Sir.—During pregnancy, transabdominal injection of dye into the amniotic sac is occasionally used when the status of the fetal membranes cannot be determined by history, physical examination, and/or simple analysis of the cervical secretions. A number of dyes have been used, including Evans blue,1 fluorescein,2 methylene blue,3 and indigo carmine.4 While fluorescein and indigo carmine are felt to be relatively benign to the fetus and mother, the toxic effects of methylene blue on the fetus have been described.5-9 It continues to be used because of its accessibility for gynecologic procedures. We describe a neonate with hemolytic anemia and prolonged hyperbilirubinemia as a result of prenatal methylene blue exposure. The pathogenesis of the complications is discussed, and previous descriptions are briefly reviewed to reinforce earlier cautions against its use for this purpose.
Patient Report.—A 2610-g female infant was born by spontaneous vaginal delivery to a