Fetal Death After Exposure to Methylene Blue Dye During Mid-Trimester Amniocentesis in Twin Pregnancy

Kidd, Sharon A.; Lancaster, Paul; Anderson, John C.; Boogert, Antheunis; Fisher, C. C.; Robertson, Rob; Wass, Debbie M.

doi:10.1002/(sici)1097-0223(199601)16:1<39::aid-pd789>3.0.co;2-p

Cited by 52 publications

(13 citation statements)

References 12 publications

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“…In concurrent research into the relationship between the use of methylene blue dye during the amniocentesis procedure and fetal death, we found a highly significant association when comparing women who had an amniocentesis with dye to women who had an amniocentesis performed without dye. 20 To determine whether the increased risk from any amniocentesis was related to dye use during amniocentesis, we separated the women in the exposed group into dye categories. Pregnancies which could not be classified definitively with respect to methylene blue exposure status (n = 24), along with their match, were excluded from these subgroup analyses.…”

Section: Resultsmentioning

confidence: 99%

A cohort study of pregnancy outcome after amniocentesis in twin pregnancy

Kidd

Lancaster

Anderson³

et al. 1997

Paediatric Perinatal Epid

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We conducted a retrospective cohort study to assess the risk of amniocentesis in twin pregnancy for adverse outcomes. The study base consisted of women who had an amniocentesis performed during twin pregnancy and a comparison representative sample of women who carried a twin pregnancy, but did not have invasive prenatal diagnosis. The 227 women in each of the exposed and non-exposed groups were residents of the state of New South Wales, Australia, over the period 1980-92, and were matched on maternal age and period of the infant's birth. Nearly 10% of twin pregnancies among the women having an amniocentesis were affected by a stillbirth, and the stillbirth rate among exposed fetuses (5.3%) was nearly twice as high as among non-exposed fetuses (3.1%). After adjustment for confounding and excluding abnormalities, there was a non-significant elevated relative risk of stillbirth after exposure to amniocentesis. The analysis by type of amniocentesis (with and without methylene blue dye) was limited by small numbers, but the burden of risk was primarily among women who had dye exposure during amniocentesis (relative risk = 3.64, 95% confidence interval = 1.15, 11.48). This increase remained after adjusting for confounding, although the confidence interval was wide. In conclusion, we were unable to establish with certainty whether an increased risk of stillbirth could be ruled out among women who had any type of amniocentesis in twin pregnancy.

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Section: Resultsmentioning

confidence: 99%

A cohort study of pregnancy outcome after amniocentesis in twin pregnancy

Kidd

Lancaster

Anderson³

et al. 1997

Paediatric Perinatal Epid

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“…4,15 There also are reports on the increased incidence of fetus papyraceus or fetal death after the use of methylene blue during early or midtrimester amniocentesis in twin pregnancies. 4,16,17 Local toxic effect of concentrated dye after swallowing amniotic fluid might damage the mucosa and cause (acquired) jejunoileal atresia. It is more likely that the intestinal stenosis and atresia are caused by systemic vasoconstriction and intrauterine methemoglobinemia after resorption of methylene blue.…”

Section: Discussionmentioning

confidence: 99%

“…It is more likely that the intestinal stenosis and atresia are caused by systemic vasoconstriction and intrauterine methemoglobinemia after resorption of methylene blue. 3,[13][14][15][16] Methylene blue is a noxious product, and its use for detection of surgical conditions in neonates should be avoided. Other dyes (Evan's blue, fluorescein, indigo carmine) should be considered during diagnostic interventions.…”

Section: Discussionmentioning

confidence: 99%

Methemoglobinemia and hemolysis after enteral administration of methylene blue in a preterm infant: relevance for pediatric surgeons

Allegaert

Miserez²,

Lerut³

et al. 2004

Journal of Pediatric Surgery

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“…Because of the implications in producing fetal intestinal atresia, it has been recommended that methylene blue should not be used for second trimester amniocentesis [6,12,15]. Furthermore, methylene blue use during mid-trimester amniocentesis in twin pregnancies increases the risk of fetal death [7] and fetal and maternal life-threatening complications [7,16].…”

Section: Discussionmentioning

confidence: 99%

Jejunal atresia related to the use of toluidine blue in genetic amniocentesis in twins

Dinger¹,

Autenrieth²,

Kamin³

et al. 2003

Journal of Perinatal Medicine

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Since 1990 avoidance of methylene blue as a dye in diagnostic amniocentesis is recommended. This is the result of the observation that a high incidence of jejuno-ileal atresia appeared in twin pregnancies following intraamniotic injection of methylene blue. We report a case of jejunal atresia in twins after injection of toluidine blue. We describe the clinical course, discuss possible teratogenic mechanisms and emphasize that no synthetic dyes should be used in second trimester amniocentesis.

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Fetal Death After Exposure to Methylene Blue Dye During Mid-Trimester Amniocentesis in Twin Pregnancy

Cited by 52 publications

References 12 publications

A cohort study of pregnancy outcome after amniocentesis in twin pregnancy

A cohort study of pregnancy outcome after amniocentesis in twin pregnancy

Methemoglobinemia and hemolysis after enteral administration of methylene blue in a preterm infant: relevance for pediatric surgeons

Jejunal atresia related to the use of toluidine blue in genetic amniocentesis in twins

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