerebrovascular accident, aspiration pneumonia, ARDS, death", sub: true },
  { text: "HELLP Syndrome (up to 12% of severe PE; 0.2–0.8% of all pregnancies)", bold: true },
  { text: "Hemolysis, Elevated Liver enzymes, Low Platelets — life-threatening", sub: true },
  { text: "DIC in 21%, abruptio placentae, hepatic haematoma / rupture", sub: true },
  { text: "Mortality rate 1–3%; delayed postpartum presentation in up to 30% of cases", sub: true },
  { text: "Stroke / Hypertensive Crisis", bold: true },
  { text: "BP ≥160/110 (severe-range) demands urgent antihypertensive treatment", sub: true },
  { text: "Haemorrhagic stroke remains a top cause of maternal death", sub: true },
  { text: "Acute Kidney Injury (AKI)", bold: true },
  { text: "Glomeruloendotheliosis → oliguria → renal failure in severe cases", sub: true },
  { text: "Pulmonary Oedema", bold: true },
  { text: "Due to capillary leak + low oncotic pressure + iatrogenic fluid overload", sub: true }
], "Refs: Sleisenger & Fordtran Gastrointestinal & Liver Disease | Petca A et al. Medicina. 2022;58(2):326");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 20 – HELLP SYNDROME DETAIL
// ══════════════════════════════════════════════════════════════════════════════
addTwoColSlide(pres, "HELLP Syndrome — Pathophysiology & Diagnosis",
  [
    { text: "Pathophysiology", bold: true },
    "Endothelial injury → platelet activation and aggregation",
    "Microangiopathic haemolytic anaemia (schistocytes, ↑LDH, ↑indirect bilirubin)",
    "Hepatic sinusoidal fibrin deposition → hepatocellular necrosis",
    "↑ vWF antigen + ADAMTS-13 dysfunction → TMA-like picture",
    "70–80% coexist with preeclampsia",
    { text: "Classification (Mississippi Triple-Class)", bold: true },
    "Class 1: Platelets <50,000 + LDH ≥600 + AST/ALT ≥70",
    "Class 2: Platelets 50–100k",
    "Class 3: Platelets 100–150k"
  ],
  [
    { text: "Clinical Features", bold: true },
    "Epigastric or RUQ pain (most common presenting symptom)",
    "Nausea, vomiting, malaise — often misdiagnosed as viral illness",
    "Headache and blurred vision in varying combinations",
    "May present with thrombocytopenia WITHOUT hypertension or proteinuria (up to 15%)",
    "Most present >27 weeks; 11% present <27 weeks",
    { text: "Key Complications", bold: true },
    "DIC (21%), placental abruption, renal failure",
    "Hepatic capsule haematoma / rupture (rare but fatal)",
    "Postpartum haemorrhage",
    "Maternal mortality 1–3%"
  ],
  "Refs: Petca A et al. Medicina 2022;58:326 | Gardikioti A et al. Int J Mol Sci 2022;23:3851 | Sleisenger & Fordtran GI Disease"
);

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 21 – FETAL/NEONATAL COMPLICATIONS
// ══════════════════════════════════════════════════════════════════════════════
addContentSlide(pres, "Fetal & Neonatal Complications", [
  { text: "Fetal Growth Restriction (FGR)", bold: true },
  { text: "Uteroplacental insufficiency limits oxygen / nutrient delivery", sub: true },
  { text: "FGR in ~30–40% of early-onset (<34 wks) preeclampsia; Doppler waveform abnormalities", sub: true },
  { text: "Preterm Birth", bold: true },
  { text: "Leading complication — both iatrogenic (indicated) and spontaneous preterm birth", sub: true },
  { text: "Twin gestations with PE: lower gestational age at delivery, lower birth weight, higher CS rate", sub: true },
  { text: "Placental Abruption", bold: true },
  { text: "Risk markedly elevated, especially with HELLP syndrome (DIC 21%)", sub: true },
  { text: "Perinatal Death", bold: true },
  { text: "Increased perinatal mortality, especially with early-onset and severe PE", sub: true },
  { text: "Intrapartum hypoxia-ischaemia risk from acute uteroplacental deterioration", sub: true },
  { text: "Long-term Fetal/Neonatal Outcomes", bold: true },
  { text: "Neurodevelopmental disability (cognitive, behavioural deficits in schoolchildren)", sub: true },
  { text: "Offspring cardiovascular and metabolic disease in adulthood (Dimitriadis et al., 2023)", sub: true }
], "Refs: Dimitriadis E et al. Nat Rev Dis Primers. 2023;9:8 | Creasy & Resnik MFM 9e");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 22 – LONG-TERM SEQUELAE
// ══════════════════════════════════════════════════════════════════════════════
addContentSlide(pres, "Long-term Sequelae & Future Cardiovascular Risk", [
  { text: "Cardiovascular Disease (CVD)", bold: true },
  { text: "Women with preeclampsia have 2–4× risk of ischaemic heart disease and stroke within 10–15 years", sub: true },
  { text: "Risk persists even without classical CVD risk factors — represents independent vascular insult or marker", sub: true },
  { text: "Hypertension & Metabolic Syndrome", bold: true },
  { text: "Chronic hypertension, obesity, insulin resistance more common in former PE mothers", sub: true },
  { text: "Screening for hypertension, diabetes, hyperlipidaemia recommended at postpartum visit and annually", sub: true },
  { text: "Renal Disease", bold: true },
  { text: "PE increases risk of ESRD ~5-fold; absolute risk remains low but significant (Brenner & Rector's Kidney, 11e)", sub: true },
  { text: "Proteinuria and reduced GFR may persist postpartum in severe cases", sub: true },
  { text: "Cardiac Structural Changes", bold: true },
  { text: "Left ventricular hypertrophy and diastolic dysfunction demonstrated post-PE (Edwards et al., 2025)", sub: true },
  { text: "Peripartum cardiomyopathy (PPCM) — HDP is a significant associated condition (Huang et al., 2025)", sub: true },
  { text: "Screening Recommendation (post-PE)", bold: true },
  { text: "Annual BP, fasting glucose, lipids, renal function; lifestyle modification counselling", sub: true }
], "Refs: Brenner & Rector Kidney 11e | Edwards JJ et al. Hypertension 2025 [PMID 40365671] | Huang W et al. Curr Cardiol Rev 2025 [PMID 39949098]");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 23 – PREVENTION & MANAGEMENT OVERVIEW
// ══════════════════════════════════════════════════════════════════════════════
addContentSlide(pres, "Prevention & Key Management Principles", [
  { text: "Primary Prevention", bold: true },
  { text: "Low-dose aspirin (81 mg/day) started before 16 weeks — reduces preterm PE by ~60% in high-risk women (ACOG 2023)", sub: true },
  { text: "Calcium supplementation (≥1 g/day) in low-calcium populations reduces PE risk", sub: true },
  { text: "Antihypertensive Therapy", bold: true },
  { text: "Initiate oral antihypertensives when BP ≥160 systolic or ≥110 diastolic (severe-range)", sub: true },
  { text: "First-line agents: labetalol, nifedipine (or hydralazine IV in acute setting)", sub: true },
  { text: "Seizure Prophylaxis", bold: true },
  { text: "Magnesium sulphate (MgSO4) — 4–6 g IV loading dose; superior to diazepam/phenytoin (Magpie Trial)", sub: true },
  { text: "Timing of Delivery", bold: true },
  { text: "Delivery is the only definitive treatment — decision balances maternal vs fetal risks", sub: true },
  { text: "Cochrane 2026 review (Beardmore-Gray et al., PMID 42161381): planned early birth vs expectant management ≥34 wks — evidence reviewed", sub: true },
  { text: "Expectant management before 34 weeks only if both maternal and fetal conditions stable", sub: true }
], "Refs: ACOG PB 222 (2023) | Ohamadike O et al. Obstet Gynecol Surv 2022 | Beardmore-Gray A et al. Cochrane 2026 [PMID 42161381]");

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 24 – REFERENCES
// ══════════════════════════════════════════════════════════════════════════════
addSectionTitle(pres, "References", "Cited Research Articles & Textbooks");

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    "1.  Dimitriadis E, Rolnik DL, Zhou W, et al. Pre-eclampsia. Nat Rev Dis Primers. 2023;9(1):8. doi:10.1038/s41572-023-00417-6 [PMID: 36797292]",
    "2.  Torres-Torres J, Espino-Y-Sosa S, Martinez-Portilla R, et al. A Narrative Review on the Pathophysiology of Preeclampsia. Int J Mol Sci. 2024;25(14):7569. doi:10.3390/ijms25147569 [PMID: 39062815]",
    "3.  Ohamadike O, Lim SL, Siegel A, et al. Hypertensive Disorders of Pregnancy: Common Clinical Conundrums. Obstet Gynecol Surv. 2022;77(4):241–254. doi:10.1097/OGX.0000000000000996 [PMID: 35395093]",
    "4.  Petca A, Miron BC, Pacu I, et al. HELLP Syndrome–Holistic Insight into Pathophysiology. Medicina (Kaunas). 2022;58(2):326. doi:10.3390/medicina58020326 [PMID: 35208649]",
    "5.  Gardikioti A, Venou TM, Gavriilaki E, et al. Molecular Advances in Preeclampsia and HELLP Syndrome. Int J Mol Sci. 2022;23(7):3851. doi:10.3390/ijms23073851 [PMID: 35409211]",
    "6.  Melchiorre K, Giorgione V, Thilaganathan B. The placenta and preeclampsia: villain or victim? Am J Obstet Gynecol. 2022;226(2S):S904–S912. doi:10.1016/j.ajog.2020.11.026 [PMID: 33771361]",
    "7.  Erez O, Romero R, Jung E, et al. Preeclampsia and eclampsia: the conceptual evolution of a syndrome. Am J Obstet Gynecol. 2022;226(2S):S786–S803. [PMID: 35177220]",
    "8.  Edwards JJ, Giorgione V, Griffiths M, et al. Cardiac Structure, Function and Mechanics in Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-Analysis. Hypertension. 2025. [PMID: 40365671]",
    "9.  Huang W, Syahruddin SS, Johansyah AA. Association of Hypertensive Disorders of Pregnancy and Peripartum Cardiomyopathy: A Systematic Review and Meta-analysis. Curr Cardiol Rev. 2025. [PMID: 39949098]",
    "10. Beardmore-Gray A, Rohwer C, Fernandez Turienzo C, et al. Planned early birth vs expectant management for HDP from 34 weeks. Cochrane Database Syst Rev. 2026 May 21. [PMID: 42161381]"
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 25 – TEXTBOOK REFERENCES
// ══════════════════════════════════════════════════════════════════════════════
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    "12. Goldman L, Schafer AI (eds). Goldman-Cecil Medicine International Edition, 2-Volume Set. 27th ed. Elsevier; 2023. (Chapter on Hypertensive Disorders of Pregnancy)",
    "13. Brenner BM, Rector FC (eds). Brenner and Rector's The Kidney, 2-Volume Set. 11th ed. Elsevier; 2020. (Chapter 28)",
    "14. Sleisenger MH, Fordtran JS (eds). Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Elsevier; 2021. (Chapter on Liver Disease in Pregnancy)",
    "15. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2023. (Updated 2023)",
    "16. International Society for the Study of Hypertension in Pregnancy (ISSHP). Classification, Diagnosis, and Management of the Hypertensive Disorders of Pregnancy: A Revised Statement. Pregnancy Hypertens. 2018;13:291–310.",
    "17. World Health Organization. WHO Recommendations for Prevention and Treatment of Pre-eclampsia and Eclampsia. Geneva: WHO; 2011. (Updated guidance available 2023)",
    "18. Story CM, Chaturvedi S, Gerber GF, et al. Hematologic disorders in pregnancy: the role of the complement system. Expert Rev Hematol. 2026;19(5):1–12. [PMID: 41784357]"
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// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 26 – THANK YOU
// ══════════════════════════════════════════════════════════════════════════════
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