Intra-amniotic Dye Alternatives for the Diagnosis of Preterm Prelabor Rupture of Membranes

Intra-amniotic dye instillation is a useful tool for evaluation of equivocal cases of preterm prelabor rupture of membranes and for genetic amniocentesis in multifetal gestation. Indigo carmine, the most used and studied dye, is no longer available. We sought to provide a resource of potential dyes for clinical use that summarizes dosing along with maternal, fetal, and neonatal outcomes. We reviewed the literature evaluating the use of alternative agents. Sodium fluorescein has proven clinical usefulness but has side effects when used intravenously. Phenolsulfonphthalein has reported clinical utility with no cases of maternal, fetal, or neonatal side effects; however, it is not currently available in the United States. Indocyanine green has been used in pregnancy for other indications. Oral phenazopyridine hydrochloride may lead to a false-positive diagnosis of preterm prelabor rupture of membranes. Evans blue and methylene blue have adverse fetal and neonatal effects. Of the dye options available, fluorescein is a readily available commercial option that has the best evidence supporting use and safety for these indications.