Protection against pertussis by immunisation.

pregnancy. It would, however, be most inappropriate in the context of a sudden increase in blood pressure in the third trimester, particularly if the patient was pregnant for the first time. The reason for this does not lie in the inherent danger of this modest elevation in the blood pressure but the warning it gives of possible impending severe pre-eclampsia. The possibility that this dangerous condition may develop very rapidly justifies a policy of admission in predisposed patients. The alternative policy of outpatient management is only permissible in the case of very reliable patients who have been taught to use Albustix daily. It is stated that diuretics "do not improve the prognosis of hypertension in pregnancy." While this is certainly true, it should be remembered that treatment with methyldopa itself has little or no influence on fetal prognosis.' The most important reason for withholding diuretic treatment in pre-eclampsia is that it may aggravate the hypovolaemia which is characteristic of this condition.2 The first agent mentioned for the parenteral treatment of acutely raised blood pressure is diazoxide. While small doses of this substance have been used without ill effect, the first line of treatment in most hospitals is parenteral hydrallazine.3 Inadequate response to this well-tried agent is extremely rare and, furthermore, it does not have the antidiuretic and tocolytic effects of diazoxide. Infusions of labetolol were recommended and I have found this agent to be safe and effective in lowering acute elevations of blood pressure in pregnancy. The literature contains no reference to its use in obstetrics, though this may well become the drug of first choice in fulminating pre-eclampsia, as it combines considerable potency with more gradual hypotensive effect. This is less likely to jeopardise uteroplacental blood flow. I agree with the authors' statement that longterm use of beta-blockers in pregnancy is controversial.4 However, many authors have failed to confirm reports of an increased perinatal mortality and one author has found an improvement in fetal outcome when oxprenolol was used for hypertension in pregnancy.5