Management, treatment and prevention
Pre-conception counselling
It is known that women with a personal or family history of puerperal psychosis or bipolar disorder are at risk of a puerperal episode. The highest risk of all (82%) is a combination of a previous postpartum episode and at least one earlier non-puerperal episode. There is a need to counsel women at high risk before they embark on pregnancy, especially those on prophylactic treatment. The issues include the teratogenic risk, the frequency of recurrence and the risks and benefit of various treatments during pregnancy and breast-feeding; a personal analysis should be made for each individual, and is best shared with close family members. The teratogenic risks of antipsychotic agents are small, but are higher with lithium and anti-convulsant agents. Carbamazepine, when taken in early pregnancy, has some teratogenic effects, but valproate is associated with spina bifida and other major malformations, and a foetal valproate syndrome; it is contra-indicated in women who may become pregnant. Given late in pregnancy, antipsychotic agents and lithium  can have adverse effects on the infant. Stopping mood-stabilisers has a high risk of recurrence during pregnancy. Pre-birth planning
If a woman at high risk becomes pregnant, it is essential to convene a planning meeting. This is urgent because the diagnosis of pregnancy may be late, and the birth may be premature. The meeting should be attended by primary care, obstetric and psychiatric staff, together (if possible) with the expectant mother and her family and (if appropriate) a social worker.
Uterine tachysystole is a condition of excessively frequent uterine contractions during pregnancy. It is most often seen in induced or augmented labor, though it can also occur during spontaneous labor.Because contraction counts are often measured over periods of ten minutes but averaged over periods of thirty minutes, there can be slight differences in how the cutoff is calculated. Generally it is defined as more frequently than once every two minutes. Although definitions may vary among studies, most use the terms defined by the American Congress of Obstetricians and Gynecologists (1999a) to describe increased uterine activity as follows:

Uterine tachysystole is defined as  more than 5 contractions in 10 minutes, averaged over a 30-minute window. Uterine hypertonus is described as a single contraction lasting longer than 2 minutes. Uterine hyperstimulation is when either condition leads to a nonreassuring fetal heart rate pattern.The American Congress of Obstetricians and Gynecologists amended these definitions in 2008. Uterine tachysystole is defined as more than 5 contractions in 10 minutes, averaged over a 30-minute period. The terms "hypertonus" and "hyperstimulation" are not recommended to be used. Uterine tachysystole has been reported to follow vaginally administered Prostaglandin E2 in 1 to 5 percent of women (Brindley and Sokol, 1988; Rayburn, 1989). It can be associated with placental abruption and perhaps with uterine leiomyomas. It can also refer to hyperstimulation with oxytocin. == References ==