Tadalafil appartiene alla classe degli inibitori selettivi della fosfodiesterasi di tipo 5, con un profilo farmacocinetico caratterizzato da un’emivita terminale di circa diciotto ore. Dopo somministrazione orale viene assorbito rapidamente e raggiunge concentrazioni plasmatiche massime in due ore. La biotrasformazione avviene principalmente tramite CYP3A4 con formazione di metaboliti inattivi, escreti in prevalenza con le feci. L’elevato legame alle proteine plasmatiche (>90%) assicura una distribuzione stabile. Nei confronti delle altre molecole della stessa classe, cialis compresse italia è noto per la durata prolungata dell’attività farmacologica.

Ocobgyns.com

Orange County ObGyns
805 West La Veta Avenue, Suite 101
Orange, CA 92868
714-997-9595 714-538-7699
Fax 714-997-1098
Juan Velez, MD Randy Fiorentino, MD Yonatan Mahller, MD, PhD
Obstetrics – Gynecology – Infertility – Minimally Invasive Surgery
Pregnancy Manual
Important Phone Numbers
St. Joseph Hospital Labor and Delivery – (714) 771-8246
Western Medical Center Labor and Delivery - (714) 953-3313
Safe Medications During Pregnancy
NAUSEA: Ginger, Vitamin B-6, Zofran, Reglan, Accupressure wrist bands
HEARTBURN: Tums, Zantac, Ranitidine, Mylanta
CONSTIPATION: Colace, Metamucil, FiberCon
HEADACHE: Tylenol, acetaminophen, Excedrin migraine (rare use ok)
COUGH/COLD: Benadryl, Robitussin DM, Cepachol lozenges, Tylenol, acetaminophen,
Claritin, Zyrtec, Humidifier, Saline nasal spray
HEMORRHOIDS: Preparation-H with cortisone, Anusol-HC, Tuck’s pads, witch hazel
SKIN RASH: Cortisone cream, Benadryl Lotion
SLEEPLESSNESS: Benadryl, Tylenol PM, Unisom
YEAST INFECTION: Monistat, Vagistat, Femstat, Fluconazole
*Medications that our physicians prescribe are safe during pregnancy.
**Advil/motrin/ibuprofen and Aleve/naproxen should be avoided.
***If possible, try to avoid any medications during pregnancy especially within the first
trimester.
1st Trimester
Morning Sickness
Most women feel nauseated during pregnancy, usually during the first trimester.
Symptoms usually start to improve around 11-13 weeks and most symptoms resolve by
16 weeks. Pregnant women should eat several small meals or snacks of bland food
throughout the day. Ginger, Vitamin B-6 and acupressure bands have been shown to
improve morning sickness. If these interventions are ineffective, you are losing weight
or vomiting daily, your physician may prescribe Zofran or Reglan.
How to Prevent Nausea
1. Avoid strong odors, cooking odors, smoke, cleaning fluids, paints or perfumes.
2. Avoid crowded places and areas with poor air circulation.
3. Do not eat foods that can cause gas: garlic, oregano, onion, bell peppers.
4. Avoid foods that make nausea worse like high-fat, fried, spicy or acidic foods.
Get plenty of fresh air. Open windows and use fans. Take a walk outdoors. In the
morning, get up slowly. Avoid sudden movements when getting out of bed. Try placing
some dry cereal, bread, biscuits or crackers within reach of your bed. Take a few bites
before getting up.
Drink lots of fluids. Carry a water bottle with you and sip small amounts when you can.
Try to drink at least 8 glasses of liquids every day. Add water to juices or make broth or
noodle soups. Try snack foods like nuts, string cheese, crackers, dried fruits, trail mix,
sandwiches or fruit juices. Eat small amounts every 2 or 3 hours, day or night. Try to eat
even if you are not hungry. Decide which foods sound good to you. You may try: Ice
cream, Breads, Cottage Cheese, Popsicles, Crackers, Berries, Peanut Butter, Yogurt,
Dry Cereal, Lemonade, Melon, Popcorn, Sour candies or Toast.
Feeling Tired
Fatigue during pregnancy is very common. Try to avoid napping for more than one hour
during the day, as this may disrupt normal sleep patterns. 30-45 minutes of daily
exercise may be beneficial. If you are taking progesterone supplementation, only take it
at night as the medication causes drowsiness.
Leg Swelling/Varicose Veins
If swelling develops much more in one leg versus the other, contact your physician.
Generalized swelling of hands and feet is common. Avoiding salt and sodium rich foods
and drinking more water should help. Elevate your feet above your heart when you are
resting. Support or compression stockings or hosiery may be necessary. Notify your
physician if swelling develops suddenly and you also have changes to your vision,
headaches or severe upper abdominal pain.
Back Pain
As pregnancy hormones loosen the ligaments of your joints and your body adjusts
to the growthof pregnancy, you may experience back pain. You can improve these
symptoms by stretching and doing back or core body exercises. Massage, heating
pads on medium setting, chiropractic care and maternity belts are safe.
Leg Cramps
Leg cramps may worsen during the third trimester. Taking magnesium gluconate 500
mg tablets twice daily or before bedtime may help. You should also increase water
intake and foods rich in potassium and calcium like bananas and certain dairy products.
Try to avoid wearing high-heels.
During pregnancy avoid: high sugar foods, raw fish or meat, cold deli meat, the cat
litterbox, X-ray, jacuzzi, spa or sauna, heavy lifting or prolonged standing.
During pregnancy: drink more water, eat foods with lots of protein (nuts, cheese,
meats) and iron (meat, spinach, broccoli), continue to exercise, stretch you back, use a
heating pad on medium setting and take your prenatal vitamins.
Exercise Safely During Pregnancy
Pilates/ yoga modified for pregnancy
Do not become overheated
Keep heart rate below 140 beats per minute
Stay well hydrated
Avoid any exercise where you could fall down or hit your belly
Avoid lifting more than 25 lbs.
Avoid High Temperature Environments
Saunas, Spas
Tanning Booths
If you have a fever of 101 degrees call us and take Tylenol
2nd Trimester
Choose a Hospital for Delivery
Around 20-24 weeks is a good time to register at the hospital. You can do this online.
Sign up for health education classes if desired. St. Joseph Hospital offers classes on
breast feeding, infant CPR, childcare basics and prepared childbirth. Remember to use
the hospital covered by your insurance unless in an emergency.
Look out for Preterm Labor Warning Signs
Contact your physician or go directly to the hospital if you have:
Menstrual-like cramps (constant or comes and goes)
Low, dull backache (constant or comes and goes)
Abdominal cramping (with or without diarrhea)
Pressure (feels heavy)
Increase or change in vaginal discharge (mucousy, watery, pink or bloody)
Fluid leaking from the vagina
5 or more uterine contractions (tightening) in one hour (may be painless)
Diabetes Screen Test (~25 weeks)
This is a blood test to screen for gestational diabetes (pregnancy induced diabetes).
The timing of this test is important. We will give you an order for the test to be done
either in our office or at the lab. You will need to be fasting to begin the test. You will
have your blood drawn, drink a sugar drink, then have your blood drawn one and two
hours after the drink. Prepare two and a half hours for this test.
Think About Birth Control Options
If you are considering a tubal ligation (permanent birth control after your deliver) you
will need to sign mandated state consent forms. Please discuss this with your
physician. Orange County ObGyns physicians perform tubal ligation at the time of
delivery at Western Medical Center. Bilateral tubal ligation after pregnancy can be
performed at other surgery centers.
If Your Blood Type is Rh negative
Problems caused by the Rh factor can be prevented in most cases with the use of a
special drug called Rhogam. Treatment is recommended whenever there is bleeding
during your pregnancy or at 28 weeks of pregnancy. We give the Rhogam shot in our
office at your 28-week visit.
Kick Counts
An active fetus usually means a healthy fetus. This is why it is important to take some
time each day to “listen” to your baby by paying attention to fetal movements.
Select a time of day when your baby is the most active. For most women, this is after
meals or before bedtime. Try to do the Kick Count at the same time every day.
1. Get in a comfortable lying or sitting position. Rest on your side.
2. Count how long it takes for you baby to move 10 times. All movements count. Your
baby should move 10 times in less than 2 hours.
3. Jot down the time of the baby’s first movement and the time of the 10th kick.
4. Since healthy babies have sleep cycles, your baby may kick less than usual or have
less than 10 kicks in 2 hours. If so, wake up the baby by drinking fluid (cold or
sweet) or by walking for 5 minutes and then repeat the Kick Count.
5. After repeating the Kick Count, if your baby still has had less than 10 kicks in 2 hours
or there is a decrease in the fetal movement, contact your physician.
6. If NO movement was felt during the initial 2 hours, do not repeat the Kick Count. Call
your physician immediately or go directly to the hospital.
3rd Trimester
Pelvic Exams and Vaginal Culture
Pelvic exams are performed around 37 weeks of pregnancy to check your cervix and
fetal position. A vaginal and rectal bacterial culture is done around 36 weeks. If this
culture is positive for Group B streptococcus, we will recommend you are treated with
IV antibiotics during labor. This is to protect the baby from this bacteria during delivery.
Signs of Labor
Contact our office or go directly to the hospital if you have:
Strong regular contractions that do not go away for at least one hour
Water bag breaks - a gush of fluid or a constant trickle
Vaginal bleeding
The baby is not moving 10 times in two hours
What do contractions feel like?
Contractions often feel like cramping or abdominal tightening. Often times they are
accompanied by lower back pain. The most important feature of true contractions is
that the feeling comes and goes in a rhythmic fashion.
When is the right time to go to the hospital for contractions?
When contractions are painful to the point of interrupting your activities and/or regular
(every 5 minutes for 2 hours) you should go to the hospital.
How do I know if I broke my water?
The best sign, or indication, that a woman has broken the amniotic sac (her water), is
continued or persistent leakage of a runny, watery substance. This fluid may be clear,
bloody, greenish or yellowish but it should be the consistency of water.
Birth Plan
Our goal is to make your birthing experience positive and personal. We encourage
pregnant patients to become educated about their upcoming birth. By creating a plan
for your delivery, you have taken the time to learn about the process of giving birth,
hospital procedures and what to expect.
Think about who you would like to be in the delivery room. In general, our physicians:
will only give you an enema if you request one
will only shave you if you need a cesarean section
will want your significant other to play an active role during your labor
will let the baby "labor down" (let the baby's head descend before pushing) when
completely dilated
do not perform episiotomies (unless emergency)
Your nurses and physicians will explain any changes in your plan of care if they arise.
When during labor is the right time to get an epidural?
There is no absolutely right time for a woman to get her epidural in labor. Often times
the best policy is to see how the labor progresses and when the pains begin. The
optimal time to consider getting an epidural during labor is when the pains become too
much to bear.
If I get my epidural too early will it run out?
No. When a woman gets an epidural a small catheter is placed into the spinal column
and medicine is continuously infused into this space. The amount of numbing medicine
can be turned up or down so that a woman gets pain relief but is not entirely numb
below the waist.
What are other options for pain relief during labor, aside from an epidural?
There other options for pain relief during labor. These are pain medications that can be
given through your IV. These medications work for about an hour and can be given up
to 3 times. However, these medications go to both the mother and the fetus and make
both sleepy. Thus, these medications are typically not given when delivery is close.
If I don’t get an epidural will I feel the stitches?
If a woman, who did not choose to get an epidural, requires stitches the physician will
give a numbing injection to the area. After giving a few minutes for the medicine to
work, the physician is able to perform the stitches without the patient feeling anything.
Select a Pediatrician
We can give you a list of physicians in the area and remember to check with your
insurance to make sure they are under your plan.
Circumcision
If you want your son circumcised, this can be done by your Orange County ObGyns
physician during your hospitalization. Some insurance plans do not pay for this service.
Please ask us if your insurance plan pays for this procedure or not. If your insurance
does not cover circumcision, you may pay for the procedure in our office.
Should I Breast Feed my baby?
Breast milk has ingredients that cannot be found in infant formula.
You can provide it for as short or as long as you want.
Even small amounts of breast milk will give you and your baby the following health
advantages:
Breast milk is more easily digested. This is important for premature babies and
babies who have had bowel surgery.
Breast milk helps protect babies from necrotizing enterocolitis a serious bowel
complication.
Breast milk provides protection against infection, such as colds, ear infections
and meningitis.
Moms of preemies have more infection fighting cells in their breast milk.
Breast milk helps PREVENT allergies.
Breast-milk-fed babies have higher IQ’s.
Breast milk babies have less SIDS (crib death).
Breastfeeding for 6 months or more gives extra protection to babies against
diabetes, childhood cancers and obesity.
Moms who breastfeed have less risk of breast and ovarian cancer.
How long will I stay in the hospital after delivery?
If you have a vaginal delivery expect to stay in the hospital around 24-48 hours. If you
have a cesarean delivery expect 48-72 hours. After delivery criteria for discharge to
home are that you are able to walk, urinate, pass gas, tolerate food and have pain
control.
How long after going home should I continue to bleed?
Continued spotting for up to a few weeks after delivery can often be normal. If you have
heavy bleeding with blood clots, severe abdominal pain or fevers call us immediately.
Is it normal to have abnormal periods after pregnancy?
It is normal for it to take several months for your body to get back to your “usual” after
childbirth.

Source: http://www.ocobgyns.com/wp-content/uploads/2013/08/OC-OBGYNs-Pregnancy-Manual.pdf