Unfavorable neonatal outcome after intraamniotic injection of methylene blue

A case is presented in which methylene blue dye was injected intraamniotically to confirm rupture of the membranes. Significant neonatal morbidity occurred as a direct result of the methylene blue dye injection. A syndrome of toxic side effects is described including hemolytic anemia, hyperbilirubinemia, and methemoglobinemia. The metabolic process is discussed. The authors suggest discontinuing the intraamniotic injection of methylene blue dye as a diagnostic aid.