670BRITISH MEDICAL JOURNAL 2 SEPTEMBER 1978 ventricle and pulmonary artery. Half of all emboli to the right ventricle cause a major complication or death. The use of beta-blocking drugs during pregnancy has been questioned for two main reasons: their possible stimulant action on uterine muscle,1 2 and their pharmacological effects on the fetus.3 In an earlier retrospective study of 10 hypertensive pregnant patients propranolol was used with success.5 We report a prospective study of nine similar high-risk pregnancies followed to term in which propranolol was used to treat hypertension. Method and resultsThree primiparous and six multiparous patients received propranolol for hypertension. In one patient treatment had been started before pregnancy; in five, it was started within three months of the onset of pregnancy; and in three it was started between the fourth and fifth month. Except in case 3, the fetal heart rates were between 120 and 150 beats/ minute. Apgar index at 1 minute was 10 in five cases, but lower in the others (8, 7, 1); Apgars at 5 minutes were 10 in these eight cases. Blood glucose concentrations recorded in seven of these eight infants were normal (>2-2 mmol/l (>40 mg/100 ml)) in five and at the lower limit of normal in the remaining two. In case number 3 the infant was born at 35 weeks by caesarean section for fetal distress (heart rate 110 beats/minute). Infant weight was 1320 g and the Apgar index was 0 at one minute and 8 at five minutes but the plasma glucose concentration was above 2-2 mmol/l. Despite immediate referral to intensive care this child died at three months of hyaline membrane disease with acute on chronic distress. Of four previous pregnancies in this patient, there had been two abortions, one premature delivery of a stillborn child, and one premature delivery of a living child. CommentThe blood pressure was controlled in eight of the nine patients during pregnancy by propranolol with no effect on uterine contractions or increased frequency of abortion and premature labour. No congenital malformations were seen in the six patients started before three months and propranolol did not seem directly responsible for fetal or maternal distress. Of the four patients who had had previous complicated pregnancies including hypertension, three had a much more satisfactory course with propranolol and in the fourth patient no improvement over previous pregnancies was seen. These results need confirmation but indicate that propranolol is effective in reducing high blood pressure in pregnancy without increasing mortality in babies already at risk.

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