Methylene Blue
Risk Factor: CM*
Class: DIAGNOSTIC AGENTS
Contents of this page:
Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers
Fetal Risk Summary
Methylene blue has been administered orally for its weak urinary germicide properties or injected into the amniotic fluid to diagnose premature rupture of the membranes. For oral dosing, nine exposures in the 1st trimester have been reported (1, p. 299). No congenital abnormalities were observed. For use anytime during pregnancy, 46 exposures were reported (1, pp. 43435). Based on three malformed infants, a possible association with malformations (type not specified) was found.
Diagnostic intraamniotic injection of methylene blue has resulted in hemolytic anemia, hyperbilirubinemia, and methemoglobinemia in the newborn (2,3,4,5,6,7,8,9,10 and 11). Doses of the dye in most reports ranged from 10 to 70 mg, but in one case, 200 mg was injected into the amniotic cavity (7). Deep blue staining of the newborn may occur after injection of the agent into the amniotic fluid (7,8 and 9,11). One author suggested that smaller doses, such as 1.6 mg, would be adequate to confirm the presence of ruptured membranes without causing hemolysis (2).
In a 1989 report, 1 mL of a 1% solution (10 mg) was used to diagnose suspected membrane rupture in a woman with premature labor at 26 weeks of gestation (12). A 920-g girl was born 18 hours later who was stained a deep blue. The clinical assessment of hypoxia was impaired by the skin color, as was pulse oximetry. A transcutaneous oxygen monitor was eventually used to measure arterial blood gas so that ventilator therapy could be regulated. No evidence of hemolysis was observed. The bluish tinge persisted for more than 2 weeks in spite of frequent baths.
Inadvertent intrauterine injection in the 1st trimester has been reported (13). No adverse effects were reported in the full-term neonate.
Multiple ileal occlusions were found in seven newborns born to mothers with twin pregnancies, at three different medical centers, who had received diagnostic intraamniotic methylene blue into one of the amniotic sacs at 1517 weeks' gestation (14). The doses in these cases ranged from 10 to 30 mg. Four of the infants required surgery for intestinal obstruction, but no information was given on the other three. The authors speculated that the mechanism of the adverse effect was related either to hemolysis or to acute intestinal hypoxia secondary to methylene blueinduced release of norepinephrine and subsequent vasoconstriction (14).
In an abstract published in 1992, data on jejunal and ileal atresia in twins were reported from Australia (15). Higher risks of atresia were found in twins, compared to singletons, and in twins delivered from older mothers. When undiluted 1% methylene blue was used in one group, one twin in nine of 40 (22.5%) twin pregnancies had atresia, compared to three cases among 53 (5.7%) in those exposed to a 0.25% solution.
A third report of the above complication appeared in 1992 (16). Intraamniotic methylene blue, 1020 mg, was used in 86 of 89 consecutive twin pregnancies for prenatal diagnosis. No dye was used in three pregnancies for technical reasons. Jejunal atresia occurred in 17 (19%) of the pregnancies; in 15 of the affected cases, it was possible to determine that the affected fetus had been the one exposed to the dye. All of the infants required surgery to relieve the intestinal obstruction. A portion of this report also described 67 newborns who were treated for jejunal atresia, 20 of whom were one of a set of twins (16). Of the 20 newborns from twins, 18 had been exposed to methylene blue during 2nd-trimester amniocentesis. Because the incidence of jejunal atresia was much higher than expected and because the dye appears to cause the defect, the authors of the study (16) and an accompanying commentary (17) recommended avoidance of methylene blue for this purpose. The commentary also alluded to the vasoconstrictor properties of methylene blue as a possible mechanism (17).
A brief 1993 report described the use of methylene blue dye in women with twins who underwent amniocentesis in the Atlanta, Georgia, area between 1977 and 1991 (18). A total of 195 women were included, 4 (2%) of whom were administered methylene blue during the procedure. Of the eight fetuses, one had anencephaly (no association with the dye), but no cases of small intestinal atresia were observed.
A 1993 article reviewed the teratogenicity and newborn adverse effects resulting from intraamniotic injection of methylene blue (19). The most frequent adverse effects in newborns were hyperbilirubinemia, hemolytic anemia with or without Heinz body formation, blue staining of the skin, and occasionally methemoglobinemia and fetal death. Respiratory distress was also frequently observed but may have been related to other causes. The structural defects observed were jejunal-ileal atresias, but the mechanism of the bowel injury is unknown. Based on the pharmacologic properties of the dye, the most likely mechanism was thought to be vascular disruption caused by methylene blueinduced arterial constriction. However, methemoglobinemia- and hemolytic anemiainduced hypoxia causing a shunting of blood away from the intestine with resulting ischemia and atresia, or a direct toxic effect from the dye when swallowed with amniotic fluid were other possible mechanisms (19).
In summary, the intraamniotic injection of methylene blue to detect ruptured membranes should be discouraged. If indicated, other dyes, such as indigo carmine or Evans blue appear to be safer alternatives, although both have limited pregnancy data (see Indigo Carmine and Evans Blue) (19).
[*Risk Factor D if injected intraamniotically.]
Breast Feeding Summary
No data are available.
References
- Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA: Publishing Sciences Group, 1977.
- Plunkett GD. Neonatal complications. Obstet Gynecol 1973;41:4767.
- Cowett RM, Hakanson DO, Kocon RW, Oh W. Untoward neonatal effect of intraamniotic administration of methylene blue. Obstet Gynecol 1976;48:74S5S.
- Kirsch IR, Cohen HJ. Heinz body hemolytic anemia from the use of methylene blue in neonates. J Pediatr 1980;96:2768.
- Crooks J. Haemolytic jaundice in a neonate after intra-amniotic injection of methylene blue. Arch Dis Child 1982;57:8723.
- McEnerney JK. McEnerney LN. Unfavorable neonatal outcome after intraamniotic injection of methylene blue. Obstet Gynecol 1983;61:35S6S.
- Serota FT, Bernbaum JC, Schwartz E. The methylene-blue baby. Lancet 1979;2:11423.
- Vincer MJ, Allen AC, Evans JR, Nwaesei C, Stinson DA. Methylene-blue-induced hemolytic anemia in a neonate. Can Med Assoc J 1987;136:5034.
- Spahr RC, Salsburey DJ, Krissberg A, Prin W. Intraamniotic injection of methylene blue leading to methemoglobinemia in one of twins. Int J Gynaecol Obstet 1980;17:4778.
- Poinsot J, Guillois B, Margis D, Carlhant D, Boog G, Alix D. Neonatal hemolytic anemia after intra-amniotic injection of methylene blue. Arch Fr Pediatr 1988;45:65760.
- Fish WH, Chazen EM. Toxic effects of methylene blue on the fetus. Am J Dis Child 1992;146:14123.
- Troche BI. The methylene-blue baby. N Engl J Med 1989;320:17567.
- Katz Z, Lancet M. Inadvertent intrauterine injection of methylene blue in early pregnancy. N Engl J Med 1981;304:1427.
- Nicolini U, Monni G. Intestinal obstruction in babies exposed in utero to methylene blue. Lancet 1990;336:12589.
- Lancaster PAL, Pedisich EL, Fisher CC, Robertson RD. Intra-amniotic methylene blue and intestinal atresia in twins (abstract). J Perinat Med 1992;20 (Suppl 1):262.
- 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;99:1413.
- McFadyen I. The dangers of intra-amniotic methylene blue. Br J Obstet Gynaecol 1992;99:8990.
- Cragan JD, Martin ML, Khoury MJ, Fernhoff PM. Dye use during amniocentesis and birth defects. Lancet 1993;341:1352.
-
Cragan JD. Teratogen update: methylene blue. Teratology 1999;60:4248.
Questions and Answers
Methylene blue?, ok my angel fish just laid eggs for the first time. i know i have read alot about using methylene blue as an anti-fungus to keep the eggs from dying? im wondering how exspensive it is, and where locally i could find some for my fishies. =) thanks for any help.
Meth Blue aids in general disease prevention, including superficial fungal infection, ich, and costia. Detoxifies fish from nitrite or cyanide poisoning. All treatment should be carried out in a hospital tank or container.
The new ones are Zinc free, chloride salt of methylene blue. Safe for use with fish eggs and fry. 4 oz treats up to 240 gallons. Would not cost you more than 3-4$.. try any local fish shop, they should have it.
What is a methylene blue and what is it's effect to our skin?, My friend said that methylene blue can make the swimming pool's water blue but does it have effect to our skin when added to the water or does it have a reaction when chlorine is added and mix?
Methylene blue is a water soluble dye sometimes used in laboratory work. It will make the water blue but in general is very unhealthy for people in the water.
You should not do this.
The dye will stain the swimming pool. It will react with chlorine in the pool too reducing the biocide level and producing other unhealthy by products.
How do determine the sensivivity of methylene blue dye in detecting DNA ?, I am a student and I am doing a science project but i am quite stuck here. What are the steps or how do i do an experiment to determine the sensivivity of methylene blue dye in detecting DNA ? Thanks buds...really appreciate it. XD
Start with a DNA sample of known concentration and make a series of dilutions. Run each of these in a gel and then stain with methylene blue. Note which is the last well where you can still see the DNA band and use that to calculate the sensitivity of the dye.
How could you seperate an aqueous mixture of methyl red and methylene blue?, How could you seperate an aqueous mixture of methyl red and methylene blue?
Adjust the pH to 7.0 if it isn't at that pH already, and extract with chloroform. The methyl red will be extracted and the methylene blue will stay in the water. If the pH is too low or too high, methyl red is ionic and will not extract.
Eosin is a red stain and methylene blue is blue?, Eosin is a red stain and methylene blue is blue. What should be the result of staining a bacterial smeal with a mixture of eosin and methylene blue?
Eosin is a fluorescent red dye resulting from the action of bromine on fluorescein. It can be used to stain cytoplasm, collagen and muscle fibers red for examination under the microscope.
Methylene blue is used for totally different functions, such as RNA DNA examination.
From my experience of using mixed stains to selectively colour mixtures of fibres, I would say that the Eosin would stain any cytoplasm, collagen and muscle fibers red and the methylene blue would stain other ingredients blue, or in a reducing medium, uncoloured.
But I make no claims to being a microbiologist or pathologist, but I have had some experience of mixed microscopic stains in other spheres.
Is methylene blue safe for anyone to use?, one of my friends was saying how methylene blue will make your pee blue for a few days. i thought it would be pretty funny to put it into my brothers food as a prank if i get some. before i buy it i wanted to make sure it wont harm him if he eats it.
SIDE EFFECTS: Nausea, stomach upset, diarrhea, vomiting or bladder irritation may occur. If any of these effects continue or become bothersome, notify your doctor. This medication causes the urine, stools and possibly skin to turn green-blue in color. Do not be alarmed. Expect this effect. The discoloration will disappear when the medication is stopped. Notify your doctor if you notice: high fever, severe nausea and vomiting, abdominal pain, headache, chest pain, dizziness, profuse sweating. If you notice other effects not listed above, contact your doctor or pharmacist.
I dont think one will hurt him, sounds like a pretty funny joke! Just watch out because I'm sure he'll want revenge!!
Where can I find Methylene Blue Stain?, I have a project due in less than a week, im doing a project on stimulus and I need the stain Methylene Blue Stain, it is sort of like DNA or RNA. I need any scientist or professinal with the stain to tell me where to get it at. I need truth, no joking around, my medical career depends on this. I live in Jacksonville, FL and so i need for the closet store. Please anyone tell me where I can get it from. Thanks for your help.
College BIO or Chem lab will have it...even Community College.
how will i use methylene blue?, one of my fish has the white spot disseas and i am going to get methylene blue how much do i put a day and how much help would be needed and can my fish die of this also?
methylene blue is very very fatal to your fish if used wrong i would try using aquarium salt first but if you decide on the methylene blue it is 1 tsp for every 5 gallons be very very careful. also it may stain your tank blue
what happens if i use methylene blue on a healthy angel fish?, i have two angels in a 10 gallon tank. they have been spawning about every two weeks and i want to keep some, but they keep eating them. so i was thinking if i should seperate them with a seperater and use meth blue to prevent fungus on the eggs.
google search methylene blue & angelfish.... it is used in breeding all the time. read the sites....
What is methylene blue made up of?, From where we can find methylene blue?
C16H18ClN3S
