Donald D Mcintire

• PhD
• Professor at University of Texas Southwestern Medical Center

Objective Screening questionnaires are one option for identification of at-risk substance use and substance use disorder (SUD) during pregnancy. We report the experience of a single institution following universal implementation of a brief screening tool for self-reported substance use at the first prenatal encounter. Study Design This is a prospe...

Objective Maternal pushing can yield lactate levels that are above the normal range for nonpregnant individuals. Many hospitals require lactate levels as part of sepsis bundles, and this can confuse the clinicians when measured during labor. The objective of this study was to observe lactate levels in uncomplicated labor. Study Design This was a pr...

This cohort study evaluates the role that community-level socioeconomic status plays in hypertension-related hospital readmission within 12 weeks after delivery.

Objective This study aimed to examine the relationship of fetal station in the first stage of labor to labor curves and cesarean delivery rates among women presenting in spontaneous labor. Study Design Labor curves for patients with nonanomalous singletons who presented in spontaneous labor to our hospital's Obstetric Triage Unit with intact membra...

OBJECTIVE To evaluate efficacy in achieving vaginal delivery with a standardized vaginal compared with oral misoprostol regimen for labor induction at term. METHODS In this single-center, cluster randomized trial, we randomized induction method by week among individuals with gestational age of 37 weeks or more, cervical dilation of 2 cm or less, i...

BACKGROUND Maternal stress has been identified as one of the most common clinical phenotypes associated with preterm birth. The American College of Obstetricians and Gynecologists recommends anxiety screening at least once in the perinatal period. The prevalence of perinatal anxiety is challenged by the absence of formalized screening protocols and...

Importance Postpartum transfusion is the most common indicator of severe maternal morbidity in the US. Higher rates of anemia are associated with a higher blood transfusion rate. Objective To determine if providing, rather than recommending, supplements with iron at prenatal visits in a medically underserved community is associated with improved h...

Objective: Given the rising rates of maternal morbidity and mortality in the United States and the contribution of mental illness, especially among individuals living in under-resourced communities, the objective was to evaluate the prevalence of unmet health-related social needs and their impact on perinatal mental health outcomes. Study design:...

Objective Circumvallate placenta has a suggested association with adverse pregnancy outcomes (antenatal bleeding, placental abruption, preterm birth, emergency cesarean, small for gestational age infants, and stillbirth). The aim was to determine if prenatal diagnosis of circumvallate placenta is associated with these adverse pregnancy outcomes. St...

One of the foremost public health concerns in obstetrics is preterm birth (PTB), which carries substantial consequences for infants, families, and societies that are well-documented. Affecting approximately 15 million births worldwide, PTB is a leading cause of death for children younger than 5 years. Unfortunately, identifying strategies to reduce...

Background: Newborn hypothermia has been implicated in neonatal morbidity without randomized evidence that it compromises the infant. Our objective was to determine if a difference in operating room temperature at cesarean birth impacts neonatal morbidity. Methods: Women undergoing cesarean delivery of a liveborn infant without major malformatio...

The timely triage of pregnant patients presenting for emergent care is an important factor for decreasing maternal morbidity and mortality. The Maternal-Fetal Triage Index (MFTI) is an assessment tool developed by the Association of Women's Health, Obstetric and Neonatal Nurses in 2014 and endorsed by the American College of Obstetricians and Gynec...

Background: The nomenclature has evolved from low implantation to cesarean scar pregnancy and criteria are recommended for identification. Management guidelines include pregnancy termination due to life-threatening complications. Objective: To apply ultrasound (US) parameters recommended by the Society for Maternal Fetal Medicine to terminate CS...

Problem definition: A substantial proportion of maternal morbidity and mortality occurs after birth. However, little is known about the optimal design of programs to improve outcomes and decrease disparities during this period. Context: Parkland Health is a tax-supported health system in Dallas that delivers more than 11,000 patients annually. A...

Objectives To investigate prognostic factors and outcomes in patients with carcinosarcoma treated at a public vs private hospital system by the same physician team. Methods Women diagnosed with stage I-IV uterine and ovarian carcinosarcoma between 1992–2022 were eligible. An IRB approved retrospective cohort study was performed. Stage and comorbid...

Background: Although substantial efforts have been made to reduce rates of adolescent pregnancy, the United States continues to have higher rates than other industrialized countries. Research and reporting usually focus on adolescents 15 to 19 years of age. While less common, there are pregnant young adolescents that are 15 years of age and younge...

Importance: Preterm birth (PTB) is the leading cause of infant morbidity and mortality worldwide. It has been suggested that vaginal progesterone (VP) treatment may reduce the recurrence of PTB. Objective: To evaluate the association of VP treatment with prevention of recurrent PTB among patients with a singleton pregnancy. Design, setting, and...

Background COVID-19 infection is associated with increased morbidity in pregnancy as well as adverse maternal and neonatal outcomes. Little is currently known about how the timing of infection during pregnancy affects these outcomes. Objective To evaluate the effect of trimester of COVID-19 infection on disease progression and severity in pregnant...

Objective Acute kidney injury (AKI)-complicating pregnancy is used as a marker of severe maternal morbidity (SMM) and frequently associated with obstetric hypertensive disorders. We examined AKI in pregnancies complicated by late-onset preeclampsia with severe features (SPE) using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We c...

BACKGROUND Although there is a well-known association of fetal bradycardia associated with maternal eclampsia, the characteristics of fetal heart rate tracings following an eclamptic seizure have not previously been thoroughly described. Fetal heart rate changes are thought to be related to maternal lactic acidemia caused by vasospasm and uterine h...

Background Severe hypertension remains one of the leading preventable causes of maternal mortality in the United States. Timeliness to response to severe hypertension in pregnancy is a critical quality indicator tracked by state and national organizations. We hypothesized that implementation of the Maternal Fetal Triage Index, a validated acuity to...

INTRODUCTION The COVID-19 pandemic has impacted mental health. We evaluated the impact on pregnant women and compared the Edinburgh Postpartum Depression Scale (EPDS) and a Maternal Postpartum Quality of Life Questionnaire (mPQOL) before and during the pandemic to evaluate the effect of the pandemic on maternal mental health and quality of life. M...

Background The American College of Obstetricians and Gynecologists states that data is insufficient to recommend Tranexamic acid (TXA) prophylaxis for postpartum hemorrhage. Objective This study's objective was to evaluate if prophylactic TXA reduces calculated blood loss versus placebo in women undergoing elective repeat cesarean delivery. Study...

Background The definition for anemia in pregnancy is outdated, derived from Scandinavian studies in the 1970’s to 1980’s. To identity women at risk of blood transfusion, a common cause of Severe Maternal Morbidity, a standard definition of anemia in pregnancy in a modern, healthy United States cohort is needed. Objective To define anemia in pregna...

Objective This study aimed to evaluate the rate and impact of episiotomy on maternal and newborn outcomes before and after restricted use of episiotomy. Study Design This population-based observational study used an obstetric database of all deliveries since 1990 that has been maintained with quality checks. Inclusion criteria were vaginal deliveri...

Background Postpartum anemia is common after delivery, and postpartum blood transfusion is the leading indicator of Severe Maternal Morbidity in the United States. While hematologic changes during the antepartum period are well understood, less is known about postpartum hematologic changes. We investigated hematologic changes in the postpartum peri...

Objective: The aim of the study is to compare perinatal outcomes for women with greater social needs, as identified by the Community Health Needs Assessment, to those of women living in other areas of the county. Study design: This was a retrospective cohort study of pregnant women delivering at a large inner-city county hospital. Perinatal outc...

Study Objective To assess differences in patient-reported goal achievement in participants undergoing laparoscopic and abdominal hysterectomy for benign indications. Design A prospective randomized controlled trial. Setting Enrollment was performed at a single, tertiary care academic institution. Patients or Participants Participants over 18 yea...

Objective To determine if maternal plasma CRH and preterm birth history were associated with recurrent preterm birth risk in a high-risk cohort. Study design Secondary analysis of pregnant women with a prior preterm birth ≤35 weeks receiving 17-alpha hydroxyprogesterone caproate for the prevention of recurrent spontaneous preterm birth. All women...

Objective: To evaluate the effectiveness of acute nifedipine tocolysis in preventing preterm birth in women in preterm labor. Method: This was a randomized, double-blind, placebo-controlled trial of nifedipine in women with a singleton pregnancy between 28 0/7 and 33 6/7 weeks of gestation who were admitted with uterine activity, intact membrane...

Objective The study aimed to evaluate the association between hemoglobin A1c values and likelihood of fetal anomalies in women with pregestational diabetes. Study Design Women with pregestational diabetes who delivered at a single institution that serves a nonreferred population from May 1, 2009 to December 31, 2018 were ascertained. Hemoglobin A1c...

Background Although simulation is now widely used to improve teamwork and communication, there is limited data demonstrating improvement in clinical outcomes. Objective Our aim was to examine the clinical performance and outcomes associated with postpartum hemorrhage due to uterine atony following implementation of a multidisciplinary simulation p...

Background: Expedited partner therapy for chlamydia trachomatis has had mixed efficacy in different populations, but data are lacking on the efficacy in a pregnant population. Objectives: Evaluate the real-world effectiveness of establishing a prenatal expedited partner therapy program in eradicating chlamydia before delivery. To examine the mat...

Importance: Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology. Objective: To explore the association of audio-only virtual prenatal care with perin...

Background Multidisciplinary simulation has been shown to improve teamwork in the obstetric literature by providing a safe, but realistic, environment for participants to learn. However, the impact of team members’ personality traits on how the team performs during an obstetric emergency has not been studied in medicine. Objectives Our objective w...

Objectives To assess pulmonary artery pressure and cardiac remodeling in pregnancy in women with pulmonary hypertension and compare these findings with studies done beyond three months postpartum. Study design Pregnant women with pulmonary hypertension from 2006 to 2017 were studied. Pulmonary hypertension was diagnosed when the pulmonary artery p...

Importance Published data suggest that there are increased hospitalizations, placental abnormalities, and rare neonatal transmission among pregnant women with coronavirus disease 2019 (COVID-19). Objectives To evaluate adverse outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and to descri...

Introduction Due to a nationwide shortage of Ringer’s lactate, normal saline became the intravenous fluid of choice at our institution in May 2018. Recent studies have shown that the administration of normal saline in critically ill patients may have adverse renal effects. Objective Our objective was to evaluate the renal function effects; if any,...

Objective: To evaluate whether the induction of labor in term gravid women with cervical dilation 2 cm or less and intact membranes by using oral misoprostol preceded by transcervical Foley bulb placement results in a significantly increased vaginal delivery rate compared with the use of oral misoprostol alone. Methods: We randomized the inducti...

Objectives The placenta accreta spectrum (PAS) incidence has risen substantially over the past century, paralleling a rise in cesarean delivery (CD) rates. Prenatal diagnosis of PAS improves maternal outcomes. The Placenta Accreta Index (PAI) is a standardized approach to prenatal diagnosis of PAS incorporating clinical risk and ultrasound (US) fin...

Preterm birth is a substantial public health concern. In 2019, the United States preterm birth rate was 10.23%, which is the fifth straight year of increase in this rate. Moreover, preterm birth accounts for approximately one-in-six infant deaths, and surviving children often suffer developmental delay or long-term neurologic impairment. While the...

Objective: Although intrahepatic cholestasis of pregnancy (ICP) remains poorly understood, there are several perinatal complications associated with this condition. This study aimed to examine perinatal outcomes of women with ICP, evaluate outcomes according to severity of disease, and monitor time to symptom improvement following diagnosis. Stud...

Objectives To prospectively evaluate low implantation of the gestational sac and other first‐trimester ultrasound (US) parameters for prediction of placenta accreta spectrum (PAS). Methods Women with a diagnosis of low implantation on clinically indicated first‐trimester US underwent a transvaginal US examination at 10 to 13 weeks’ gestation to as...

Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome are both associated with significant maternal and perinatal morbidity and mortality. Because of the overlap of several clinical and laboratory findings differentiation can sometimes be difficult. Both disorders have been of interest for m...

Objectives To evaluate fetal anomaly detection in pregnancies with pregestational diabetes, according to the gestational age at the time of specialized sonography, use of follow‐up sonography, maternal body mass index, and organ system(s) involved. Methods Women with pregestational diabetes who received prenatal care and delivered a live‐born or s...

Background: In 2014, the National Institute of Child Health and Human Development Fetal Imaging Workshop consensus recommended that sonograms be offered routinely to all pregnant women. In the absence of another indication, this examination is recommended at 18 to 22 weeks of gestation. Studies of anomaly detection often focus on pregnancies at ri...

Objective To evaluate the association of ARCHITECT chemiluminescent immunoassay (CIA) signal strength (signal-to-cutoff [S/CO] ratio), with maternal syphilis stage, rapid plasma reagin (RPR) reactivity, and congenital syphilis. Study Design A prospective observational study of reverse syphilis screening was conducted. Pregnant women were screened w...

Objective We evaluate diagnostic accuracy of the ARCHITECT chemiluminescent immunoassay (CIA) screening test in pregnancy, and evaluate pregnancy outcomes among screen-positive women. Study Design Samples from routine prenatal rapid plasma reagin (RPR) tests were collected between June 22 and August 18, 2017 and frozen. Samples were batch-tested wi...