"hypertensive disorders of pregnancy" AND "etiopathogenesis"

"preeclampsia" AND "pathophysiology" AND "placenta"

"preeclampsia" AND "complications" AND "maternal fetal"

PMID: 38674114

"preeclampsia" AND "HELLP syndrome" AND "eclampsia"

"preeclampsia" AND "sFlt1" AND "PlGF" AND "biomarker"

PMID: 41293035

PMID: 39949098

PMID: 40399152

mkdir -p /home/daytona/workspace/hdp-symposium && ls /home/daytona/workspace/hdp…

~/hdp-symposium/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = 'LAYOUT_16x9';
pres.author = 'Symposium';
pres.title = 'Hypertensive Disorders of Pregnancy';

// ─── COLOUR PALETTE ───────────────────────────────────────────────
const DEEP_NAVY   = "0D2137";   // dominant background
const TEAL        = "0A7E8C";   // accent headings / shapes
const AMBER       = "E8A020";   // highlight accent
const WHITE       = "FFFFFF";
const LIGHT_GREY  = "D8E4EC";
const SOFT_BLUE   = "1B4F72";   // secondary background
const DANGER_RED  = "C0392B";   // complications / severity
const TEXT_DARK   = "1A2740";
const MINT        = "17A589";   // positive/normal
const SLIDE_BG    = "F0F4F8";   // light slide backgrounds

// ─── HELPER FUNCTIONS ─────────────────────────────────────────────
function addDarkSlide(pres, bg) {
  const s = pres.addSlide();
  s.background = { color: bg || DEEP_NAVY };
  return s;
}

function addLightSlide(pres) {
  const s = pres.addSlide();
  s.background = { color: SLIDE_BG };
  return s;
}

function sectionBar(slide, text, color) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: color || TEAL } });
  slide.addText(text, { x: 0.2, y: 0.05, w: 9.6, h: 0.45, fontSize: 14, bold: true, color: WHITE, valign: "middle" });
}

function accentLine(slide, y, color) {
  slide.addShape(pres.ShapeType.rect, { x: 0.3, y: y, w: 0.08, h: 0.35, fill: { color: color || AMBER } });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE SLIDE
// ═══════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, DEEP_NAVY);

  // Top decorative bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.18, fill: { color: TEAL } });
  // Bottom bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.25, w: 10, h: 0.375, fill: { color: SOFT_BLUE } });
  // Amber accent strip
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.18, w: 0.12, h: 5.07, fill: { color: AMBER } });

  // Decorative circle
  s.addShape(pres.ShapeType.ellipse, { x: 7.2, y: 0.8, w: 2.5, h: 2.5, fill: { color: TEAL }, line: { color: AMBER, width: 3 } });
  s.addText("HDP", { x: 7.2, y: 1.4, w: 2.5, h: 1.3, fontSize: 36, bold: true, color: WHITE, align: "center", valign: "middle" });

  s.addText("HYPERTENSIVE DISORDERS\nOF PREGNANCY", {
    x: 0.5, y: 0.6, w: 6.5, h: 1.6,
    fontSize: 32, bold: true, color: WHITE, align: "left",
    charSpacing: 2, breakLine: false
  });
  s.addText("Etiopathogenesis • Clinical Features • Complications", {
    x: 0.5, y: 2.3, w: 6.5, h: 0.6,
    fontSize: 16, color: AMBER, italic: true, align: "left"
  });
  s.addText("A Symposium for Postgraduate Residents", {
    x: 0.5, y: 3.0, w: 6.5, h: 0.45,
    fontSize: 13, color: LIGHT_GREY, align: "left"
  });
  s.addText("Based on ACOG Guidelines & Recent Systematic Reviews (2024–2026)", {
    x: 0.5, y: 3.5, w: 6.5, h: 0.45,
    fontSize: 11, color: LIGHT_GREY, italic: true, align: "left"
  });
  s.addText("Vera-Ponce VJ et al., Front Reprod Health 2025  |  Chiang YT et al., Int J Mol Sci 2024  |  Huang W et al., Curr Cardiol Rev 2025", {
    x: 0.2, y: 5.28, w: 9.6, h: 0.3,
    fontSize: 8, color: LIGHT_GREY, align: "left"
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 2 — SYMPOSIUM AGENDA / OVERVIEW
// ═══════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBar(s, "SYMPOSIUM OVERVIEW", DEEP_NAVY);

  s.addText("Session Outline", { x: 0.3, y: 0.65, w: 9.4, h: 0.5, fontSize: 22, bold: true, color: TEXT_DARK });

  const sessions = [
    { num: "01", title: "Classification & Epidemiology", desc: "ACOG definitions, global burden, risk factors" },
    { num: "02", title: "Etiopathogenesis", desc: "Two-stage model, trophoblast dysfunction, angiogenic imbalance, molecular mechanisms" },
    { num: "03", title: "Clinical Features & Diagnosis", desc: "Gestational HTN, preeclampsia, eclampsia, HELLP — diagnostic criteria" },
    { num: "04", title: "Complications", desc: "Maternal organ involvement, fetal complications, long-term sequelae" },
    { num: "05", title: "Recent Evidence & Biomarkers", desc: "sFlt-1/PlGF, heparan sulfate, genetic & epigenetic markers (2024–2026 data)" },
    { num: "06", title: "Management Pearls", desc: "Acute antihypertensives, MgSO₄, delivery timing, prevention" },
  ];

  sessions.forEach((sess, i) => {
    const col = i < 3 ? 0 : 1;
    const row = i % 3;
    const x = col === 0 ? 0.3 : 5.2;
    const y = 1.25 + row * 1.3;

    s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 1.1, fill: { color: col === 0 ? "E8F4FC" : "EEF8F7" }, line: { color: col === 0 ? TEAL : MINT, width: 1.5 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 0.5, h: 1.1, fill: { color: col === 0 ? TEAL : MINT } });
    s.addText(sess.num, { x, y: y + 0.35, w: 0.5, h: 0.4, fontSize: 14, bold: true, color: WHITE, align: "center" });
    s.addText(sess.title, { x: x + 0.6, y: y + 0.05, w: 3.9, h: 0.4, fontSize: 12, bold: true, color: TEXT_DARK });
    s.addText(sess.desc, { x: x + 0.6, y: y + 0.48, w: 3.9, h: 0.55, fontSize: 9.5, color: "4A5568", italic: true });
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 3 — CLASSIFICATION
// ═══════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBar(s, "01  |  CLASSIFICATION (ACOG 2020)", DEEP_NAVY);

  s.addText("ACOG Classification of Hypertensive Disorders of Pregnancy", {
    x: 0.3, y: 0.65, w: 9.4, h: 0.45, fontSize: 18, bold: true, color: TEXT_DARK
  });

  const classes = [
    { label: "Gestational\nHypertension", color: "4A90D9", desc: "BP ≥140/90 mmHg at ≥20 weeks\nNo proteinuria / organ dysfunction\nOccurs in 6–17% of nulliparous women" },
    { label: "Preeclampsia\n± Severe Features", color: TEAL, desc: "BP ≥140/90 + proteinuria OR organ dysfunction\nSevere: BP ≥160/110 or end-organ damage\nAffects 4.43% globally (Vera-Ponce 2025)" },
    { label: "Eclampsia", color: AMBER, desc: "New-onset seizures in preeclamptic patient\nGlobal prevalence: 0.43%\n1 in 2000–3000 deliveries in high-resource settings" },
    { label: "HELLP\nSyndrome", color: DANGER_RED, desc: "Hemolysis + Elevated Liver enzymes\n+ Low Platelets (<100,000/µL)\nGlobal prevalence: 0.39%" },
    { label: "Superimposed\nPreeclampsia", color: SOFT_BLUE, desc: "Preeclampsia on chronic hypertension\nHighest PPCM risk (OR 5.77)\nHardest to diagnose clinically" },
    { label: "Chronic\nHypertension", color: "7B8D8E", desc: "BP ≥140/90 before 20 weeks\nor persisting >12 weeks postpartum\nOR pre-existing diagnosis" },
  ];

  classes.forEach((cl, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.25 + col * 3.2;
    const y = 1.2 + row * 2.1;
    s.addShape(pres.ShapeType.rect, { x, y, w: 3.0, h: 0.5, fill: { color: cl.color } });
    s.addText(cl.label, { x, y, w: 3.0, h: 0.5, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x, y: y + 0.5, w: 3.0, h: 1.5, fill: { color: WHITE }, line: { color: cl.color, width: 1.5 } });
    s.addText(cl.desc, { x: x + 0.1, y: y + 0.58, w: 2.8, h: 1.35, fontSize: 9.5, color: TEXT_DARK });
  });

  s.addText("Source: ACOG Practice Bulletin 222 (2020) | Vera-Ponce VJ et al., Front Reprod Health 2025 (PMID: 41293035)", {
    x: 0.3, y: 5.32, w: 9.4, h: 0.25, fontSize: 7.5, color: "6B7280", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 4 — EPIDEMIOLOGY
// ═══════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, SOFT_BLUE);

  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: TEAL } });
  s.addText("01  |  EPIDEMIOLOGY & GLOBAL BURDEN", { x: 0.2, y: 0.05, w: 9.6, h: 0.45, fontSize: 14, bold: true, color: WHITE, valign: "middle" });

  s.addText("Global Prevalence — Meta-analysis of 70 studies (Vera-Ponce et al., 2025)", {
    x: 0.3, y: 0.65, w: 9.4, h: 0.45, fontSize: 14, bold: true, color: AMBER
  });

  const stats = [
    { val: "4.43%", label: "Preeclampsia\n(95% CI: 3.73–5.20)", color: TEAL },
    { val: "0.43%", label: "Eclampsia\n(95% CI: 0.19–0.76)", color: AMBER },
    { val: "0.39%", label: "HELLP Syndrome\n(95% CI: 0.16–0.72)", color: DANGER_RED },
    { val: "5–7%", label: "All HDP\nper pregnancy", color: MINT },
  ];

  stats.forEach((st, i) => {
    const x = 0.3 + i * 2.35;
    s.addShape(pres.ShapeType.ellipse, { x, y: 1.2, w: 2.0, h: 2.0, fill: { color: st.color } });
    s.addText(st.val, { x, y: 1.55, w: 2.0, h: 0.7, fontSize: 24, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addText(st.label, { x, y: 2.25, w: 2.0, h: 0.8, fontSize: 9, color: WHITE, align: "center" });
  });

  s.addText("Key Risk Factors", { x: 0.3, y: 3.3, w: 9.4, h: 0.4, fontSize: 13, bold: true, color: AMBER });

  const risks = [
    "Nulliparity", "Prior h/o preeclampsia (8× risk)", "Chronic hypertension",
    "Non-Hispanic Black women", "Obesity (BMI >30)", "Multiple gestation",
    "Age extremes (<18 or >35)", "Family history", "Diabetes / Renal disease"
  ];

  const cols = [risks.slice(0, 3), risks.slice(3, 6), risks.slice(6, 9)];
  cols.forEach((col, ci) => {
    col.forEach((risk, ri) => {
      s.addShape(pres.ShapeType.rect, { x: 0.3 + ci * 3.2, y: 3.75 + ri * 0.38, w: 0.25, h: 0.28, fill: { color: AMBER } });
      s.addText(risk, { x: 0.65 + ci * 3.2, y: 3.75 + ri * 0.38, w: 2.8, h: 0.28, fontSize: 10, color: WHITE });
    });
  });

  s.addText("Vera-Ponce VJ et al. Front Reprod Health. 2025. PMID: 41293035", {
    x: 0.3, y: 5.32, w: 9.4, h: 0.25, fontSize: 7.5, color: LIGHT_GREY, italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 5 — ETIOPATHOGENESIS: TWO-STAGE MODEL
// ═══════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBar(s, "02  |  ETIOPATHOGENESIS: THE TWO-STAGE MODEL", TEAL);

  s.addText("The Two-Stage Model of Preeclampsia", {
    x: 0.3, y: 0.65, w: 9.4, h: 0.45, fontSize: 18, bold: true, color: TEXT_DARK
  });

  // Stage 1 box
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.15, w: 4.1, h: 3.9, fill: { color: "E3F2FD" }, line: { color: TEAL, width: 2 } });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.15, w: 4.1, h: 0.5, fill: { color: TEAL } });
  s.addText("STAGE 1  (Placental)", { x: 0.3, y: 1.15, w: 4.1, h: 0.5, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle" });
  s.addText("8–18 Weeks Gestation", { x: 0.3, y: 1.7, w: 4.1, h: 0.35, fontSize: 10, color: TEAL, bold: true, align: "center" });

  const stage1 = [
    "Failure of extravillous trophoblast invasion",
    "Defective spiral artery remodeling",
    "Shallow invasion → high-resistance uteroplacental circulation",
    "Placental ischemia & oxidative stress",
    "↑ Heparan sulfate release from damaged syncytiotrophoblast (Gómez-Gutiérrez 2026)",
    "Faulty endovascular remodeling → ↑ sFlt-1 & sEng production"
  ];
  stage1.forEach((pt, i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.45, y: 2.1 + i * 0.44, w: 0.2, h: 0.22, fill: { color: TEAL } });
    s.addText(pt, { x: 0.75, y: 2.08 + i * 0.44, w: 3.5, h: 0.38, fontSize: 9.5, color: TEXT_DARK });
  });

  // Arrow
  s.addShape(pres.ShapeType.rect, { x: 4.6, y: 2.85, w: 0.8, h: 0.18, fill: { color: AMBER } });
  s.addText("→", { x: 4.55, y: 2.6, w: 0.9, h: 0.6, fontSize: 28, bold: true, color: AMBER, align: "center" });
  s.addText("triggers", { x: 4.5, y: 3.05, w: 1.0, h: 0.3, fontSize: 9, color: AMBER, align: "center", italic: true });

  // Stage 2 box
  s.addShape(pres.ShapeType.rect, { x: 5.6, y: 1.15, w: 4.1, h: 3.9, fill: { color: "FFF3E0" }, line: { color: AMBER, width: 2 } });
  s.addShape(pres.ShapeType.rect, { x: 5.6, y: 1.15, w: 4.1, h: 0.5, fill: { color: AMBER } });
  s.addText("STAGE 2  (Maternal Syndrome)", { x: 5.6, y: 1.15, w: 4.1, h: 0.5, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle" });
  s.addText(">20 Weeks — Clinical Manifestation", { x: 5.6, y: 1.7, w: 4.1, h: 0.35, fontSize: 10, color: AMBER, bold: true, align: "center" });

  const stage2 = [
    "↑ Anti-angiogenic factors: sFlt-1 & soluble endoglin (sEng)",
    "Sequestration of VEGF & PlGF → endothelial dysfunction",
    "Generalized vasospasm & hypertension",
    "Systemic inflammatory response & complement activation",
    "Multi-organ endothelial injury",
    "Hemoconcentration & ↑ vascular permeability → proteinuria"
  ];
  stage2.forEach((pt, i) => {
    s.addShape(pres.ShapeType.rect, { x: 5.75, y: 2.1 + i * 0.44, w: 0.2, h: 0.22, fill: { color: AMBER } });
    s.addText(pt, { x: 6.05, y: 2.08 + i * 0.44, w: 3.5, h: 0.38, fontSize: 9.5, color: TEXT_DARK });
  });

  s.addText("Goldman-Cecil Medicine | Chiang YT et al., Int J Mol Sci 2024 (PMID: 38674114) | Gómez-Gutiérrez AM et al., Placenta 2026 (PMID: 40399152)", {
    x: 0.3, y: 5.32, w: 9.4, h: 0.25, fontSize: 7.5, color: "6B7280", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 6 — MOLECULAR MECHANISMS
// ═══════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, DEEP_NAVY);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: TEAL } });
  s.addText("02  |  MOLECULAR MECHANISMS OF PREECLAMPSIA", { x: 0.2, y: 0.05, w: 9.6, h: 0.45, fontSize: 14, bold: true, color: WHITE, valign: "middle" });

  s.addText("Systematic Review — Chiang YT, Seow KM, Chen KH. Int J Mol Sci 2024", {
    x: 0.3, y: 0.65, w: 9.4, h: 0.35, fontSize: 11, bold: true, color: AMBER
  });

  const mechanisms = [
    {
      title: "Fetal Microchimerism",
      color: TEAL,
      points: ["Fetal cells persist in maternal circulation", "Mechanistic link between placental dysfunction & maternal syndrome", "Modulates immune tolerance"]
    },
    {
      title: "Angiogenic Imbalance",
      color: AMBER,
      points: ["↑ sFlt-1 sequesters free VEGF & PlGF", "↑ Soluble endoglin → anti-TGF-β activity", "Net result: endothelial injury & hypertension"]
    },
    {
      title: "Immune Dysregulation",
      color: MINT,
      points: ["↓ Soluble HLA-G → impaired maternal-fetal tolerance", "Complement system activation", "Pro-inflammatory cytokine surge (IL-6, TNF-α)"]
    },
    {
      title: "Epigenetic / RNA Regulation",
      color: "A569BD",
      points: ["CircRNA_06354 — early-onset PE via hsa-miR-92a-3p/VEGF-A", "miR-519d & miR-517-5p — dysregulate trophoblast function", "lncRNAs (IGFBP1, EGFR-AS1) — impair angiogenesis"]
    },
    {
      title: "Extracellular Matrix Changes",
      color: DANGER_RED,
      points: ["↑ Heparan sulfate (HS) in maternal serum", "SMD 1.2 increase in PE vs. normal pregnancy (Gómez-Gutiérrez 2026)", "Syncytiotrophoblast damage releases HS into blood"]
    },
    {
      title: "HIF-1α Dysregulation",
      color: SOFT_BLUE,
      points: ["Hypoxia-inducible factor 1-α upregulated", "Placental hypoxia → abnormal gene expression", "MMP & endothelin dysregulation → defective invasion"]
    }
  ];

  mechanisms.forEach((mech, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.2 + col * 3.27;
    const y = 1.1 + row * 2.2;

    s.addShape(pres.ShapeType.rect, { x, y, w: 3.05, h: 0.42, fill: { color: mech.color } });
    s.addText(mech.title, { x, y, w: 3.05, h: 0.42, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x, y: y + 0.42, w: 3.05, h: 1.65, fill: { color: "1A2F45" }, line: { color: mech.color, width: 1 } });
    mech.points.forEach((pt, pi) => {
      s.addText("• " + pt, { x: x + 0.1, y: y + 0.5 + pi * 0.48, w: 2.85, h: 0.42, fontSize: 9.5, color: LIGHT_GREY });
    });
  });

  s.addText("Chiang YT et al., Int J Mol Sci 2024 (PMID: 38674114)  |  Gómez-Gutiérrez AM et al., Placenta 2026 (PMID: 40399152)", {
    x: 0.3, y: 5.32, w: 9.4, h: 0.25, fontSize: 7.5, color: LIGHT_GREY, italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 7 — RISK FACTORS (DEEPER)
// ═══════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBar(s, "02  |  PREDISPOSING FACTORS & IMMUNOLOGICAL BASIS", TEAL);

  s.addText("Why Does Stage 1 Fail?", { x: 0.3, y: 0.65, w: 9.4, h: 0.45, fontSize: 18, bold: true, color: TEXT_DARK });

  // Left column: immunological
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.2, w: 4.3, h: 4.1, fill: { color: "E8F8F5" }, line: { color: MINT, width: 1.5 } });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.2, w: 4.3, h: 0.45, fill: { color: MINT } });
  s.addText("IMMUNOLOGICAL FACTORS", { x: 0.3, y: 1.2, w: 4.3, h: 0.45, fontSize: 12, bold: true, color: WHITE, align: "center", valign: "middle" });
  const imm = [
    "Limited exposure to paternal antigens → impaired tolerance",
    "Primipaternity / new partner → ↑ risk",
    "NK cell dysfunction in decidua",
    "Th1/Th2 imbalance → excess inflammatory response",
    "↓ Regulatory T cells (Tregs) at maternal-fetal interface",
    "Complement activation (C3, C5a) → trophoblast injury",
    "HLA-G reduction → impaired immune tolerance (Chiang 2024)"
  ];
  imm.forEach((pt, i) => {
    accentLine(s, 1.75 + i * 0.48, MINT);
    s.addText(pt, { x: 0.55, y: 1.75 + i * 0.48, w: 3.9, h: 0.42, fontSize: 9.5, color: TEXT_DARK });
  });

  // Right column: genetic
  s.addShape(pres.ShapeType.rect, { x: 5.3, y: 1.2, w: 4.3, h: 4.1, fill: { color: "F0F0FB" }, line: { color: SOFT_BLUE, width: 1.5 } });
  s.addShape(pres.ShapeType.rect, { x: 5.3, y: 1.2, w: 4.3, h: 0.45, fill: { color: SOFT_BLUE } });
  s.addText("GENETIC & HORMONAL FACTORS", { x: 5.3, y: 1.2, w: 4.3, h: 0.45, fontSize: 12, bold: true, color: WHITE, align: "center", valign: "middle" });
  const gen = [
    "Polygenic inheritance — maternal & fetal genome interactions",
    "FLT1 gene variants → excess sFlt-1 production",
    "AGT (angiotensinogen) polymorphisms",
    "↓ PPAR-γ expression → impaired trophoblast differentiation",
    "↑ Endothelin-1 (ET-1) → vasoconstriction",
    "Low calcium intake → ↑ PTH → ↑ vascular tone",
    "Dysregulated renin-angiotensin-aldosterone system"
  ];
  gen.forEach((pt, i) => {
    accentLine(s, 1.75 + i * 0.48, SOFT_BLUE);
    s.addText(pt, { x: 5.55, y: 1.75 + i * 0.48, w: 3.9, h: 0.42, fontSize: 9.5, color: TEXT_DARK });
  });

  s.addText("Goldman-Cecil Medicine, 2024  |  Chiang YT et al., Int J Mol Sci 2024", {
    x: 0.3, y: 5.32, w: 9.4, h: 0.25, fontSize: 7.5, color: "6B7280", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 8 — CLINICAL FEATURES: GESTATIONAL HTN & PREECLAMPSIA
// ═══════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBar(s, "03  |  CLINICAL FEATURES — GESTATIONAL HYPERTENSION & PREECLAMPSIA", DEEP_NAVY);

  s.addText("Diagnostic Criteria (ACOG Practice Bulletin 222, 2020)", {
    x: 0.3, y: 0.65, w: 9.4, h: 0.4, fontSize: 15, bold: true, color: TEXT_DARK
  });

  // Gestational HTN
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 1.1, w: 4.4, h: 4.15, fill: { color: "EBF5FB" }, line: { color: "4A90D9", width: 2 } });
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 1.1, w: 4.4, h: 0.5, fill: { color: "4A90D9" } });
  s.addText("GESTATIONAL HYPERTENSION", { x: 0.2, y: 1.1, w: 4.4, h: 0.5, fontSize: 12, bold: true, color: WHITE, align: "center", valign: "middle" });
  const gHtn = [
    { bold: "BP:", text: " ≥140/90 mmHg on 2 occasions ≥4h apart" },
    { bold: "Onset:", text: " ≥20 weeks gestation" },
    { bold: "Absence of:", text: " proteinuria, organ dysfunction" },
    { bold: "Incidence:", text: " 6–17% nulliparous, 2–4% multiparous" },
    { bold: "Progression:", text: " ~25% progress to preeclampsia" },
    { bold: "Resolution:", text: " BP normalises by 12 weeks postpartum" },
    { bold: "Chronic HTN if:", text: " persists >12 weeks postpartum" },
  ];
  gHtn.forEach((item, i) => {
    s.addText([
      { text: item.bold, options: { bold: true, color: "4A90D9" } },
      { text: item.text, options: { color: TEXT_DARK } }
    ], { x: 0.4, y: 1.72 + i * 0.48, w: 4.0, h: 0.42, fontSize: 10 });
  });

  // Preeclampsia
  s.addShape(pres.ShapeType.rect, { x: 5.4, y: 1.1, w: 4.4, h: 4.15, fill: { color: "E8F8F5" }, line: { color: TEAL, width: 2 } });
  s.addShape(pres.ShapeType.rect, { x: 5.4, y: 1.1, w: 4.4, h: 0.5, fill: { color: TEAL } });
  s.addText("PREECLAMPSIA", { x: 5.4, y: 1.1, w: 4.4, h: 0.5, fontSize: 12, bold: true, color: WHITE, align: "center", valign: "middle" });
  const pe = [
    { bold: "BP:", text: " ≥140/90 mmHg at ≥20 weeks" },
    { bold: "PLUS proteinuria:", text: " ≥300 mg/24h or P:Cr ratio ≥0.3" },
    { bold: "OR", text: " end-organ dysfunction (see next slide)" },
    { bold: "Early-onset:", text: " <34 weeks (more severe, placental)" },
    { bold: "Late-onset:", text: " ≥34 weeks (more common, maternal)" },
    { bold: "Hemoconcentration:", text: " hallmark finding" },
    { bold: "Systemic:", text: " affects virtually every organ system" },
  ];
  pe.forEach((item, i) => {
    s.addText([
      { text: item.bold, options: { bold: true, color: TEAL } },
      { text: item.text, options: { color: TEXT_DARK } }
    ], { x: 5.6, y: 1.72 + i * 0.48, w: 4.0, h: 0.42, fontSize: 10 });
  });

  s.addText("Goldman-Cecil Medicine 2024  |  Creasy & Resnik's Maternal-Fetal Medicine", {
    x: 0.3, y: 5.32, w: 9.4, h: 0.25, fontSize: 7.5, color: "6B7280", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 9 — SEVERE FEATURES / ECLAMPSIA / HELLP
// ═══════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBar(s, "03  |  SEVERE FEATURES, ECLAMPSIA & HELLP SYNDROME", DANGER_RED);

  s.addText("Criteria for Severe Features (ACOG 222, 2020)", {
    x: 0.3, y: 0.65, w: 9.4, h: 0.4, fontSize: 15, bold: true, color: DANGER_RED
  });

  // Severe features table
  const headers = ["System", "Criterion", "Threshold"];
  const rows = [
    ["Cardiovascular", "Systolic BP", "≥160 mmHg on 2 occasions ≥4h apart"],
    ["Cardiovascular", "Diastolic BP", "≥110 mmHg on 2 occasions ≥4h apart"],
    ["Haematology", "Thrombocytopenia", "Platelet count <100,000/µL"],
    ["Hepatic", "Liver enzymes", ">2× upper limit of normal"],
    ["Hepatic", "Pain", "Severe RUQ or epigastric pain unresponsive to medication"],
    ["Renal", "Serum creatinine", ">1.1 mg/dL or doubling of baseline"],
    ["Pulmonary", "Pulmonary oedema", "New-onset pulmonary oedema"],
    ["Neurological", "Headache", "New-onset severe headache unresponsive to analgesia"],
    ["Neurological", "Visual", "Blurred vision, scotoma, photopsia"],
  ];

  const colW = [1.6, 2.2, 5.5];
  const colX = [0.2, 1.85, 4.1];
  // Header
  headers.forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x: colX[i], y: 1.1, w: colW[i], h: 0.38, fill: { color: DANGER_RED } });
    s.addText(h, { x: colX[i], y: 1.1, w: colW[i], h: 0.38, fontSize: 10, bold: true, color: WHITE, align: "center", valign: "middle" });
  });
  rows.forEach((row, ri) => {
    const bg = ri % 2 === 0 ? "FFF5F5" : WHITE;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: colX[ci], y: 1.48 + ri * 0.36, w: colW[ci], h: 0.36, fill: { color: bg }, line: { color: "E0E0E0", width: 0.5 } });
      s.addText(cell, { x: colX[ci] + 0.05, y: 1.48 + ri * 0.36, w: colW[ci] - 0.1, h: 0.36, fontSize: 9, color: TEXT_DARK, valign: "middle" });
    });
  });

  // Eclampsia & HELLP boxes at bottom
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 4.8, w: 4.6, h: 0.72, fill: { color: "FFFDE7" }, line: { color: AMBER, width: 1.5 } });
  s.addText([
    { text: "ECLAMPSIA: ", options: { bold: true, color: AMBER } },
    { text: "New-onset tonic-clonic/focal seizures. Rule out other causes. May be preceded by severe headache, visual disturbances. PRES on MRI (occipital/parietal).", options: { color: TEXT_DARK } }
  ], { x: 0.3, y: 4.83, w: 4.4, h: 0.66, fontSize: 9.5 });

  s.addShape(pres.ShapeType.rect, { x: 5.3, y: 4.8, w: 4.4, h: 0.72, fill: { color: "FFF0F0" }, line: { color: DANGER_RED, width: 1.5 } });
  s.addText([
    { text: "HELLP SYNDROME: ", options: { bold: true, color: DANGER_RED } },
    { text: "Haemolysis (LDH >600, fragmented RBCs) + LFTs >2× normal + Platelets <100,000/µL. May present WITHOUT hypertension in 20% cases.", options: { color: TEXT_DARK } }
  ], { x: 5.4, y: 4.83, w: 4.2, h: 0.66, fontSize: 9.5 });

  s.addText("Goldman-Cecil Medicine 2024 — Table 221-7  |  ACOG Practice Bulletin 222", {
    x: 0.3, y: 5.56, w: 9.4, h: 0.25, fontSize: 7.5, color: "6B7280", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 10 — COMPLICATIONS: MATERNAL
// ═══════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, DEEP_NAVY);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: DANGER_RED } });
  s.addText("04  |  COMPLICATIONS — MATERNAL", { x: 0.2, y: 0.05, w: 9.6, h: 0.45, fontSize: 14, bold: true, color: WHITE, valign: "middle" });

  s.addText("Multi-System Organ Involvement", {
    x: 0.3, y: 0.65, w: 9.4, h: 0.4, fontSize: 16, bold: true, color: AMBER
  });

  const organs = [
    { system: "Cardiovascular", color: DANGER_RED, comps: ["Severe hypertension → hypertensive crisis", "Pulmonary oedema (↑ afterload + ↑ permeability)", "Peripartum cardiomyopathy (PPCM)\nOR 13.33 with severe PE (Huang W 2025)"] },
    { system: "CNS / Neurological", color: "A569BD", comps: ["Eclamptic seizures", "PRES — posterior reversible encephalopathy", "Stroke / intracranial haemorrhage", "Cortical blindness"] },
    { system: "Hepatic", color: AMBER, comps: ["Hepatocellular necrosis", "Subcapsular haematoma → rupture", "HELLP syndrome (0.39% of pregnancies)", "Elevated ALT/AST >2× normal"] },
    { system: "Renal", color: TEAL, comps: ["Acute tubular necrosis", "Glomeruloendotheliosis", "Renal insufficiency (Cr >1.1 mg/dL)", "Oliguria / acute kidney injury"] },
    { system: "Haematological", color: MINT, comps: ["Thrombocytopenia (↓100,000/µL)", "Microangiopathic haemolytic anaemia", "DIC in severe cases", "↑ LDH, ↓ haptoglobin"] },
    { system: "Long-Term Sequelae", color: SOFT_BLUE, comps: ["Chronic HTN in 36.5% after 2–7 yrs", "CVD risk ratio: 2× (8× early-onset PE)", "Stage 2 HTN rates: 25–50% within years", "AHA classifies prior PE as CVD risk factor"] },
  ];

  organs.forEach((org, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.2 + col * 3.27;
    const y = 1.1 + row * 2.3;

    s.addShape(pres.ShapeType.rect, { x, y, w: 3.05, h: 0.4, fill: { color: org.color } });
    s.addText(org.system, { x, y, w: 3.05, h: 0.4, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x, y: y + 0.4, w: 3.05, h: 1.78, fill: { color: "142030" }, line: { color: org.color, width: 1 } });
    org.comps.forEach((comp, ci) => {
      s.addText("• " + comp, { x: x + 0.1, y: y + 0.48 + ci * 0.42, w: 2.85, h: 0.38, fontSize: 9, color: LIGHT_GREY });
    });
  });

  s.addText("Creasy & Resnik MFM | Huang W et al., Curr Cardiol Rev 2025 (PMID: 39949098)  |  Goldman-Cecil Medicine 2024", {
    x: 0.3, y: 5.32, w: 9.4, h: 0.25, fontSize: 7.5, color: LIGHT_GREY, italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 11 — COMPLICATIONS: FETAL & PERIPARTUM CARDIOMYOPATHY
// ═══════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBar(s, "04  |  FETAL COMPLICATIONS & PERIPARTUM CARDIOMYOPATHY", DANGER_RED);

  s.addText("Fetal & Neonatal Complications", {
    x: 0.3, y: 0.65, w: 5.5, h: 0.4, fontSize: 16, bold: true, color: TEXT_DARK
  });

  const fetalComps = [
    { title: "Placental Insufficiency", desc: "Defective spiral artery remodeling → uteroplacental ischaemia → fetal hypoxia" },
    { title: "FGR / IUGR", desc: "Fetal growth restriction — especially in early-onset PE (<34 wks)" },
    { title: "Oligohydramnios", desc: "Reduced renal perfusion → decreased amniotic fluid volume" },
    { title: "Prematurity", desc: "Iatrogenic preterm birth — delivery the only cure for PE" },
    { title: "Placental Abruption", desc: "↑ risk with severe PE; may cause fetal distress or demise" },
    { title: "Perinatal Mortality", desc: "Leading cause of perinatal death in HIC; higher in LMIC" },
  ];

  fetalComps.forEach((fc, i) => {
    const y = 1.12 + i * 0.58;
    s.addShape(pres.ShapeType.rect, { x: 0.2, y, w: 1.9, h: 0.44, fill: { color: DANGER_RED } });
    s.addText(fc.title, { x: 0.2, y, w: 1.9, h: 0.44, fontSize: 9.5, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x: 2.15, y, w: 3.5, h: 0.44, fill: { color: "FFF5F5" }, line: { color: DANGER_RED, width: 0.5 } });
    s.addText(fc.desc, { x: 2.25, y: y + 0.03, w: 3.3, h: 0.38, fontSize: 9.5, color: TEXT_DARK, valign: "middle" });
  });

  // PPCM spotlight box
  s.addShape(pres.ShapeType.rect, { x: 5.9, y: 0.65, w: 3.85, h: 4.55, fill: { color: "FFF8E1" }, line: { color: AMBER, width: 2 } });
  s.addShape(pres.ShapeType.rect, { x: 5.9, y: 0.65, w: 3.85, h: 0.5, fill: { color: AMBER } });
  s.addText("SPOTLIGHT: HDP & PPCM", { x: 5.9, y: 0.65, w: 3.85, h: 0.5, fontSize: 12, bold: true, color: WHITE, align: "center", valign: "middle" });
  s.addText("Huang W et al., Curr Cardiol Rev 2025\nSystematic Review & Meta-analysis\n13 studies | 11,951 PPCM cases", {
    x: 6.0, y: 1.22, w: 3.65, h: 0.7, fontSize: 9.5, color: "5D4037", italic: true
  });

  const ppcmData = [
    { label: "Severe Preeclampsia", or: "OR 13.33", ci: "(CI: 5.95–29.83)", color: DANGER_RED },
    { label: "Superimposed PE", or: "OR 5.77", ci: "p <0.01", color: "E67E22" },
    { label: "Chronic Hypertension", or: "OR 4.73", ci: "p <0.01", color: AMBER },
    { label: "Preeclampsia", or: "OR 4.70", ci: "p <0.01", color: MINT },
    { label: "Gestational HTN", or: "OR 3.13", ci: "p <0.01", color: TEAL },
  ];

  ppcmData.forEach((item, i) => {
    const y = 2.05 + i * 0.56;
    s.addShape(pres.ShapeType.rect, { x: 6.0, y, w: 1.5, h: 0.44, fill: { color: item.color } });
    s.addText(item.or, { x: 6.0, y, w: 1.5, h: 0.44, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addText(item.label + "\n" + item.ci, { x: 7.58, y, w: 2.0, h: 0.44, fontSize: 9, color: TEXT_DARK });
  });

  s.addText("Clinical Implication: Screen for PPCM in all HDP patients with dyspnoea, orthopnoea, or ↓ exercise tolerance", {
    x: 5.9, y: 4.9, w: 3.85, h: 0.35, fontSize: 9, color: "5D4037", bold: true, align: "center"
  });

  s.addText("Huang W et al., Curr Cardiol Rev 2025 (PMID: 39949098)  |  Creasy & Resnik Maternal-Fetal Medicine", {
    x: 0.3, y: 5.32, w: 9.4, h: 0.25, fontSize: 7.5, color: "6B7280", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 12 — NOVEL BIOMARKERS
// ═══════════════════════════════════════════════════════════════════
{
  const s = addDarkSlide(pres, SOFT_BLUE);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: MINT } });
  s.addText("05  |  BIOMARKERS & RECENT EVIDENCE (2024–2026)", { x: 0.2, y: 0.05, w: 9.6, h: 0.45, fontSize: 14, bold: true, color: WHITE, valign: "middle" });

  s.addText("Emerging & Validated Biomarkers for Prediction & Surveillance", {
    x: 0.3, y: 0.65, w: 9.4, h: 0.38, fontSize: 14, bold: true, color: AMBER
  });

  const biomarkers = [
    {
      name: "sFlt-1 / PlGF Ratio",
      status: "Validated",
      statusColor: MINT,
      detail: "Anti-angiogenic imbalance marker. sFlt-1:PlGF <38 rules out PE within 1 week. EMA-approved screening tool. Best predictor for early-onset PE.",
      evidence: "Goldman-Cecil Medicine 2024"
    },
    {
      name: "Heparan Sulfate (HS)",
      status: "Emerging",
      statusColor: AMBER,
      detail: "Released from damaged syncytiotrophoblast & endothelial cells. Meta-analysis shows SMD 1.2 increase in PE vs. normal pregnancy. Higher in early-onset PE.",
      evidence: "Gómez-Gutiérrez AM, Placenta 2026 (PMID: 40399152)"
    },
    {
      name: "Soluble HLA-G",
      status: "Research",
      statusColor: "A569BD",
      detail: "Reduced in preeclampsia. Involved in maternal-fetal immune tolerance. Potential predictor of defective trophoblast invasion.",
      evidence: "Chiang YT, Int J Mol Sci 2024 (PMID: 38674114)"
    },
    {
      name: "MicroRNAs (miRNAs)",
      status: "Research",
      statusColor: "E67E22",
      detail: "CircRNA_06354 → early PE via hsa-miR-92a-3p/VEGF-A pathway. miR-519d & miR-517-5p impair trophoblast function. C19MC cluster dysregulated in PE.",
      evidence: "Chiang YT, Int J Mol Sci 2024 (PMID: 38674114)"
    },
    {
      name: "Soluble Endoglin (sEng)",
      status: "Validated",
      statusColor: MINT,
      detail: "Anti-TGF-β activity → worsens endothelial dysfunction. Elevated before clinical PE onset. Correlates with disease severity.",
      evidence: "Goldman-Cecil Medicine 2024"
    },
    {
      name: "Matrix Metalloproteinases (MMPs)",
      status: "Emerging",
      statusColor: AMBER,
      detail: "MMP-2, MMP-9 dysregulation → defective spiral artery remodeling. Potential early marker for predicting PE onset.",
      evidence: "Chiang YT, Int J Mol Sci 2024"
    },
  ];

  biomarkers.forEach((bm, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.2 + col * 4.9;
    const y = 1.1 + row * 1.5;

    s.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 1.35, fill: { color: "1A3045" }, line: { color: bm.statusColor, width: 1.5 } });
    s.addShape(pres.ShapeType.rect, { x, y, w: 2.8, h: 0.38, fill: { color: "1A3045" } });
    s.addText(bm.name, { x: x + 0.1, y: y + 0.05, w: 2.8, h: 0.3, fontSize: 11, bold: true, color: WHITE });
    s.addShape(pres.ShapeType.rect, { x: x + 3.0, y: y + 0.06, w: 1.45, h: 0.27, fill: { color: bm.statusColor } });
    s.addText(bm.status, { x: x + 3.0, y: y + 0.06, w: 1.45, h: 0.27, fontSize: 9, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addText(bm.detail, { x: x + 0.1, y: y + 0.42, w: 4.35, h: 0.65, fontSize: 9, color: LIGHT_GREY });
    s.addText(bm.evidence, { x: x + 0.1, y: y + 1.1, w: 4.35, h: 0.22, fontSize: 8, color: AMBER, italic: true });
  });

  s.addText("Gómez-Gutiérrez AM, Placenta 2026 (PMID: 40399152)  |  Chiang YT, Int J Mol Sci 2024 (PMID: 38674114)", {
    x: 0.3, y: 5.32, w: 9.4, h: 0.25, fontSize: 7.5, color: LIGHT_GREY, italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 13 — MANAGEMENT PEARLS
// ═══════════════════════════════════════════════════════════════════
{
  const s = addLightSlide(pres);
  sectionBar(s, "06  |  MANAGEMENT PEARLS FOR POSTGRADUATE RESIDENTS", DEEP_NAVY);

  s.addText("Key Management Principles", {
    x: 0.3, y: 0.65, w: 9.4, h: 0.4, fontSize: 16, bold: true, color: TEXT_DARK
  });

  // Antihypertensives table
  s.addText("Acute Antihypertensive Therapy (BP ≥160/110 mmHg)", {
    x: 0.3, y: 1.1, w: 5.5, h: 0.35, fontSize: 12, bold: true, color: TEAL
  });

  const ahHeaders = ["Drug", "Route", "Dose", "Notes"];
  const ahColW = [1.3, 0.7, 2.1, 1.3];
  const ahColX = [0.2, 1.55, 2.3, 4.45];
  ahHeaders.forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x: ahColX[i], y: 1.5, w: ahColW[i], h: 0.35, fill: { color: TEAL } });
    s.addText(h, { x: ahColX[i], y: 1.5, w: ahColW[i], h: 0.35, fontSize: 9.5, bold: true, color: WHITE, align: "center", valign: "middle" });
  });

  const ahRows = [
    ["Labetalol", "IV", "20–80 mg q10–30 min (max 300 mg)\nor 1–2 mg/min infusion", "1st line IV, avoid in asthma"],
    ["Hydralazine", "IV", "5–10 mg q 20–40 min\n(max 20 mg)", "Caution: maternal hypotension"],
    ["Nifedipine IR", "PO", "10–20 mg then q 20 min\n(max 180 mg/day)", "Avoid sublingual route"],
  ];

  ahRows.forEach((row, ri) => {
    const bg = ri % 2 === 0 ? "EBF5FB" : WHITE;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: ahColX[ci], y: 1.85 + ri * 0.58, w: ahColW[ci], h: 0.55, fill: { color: bg }, line: { color: LIGHT_GREY, width: 0.5 } });
      s.addText(cell, { x: ahColX[ci] + 0.04, y: 1.85 + ri * 0.58, w: ahColW[ci] - 0.08, h: 0.55, fontSize: 9, color: TEXT_DARK, valign: "middle" });
    });
  });

  // MgSO4 box
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 3.6, w: 5.5, h: 1.0, fill: { color: "EFF8FF" }, line: { color: SOFT_BLUE, width: 1.5 } });
  s.addText([
    { text: "MgSO₄ Protocol: ", options: { bold: true, color: SOFT_BLUE } },
    { text: "Loading dose 4–6 g IV over 15–20 min, then 2 g/hr maintenance. Therapeutic range: 4–7 mEq/L. Antidote: Calcium gluconate 1 g IV. Monitor: reflexes, RR, urine output. Cleared by kidney — reduce in renal impairment.", options: { color: TEXT_DARK } }
  ], { x: 0.35, y: 3.65, w: 5.25, h: 0.9, fontSize: 9.5 });

  // Right panel
  s.addShape(pres.ShapeType.rect, { x: 5.9, y: 1.1, w: 3.85, h: 3.55, fill: { color: "F0FFF4" }, line: { color: MINT, width: 1.5 } });
  s.addShape(pres.ShapeType.rect, { x: 5.9, y: 1.1, w: 3.85, h: 0.42, fill: { color: MINT } });
  s.addText("DELIVERY — THE ONLY CURE", { x: 5.9, y: 1.1, w: 3.85, h: 0.42, fontSize: 11, bold: true, color: WHITE, align: "center", valign: "middle" });

  const delivery = [
    "PE without severe features at ≥37 weeks → delivery",
    "PE with severe features at ≥34 weeks → delivery",
    "Severe PE <34 wks → consider steroids + stabilise",
    "Eclampsia → IV MgSO₄ then deliver (not emergency CS unless abruption)",
    "HELLP syndrome → delivery regardless of GA",
    "Caesarean NOT mandated by PE/eclampsia alone",
    "Postpartum: continue antihypertensives for ≥72h"
  ];
  delivery.forEach((pt, i) => {
    s.addText("• " + pt, { x: 6.05, y: 1.6 + i * 0.44, w: 3.55, h: 0.4, fontSize: 9.5, color: TEXT_DARK });
  });

  // Prevention bar
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 4.68, w: 9.55, h: 0.52, fill: { color: AMBER } });
  s.addText("PREVENTION: Low-dose aspirin 81–150 mg/day from 12–28 wks in high-risk women  |  Calcium 1.5–2 g/day in low-calcium populations (Zhu Q, Preg Hypertens 2024)  |  Optimize BMI before pregnancy", {
    x: 0.3, y: 4.7, w: 9.4, h: 0.46, fontSize: 9, color: WHITE, bold: true, align: "center", valign: "middle"
  });

  s.addText("Goldman-Cecil Medicine 2024 — Table 221-6  |  Zhu Q et al., Pregnancy Hypertens 2024 (PMID: 39608269)", {
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  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 14 — LONG-TERM CONSEQUENCES
// ═══════════════════════════════════════════════════════════════════
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  s.addText("04  |  LONG-TERM CONSEQUENCES — PREGNANCY AS A STRESS TEST", { x: 0.2, y: 0.05, w: 9.6, h: 0.45, fontSize: 14, bold: true, color: WHITE, valign: "middle" });

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    { outcome: "Chronic\nHypertension", risk: "36.5%", timeframe: "2–7 yrs", rr: "RR ~2–3×", color: DANGER_RED },
    { outcome: "Cardiovascular\nDisease (CVD)", risk: "↑ 2–8×", timeframe: "Within 5 yrs", rr: "CAD, CVA, HF", color: "E67E22" },
    { outcome: "End-Stage\nRenal Disease", risk: "↑ Risk", timeframe: "Long-term", rr: "Glomerular damage", color: TEAL },
    { outcome: "Stage 2 HTN\n(Early-onset PE)", risk: "50%", timeframe: "Post-delivery", rr: "vs <4% controls", color: "A569BD" },
    { outcome: "LV Diastolic\nDysfunction", risk: "↑ Risk", timeframe: "≤10 yrs post-PE", rr: "Silent HF, LV remodelling", color: MINT },
    { outcome: "Future\nDiabetes", risk: "↑ Risk", timeframe: "Long-term", rr: "Metabolic syndrome overlap", color: AMBER },
  ];

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  s.addText("Clinical Pearl: All women with prior HDP require postnatal CVD risk counselling, BP monitoring, and lifestyle modification advice", {
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  s.addText("Creasy & Resnik Maternal-Fetal Medicine, 9e  |  AHA 2021 Guidelines", {
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// ═══════════════════════════════════════════════════════════════════
// SLIDE 15 — REFERENCES
// ═══════════════════════════════════════════════════════════════════
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  s.addText("REFERENCES & FURTHER READING", { x: 0.2, y: 0.05, w: 9.6, h: 0.45, fontSize: 14, bold: true, color: WHITE, valign: "middle" });

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    "1. Vera-Ponce VJ et al. Global prevalence of preeclampsia, eclampsia, and HELLP syndrome: a systematic review and meta-analysis. Front Reprod Health. 2025. PMID: 41293035",
    "2. Chiang YT, Seow KM, Chen KH. The Pathophysiological, Genetic, and Hormonal Changes in Preeclampsia: A Systematic Review of the Molecular Mechanisms. Int J Mol Sci. 2024;25(8):4532. PMID: 38674114",
    "3. Gómez-Gutiérrez AM et al. Maternal serum heparan sulfate in preeclampsia pathophysiology: Insights from a systematic review and meta-analysis. Placenta. 2026. PMID: 40399152",
    "4. Huang W et al. Association of Hypertensive Disorders of Pregnancy and their Clinical Features with Peripartum Cardiomyopathy: A Systematic Review and Meta-analysis. Curr Cardiol Rev. 2025. PMID: 39949098",
    "5. Zhu Q et al. Effectiveness of calcium supplementation in the prevention of gestational hypertension: A systematic review and meta-analysis. Pregnancy Hypertens. 2024. PMID: 39608269",
    "6. Goldman-Cecil Medicine International Edition. 2 Volume Set. 27th ed. Philadelphia: Elsevier; 2024.",
    "7. Creasy & Resnik's Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia: Elsevier; 2022.",
    "8. American College of Obstetricians and Gynecologists. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135:237–260.",
    "9. American Heart Association. Hypertension in Pregnancy — Established Risk Factor for CVD. AHA Scientific Statement, 2021.",
  ];

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// ═══════════════════════════════════════════════════════════════════
// SLIDE 16 — CLOSING / TAKE-HOME MESSAGES
// ═══════════════════════════════════════════════════════════════════
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    { num: "1", msg: "HDP is a spectrum — gestational HTN, preeclampsia, eclampsia, HELLP, and superimposed PE each carry distinct risk profiles and require tailored management.", color: TEAL },
    { num: "2", msg: "Etiopathogenesis is driven by a two-stage model: failed trophoblast invasion (Stage 1) → anti-angiogenic factor release causing endothelial dysfunction (Stage 2). Novel molecular targets include miRNAs, heparan sulfate, and HIF-1α.", color: AMBER },
    { num: "3", msg: "Severe features demand immediate action: IV antihypertensives within 30–60 min, MgSO₄ for seizure prophylaxis, and delivery as definitive treatment.", color: DANGER_RED },
    { num: "4", msg: "PPCM screening: all HDP patients, especially severe PE (OR 13.33), should be evaluated for peripartum cardiomyopathy with any cardiorespiratory symptoms.", color: MINT },
    { num: "5", msg: "Pregnancy is a cardiovascular stress test. Women with prior HDP have 2–8× elevated long-term CVD risk — postpartum risk counselling is mandatory.", color: "A569BD" },
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// ─── WRITE FILE ───────────────────────────────────────────────────
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