[ { "page": 1, "items": [ { "page": 1, "type": "TEXT", "location": { "l": 221.3976, "t": 569.843, "r": 392.423, "b": 514.8981 }, "text": "NHS\nRoyal Cornwall Hospitals\nNHS Trust", "reading_order": 0 }, { "page": 1, "type": "TITLE", "location": { "l": 131.927, "t": 456.3543, "r": 390.2642, "b": 364.6995 }, "text": "Aspirin to prevent pre-eclampsia and fetal growth restriction", "reading_order": 1, "level": 1 }, { "page": 1, "type": "FIGURE", "location": { "l": 135.5251, "t": 335.1877, "r": 390.7439, "b": 69.8208 }, "text": "", "reading_order": 2 }, { "page": 1, "type": "TEXT", "location": { "l": 194.0527, "t": 50.866, "r": 331.9764, "b": 33.1109 }, "text": "One + all | we care", "reading_order": 3 } ] }, { "page": 2, "items": [ { "page": 2, "type": "TITLE", "location": { "l": 26.1455, "t": 569.1232, "r": 152.7955, "b": 554.0074 }, "text": "Who is this leaflet for?", "reading_order": 0, "level": 2 }, { "page": 2, "type": "TEXT", "location": { "l": 26.1455, "t": 548.9688, "r": 389.3047, "b": 504.8209 }, "text": "Some pregnancies are at higher risk of pre-eclampsia and fetal growth restriction. This leaflet explains what these conditions are, who is at higher risk, and who could benefit from taking aspirin to reduce their risk.", "reading_order": 1 }, { "page": 2, "type": "TITLE", "location": { "l": 25.6658, "t": 486.5859, "r": 387.6256, "b": 470.2704 }, "text": "Who is at higher risk of pre-eclampsia or fetal growth restriction?", "reading_order": 2, "level": 2 }, { "page": 2, "type": "TEXT", "location": { "l": 26.1455, "t": 465.9516, "r": 378.5107, "b": 437.3995 }, "text": "At your 'booking' appointment your midwife will complete a risk assessment and will recommend aspirin if you have:", "reading_order": 3 }, { "page": 2, "type": "TEXT", "location": { "l": 26.3854, "t": 425.4028, "r": 144.64, "b": 411.0068 }, "text": "Any one of these factors:", "reading_order": 4 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 27.105, "t": 406.688, "r": 389.7844, "b": 377.8959 }, "text": "certain medical conditions (e.g. high blood pressure, chronic kidney disease, lupus, rheumatoid arthritis, diabetes)", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 5 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 26.6253, "t": 373.3371, "r": 249.2222, "b": 358.7012 }, "text": "high blood pressure in a previous pregnancy", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 6 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 27.105, "t": 355.1022, "r": 358.3618, "b": 325.3504 }, "text": "previous pregnancy birthweight lower than 3^{rd} centile or evidence of placental dysfunction", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 7 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 27.105, "t": 322.2312, "r": 377.3113, "b": 292.7194 }, "text": "previous stillbirth with birthweight lower than 10th centile or evidence of placental dysfunction", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 8 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 27.105, "t": 289.6002, "r": 392.423, "b": 260.0883 }, "text": "low PAPP-A (part of first trimester screening bloods, you will be contacted if this is low).", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 9 }, { "page": 2, "type": "TEXT", "location": { "l": 26.6253, "t": 245.6923, "r": 145.5995, "b": 231.5362 }, "text": "Any two of these factors:", "reading_order": 10 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 226.9775, "r": 116.3357, "b": 212.3415 }, "text": "first pregnancy", "marker": "•", "list_id": "L2", "level": 0, "reading_order": 11 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 208.7425, "r": 194.0527, "b": 193.8666 }, "text": "10 years or more since last baby", "marker": "•", "list_id": "L2", "level": 0, "reading_order": 12 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 189.7877, "r": 140.0825, "b": 175.1517 }, "text": "over 40 years of age", "marker": "•", "list_id": "L2", "level": 0, "reading_order": 13 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 171.0729, "r": 131.4473, "b": 157.6366 }, "text": "BMI of 35 or more", "marker": "•", "list_id": "L2", "level": 0, "reading_order": 14 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 153.0778, "r": 187.3364, "b": 137.962 }, "text": "family history of pre-eclampsia", "marker": "•", "list_id": "L2", "level": 0, "reading_order": 15 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 133.8831, "r": 136.4845, "b": 119.2471 }, "text": "multiple pregnancy.", "marker": "•", "list_id": "L2", "level": 0, "reading_order": 16 } ] }, { "page": 3, "items": [ { "page": 3, "type": "TITLE", "location": { "l": 26.1455, "t": 569.1232, "r": 155.9138, "b": 553.5275 }, "text": "What is pre-eclampsia?", "reading_order": 0, "level": 2 }, { "page": 3, "type": "TEXT", "location": { "l": 26.1455, "t": 548.7288, "r": 379.71, "b": 489.7051 }, "text": "Pre-eclampsia causes high blood pressure and protein in the urine. It is a common condition, affecting around 1 in 20 pregnancies. Sometimes it can affect pregnancies severely and early, and can be life threatening for you and your baby. It typically occurs after 20 weeks of pregnancy.", "reading_order": 1 }, { "page": 3, "type": "TITLE", "location": { "l": 25.9057, "t": 471.4701, "r": 165.0287, "b": 456.5942 }, "text": "What are the symptoms?", "reading_order": 2, "level": 2 }, { "page": 3, "type": "TEXT", "location": { "l": 26.1455, "t": 451.3157, "r": 306.0707, "b": 437.3995 }, "text": "It may cause no symptoms at all but the following can occur:", "reading_order": 3 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 432.6008, "r": 124.0114, "b": 419.6444 }, "text": "severe headache", "marker": "•", "list_id": "L3", "level": 0, "reading_order": 4 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 414.6058, "r": 175.1032, "b": 400.2097 }, "text": "flashing lights in your vision", "marker": "•", "list_id": "L3", "level": 0, "reading_order": 5 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 26.6253, "t": 396.1309, "r": 284.4827, "b": 381.4949 }, "text": "rapidly increasing swelling of the face, hands or feet", "marker": "•", "list_id": "L3", "level": 0, "reading_order": 6 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 376.6962, "r": 143.6805, "b": 362.7801 }, "text": "nausea and vomiting", "marker": "•", "list_id": "L3", "level": 0, "reading_order": 7 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 27.105, "t": 358.4612, "r": 158.3125, "b": 343.8253 }, "text": "pain just under your ribs", "marker": "•", "list_id": "L3", "level": 0, "reading_order": 8 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 340.2263, "r": 136.2447, "b": 325.3504 }, "text": "feeling very unwell.", "marker": "•", "list_id": "L3", "level": 0, "reading_order": 9 }, { "page": 3, "type": "TITLE", "location": { "l": 26.3854, "t": 305.9157, "r": 127.1297, "b": 290.7999 }, "text": "How is it treated?", "reading_order": 10, "level": 2 }, { "page": 3, "type": "TEXT", "location": { "l": 25.6658, "t": 286.0012, "r": 392.423, "b": 198.1854 }, "text": "The only cure for pre-eclampsia is birth. Medication can control high blood pressure, and you can be closely monitored, but when pre-eclampsia occurs it persists until birth. In pregnancies at higher risk of pre-eclampsia, taking aspirin 150mg at night daily from 12 to 36 weeks reduces the chances of pre-eclampsia occurring. Pre-eclampsia, especially when it occurs early, is often associated with fetal growth restriction.", "reading_order": 11 }, { "page": 3, "type": "TITLE", "location": { "l": 25.6658, "t": 179.7105, "r": 207.0055, "b": 164.8346 }, "text": "What is fetal growth restriction?", "reading_order": 12, "level": 2 }, { "page": 3, "type": "TEXT", "location": { "l": 25.9057, "t": 159.796, "r": 391.4635, "b": 101.0122 }, "text": "This is the medical term for when babies grow smaller than other babies. It usually occurs when there is an underlying placental problem. These babies are healthy and the placenta is still functioning, though the baby's blood supply may be limited, putting it at risk of poor growth.", "reading_order": 13 } ] }, { "page": 4, "items": [ { "page": 4, "type": "TEXT", "location": { "l": 25.9057, "t": 568.6433, "r": 391.7034, "b": 467.1513 }, "text": "Often these babies are picked up by ultrasound scan and their weight estimated to be ‘under the 3rd centile’ – meaning that if 100 babies were measured at this stage in pregnancy, these babies would be one of the smallest three. These babies have close monitoring with regular ultrasound scans to look for signs of the placenta not functioning properly. Earlier birth with induction of labour or caesarean section may be recommended. This often occurs at 37 weeks but may be needed earlier.", "reading_order": 0 }, { "page": 4, "type": "TEXT", "location": { "l": 25.9057, "t": 454.4348, "r": 365.5578, "b": 394.4513 }, "text": "The placenta implants in the first part of pregnancy (before 16 weeks), so medication to improve placental function needs to be taken early. In pregnancies at higher risk of fetal growth restriction taking aspirin 150mg nightly from 12 to 36 weeks reduces the chances of it occurring.", "reading_order": 1 }, { "page": 4, "type": "TITLE", "location": { "l": 26.6253, "t": 376.9362, "r": 160.7111, "b": 361.5804 }, "text": "How does aspirin work?", "reading_order": 2, "level": 2 }, { "page": 4, "type": "TEXT", "location": { "l": 25.6658, "t": 357.0216, "r": 389.7844, "b": 283.122 }, "text": "Aspirin reduces the activity of platelets. Platelets are involved in reducing blood supply to the placenta as it implants. Aspirin therefore appears to help the placenta implant better in pregnancies where there is a higher risk of placental problems. It has been shown in high quality clinical trials to reduce the risk of pre-eclampsia and fetal growth restriction.", "reading_order": 3 }, { "page": 4, "type": "TITLE", "location": { "l": 25.6658, "t": 265.127, "r": 266.4926, "b": 249.2913 }, "text": "Are there any risks to aspirin in pregnancy?", "reading_order": 4, "level": 2 }, { "page": 4, "type": "TEXT", "location": { "l": 25.6658, "t": 245.4524, "r": 385.227, "b": 186.1887 }, "text": "Aspirin 150mg at night from 12 weeks is safe in pregnancy and recommended in those at higher risk of pre-eclampsia and fetal growth restriction. At this dose it has been shown to have benefits, and there is no evidence of harm to the baby or fetal abnormalities caused by aspirin at this dose.", "reading_order": 5 }, { "page": 4, "type": "TEXT", "location": { "l": 25.6658, "t": 173.4722, "r": 384.9871, "b": 71.2604 }, "text": "Aspirin reduces platelet activity, therefore it makes blood a little slower to clot. As blood usually clots quicker in pregnancy this usually doesn't cause any problem. However, there is a small possible increase in bleeding after birth (post partum haemorrhage –PPH) when taking aspirin, so aspirin should be stopped at 36 weeks. If you are taking aspirin during pregnancy and you have multiple bleeds or a large bleed then discuss with your midwife or doctor whether you should continue it.", "reading_order": 6 } ] }, { "page": 5, "items": [ { "page": 5, "type": "TITLE", "location": { "l": 26.6253, "t": 569.1232, "r": 204.1271, "b": 553.5275 }, "text": "Is aspirin suitable for everyone?", "reading_order": 0, "level": 2 }, { "page": 5, "type": "TEXT", "location": { "l": 26.8651, "t": 549.2087, "r": 221.1577, "b": 534.3328 }, "text": "No, you shouldn't take aspirin if you have:", "reading_order": 1 }, { "page": 5, "type": "LIST_ITEM", "location": { "l": 27.105, "t": 530.2539, "r": 356.203, "b": 502.1816 }, "text": "any known allergy, intolerance or contraindication to aspirin or non-steroidals (NSAIDs)", "marker": "•", "list_id": "L4", "level": 0, "reading_order": 2 }, { "page": 5, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 497.143, "r": 188.5357, "b": 483.2269 }, "text": "active stomach or peptic ulcers", "marker": "•", "list_id": "L4", "level": 0, "reading_order": 3 }, { "page": 5, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 478.6681, "r": 202.448, "b": 464.512 }, "text": "current kidney or liver dysfunction", "marker": "•", "list_id": "L4", "level": 0, "reading_order": 4 }, { "page": 5, "type": "LIST_ITEM", "location": { "l": 26.8651, "t": 460.1932, "r": 362.9193, "b": 445.0774 }, "text": "recent history of heavy vaginal bleeding (e.g. within the past 1 week).", "marker": "•", "list_id": "L4", "level": 0, "reading_order": 5 }, { "page": 5, "type": "TEXT", "location": { "l": 26.1455, "t": 431.4011, "r": 368.1964, "b": 402.1292 }, "text": "If you are unsure whether any of the above apply to you, discuss with your doctor or community midwife before taking.", "reading_order": 6 }, { "page": 5, "type": "TITLE", "location": { "l": 25.9057, "t": 383.1744, "r": 161.4307, "b": 367.3388 }, "text": "Where can I get aspirin?", "reading_order": 7, "level": 2 }, { "page": 5, "type": "TEXT", "location": { "l": 25.6658, "t": 362.7801, "r": 387.1459, "b": 319.352 }, "text": "Aspirin is available over the counter at any pharmacy or supermarket. Alternatively your doctor can issue a prescription. The correct dose is 150mg at night between 12 and 36 weeks.", "reading_order": 8 }, { "page": 5, "type": "TITLE", "location": { "l": 26.6253, "t": 300.1573, "r": 112.7377, "b": 284.5616 }, "text": "Any questions?", "reading_order": 9, "level": 2 }, { "page": 5, "type": "TEXT", "location": { "l": 26.3854, "t": 280.4827, "r": 369.8755, "b": 264.4072 }, "text": "If you have any further questions please speak to your community midwife.", "reading_order": 10 } ] }, { "page": 6, "items": [ { "page": 6, "type": "TEXT", "location": { "l": 25.4259, "t": 147.5593, "r": 359.5612, "b": 95.7336 }, "text": "If you would like this leaflet in large print, braille, audio version\nor in another language, please contact the General Office on\n01872 252690", "reading_order": 0 } ] } ]