INDIGO CARMINE

Fetal Risk Summary

Indigo carmine is used as a diagnostic dye. No reports linking its use with congenital defects have been located. Intraamniotic injection has been conducted without apparent effect on the fetus (1,2 and 3). Because of its known toxicities after IV administration, however, the dye should not be considered totally safe (4).

A report of jejunal atresia, possibly secondary to the use of methylene blue (see Methylene Blue) during genetic amniocentesis in pregnancies with twins was published in 1992 (5). A portion of this report described 67 newborns treated for the defect, 20 of whom were one of a set of twins. Of these latter cases, 2nd-trimester amniocentesis had been performed with indigo carmine in 1 case and with methylene blue in 18 cases. An accompanying commentary noted that indigo carmine, like methylene blue, is a vasoconstrictor and may also induce small bowel atresia (6).

A brief 1993 report described the use of indigo carmine in women with twins who underwent amniocentesis between 1977 and 1991 in the United States (7). A total of 195 women were included, 78 (40%) of whom were administered indigo carmine during the procedure. Of the 156 fetuses (total data included live births, stillbirths, intrauterine deaths, and fetuses that were electively terminated; specific data for indigo carmine was not given), 7 (4.5%) had a major birth defect. Included in this number were two infants from the same set of twins who had syndactyly, clubfoot (one), hydrocephaly (one), urethral obstruction sequence (one), and multiple congenital defects (two) (7). None of the exposed infants had small intestinal atresia.

Breast Feeding Summary

No data are available.

References

1. Elias S, Gerbie AB, Simpson JL, Nadler HL, Sabbagha RE, Shkolnik A. Genetic amniocentesis in twin gestations. Am J Obstet Gynecol 1980;138:169–74.
2. Horger EO III, Moody LO. Use of indigo carmine for twin amniocentesis and its effect on bilirubin analysis. Am J Obstet Gynecol 1984;150:858–60.
3. Pijpers L, Jahoda MGJ, Vosters RPL, Niermeijer MF, Sachs ES. Genetic amniocentesis in twin pregnancies. Br J Obstet Gynaecol 1988;95:323–6.
4. Fribourg S. Safety of intraamniotic injection of indigo carmine. Am J Obstet Gynecol 1981;140:350–1.
5. Van Der Pol JG, Wolf H, Boer K, Treffers PE, Leschot NJ, Hey HA, Vos A. Jejunal atresia related to the use of methylene blue in genetic amniocentesis in twins. Br J Obstet Gynaecol 1992;99:141–3.
6. McFadyen I. The dangers of intra-amniotic methylene blue. Br J Obstet Gynaecol 1992;99:89–90.
7. Cragan JD, Martin ML, Khoury MJ, Fernhoff PM. Dye use during amniocentesis and birth defects. Lancet 1993;341:1352.