Giuseppe Rizzo

Bio: Giuseppe Rizzo is an academic researcher from University of Rome Tor Vergata. The author has contributed to research in topics: Medicine & Fetus. The author has an hindex of 48, co-authored 306 publications receiving 7805 citations. Previous affiliations of Giuseppe Rizzo include The Catholic University of America & University of Turin.

Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis.

Abstract: Objective The aim of this systematic review was to report pregnancy and perinatal outcomes of coronavirus spectrum infections, and particularly coronavirus 2019 (COVID-19) disease because of severe acute respiratory syndrome–coronavirus-2 infection during pregnancy. Data Sources Medline, Embase, Cinahl, and Clinicaltrials.gov databases were searched electronically utilizing combinations of word variants for coronavirus or severe acute respiratory syndrome or SARS or Middle East respiratory syndrome or MERS or COVID-19 and pregnancy. The search and selection criteria were restricted to English language. Study Eligibility Criteria Inclusion criteria were hospitalized pregnant women with a confirmed coronavirus related–illness, defined as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), or COVID-19. Study Appraisal and Synthesis Methods We used meta-analyses of proportions to combine data and reported pooled proportions, so that a pooled proportion may not coincide with the actual raw proportion in the results. The pregnancy outcomes observed included miscarriage, preterm birth, preeclampsia, preterm prelabor rupture of membranes, fetal growth restriction, and mode of delivery. The perinatal outcomes observed were fetal distress, Apgar score Results Nineteen studies including 79 hospitalized women were eligible for this systematic review: 41 pregnancies (51.9%) affected by COVID-19, 12 (15.2%) by MERS, and 26 (32.9%) by SARS. An overt diagnosis of pneumonia was made in 91.8%, and the most common symptoms were fever (82.6%), cough (57.1%), and dyspnea (27.0%). For all coronavirus infections, the pooled proportion of miscarriage was 64.7% (8/12; 95% confidence interval, 37.9-87.3), although reported only for women affected by SARS in two studies with no control group; the pooled proportion of preterm birth Conclusion In hospitalized mothers infected with coronavirus infections, including COVID-19, >90% of whom also had pneumonia, preterm birth is the most common adverse pregnancy outcome. COVID-19 infection was associated with higher rate (and pooled proportions) of preterm birth, preeclampsia, cesarean, and perinatal death. There have been no published cases of clinical evidence of vertical transmission. Evidence is accumulating rapidly, so these data may need to be updated soon. The findings from this study can guide and enhance prenatal counseling of women with COVID-19 infection occurring during pregnancy, although they should be interpreted with caution in view of the very small number of included cases.

Normal values of Pulsatility Index from fetal vessels: a cross-sectional study on 1556 healthy fetuses.

Abstract: In a cross-sectional study of 1556 uncomplicated pregnancies velocity waveforms were recorded at the level of fetal umbilical artery, descending aorta, renal artery, internal carotid artery and middle cerebral artery. Reference limits for the Pulsatility Index of each vessel were constructed by regression analysis and a progressive fall during gestation was evidenced in all the vascular districts investigated with the exception of descending aorta. Furthermore we calculated the ratios between Pulsatility Index values of cerebral and peripheral vessels which may be relevant for the early diagnosis of the haemodynamic abnormalities occurring during the brain sparing effect.

Effects of coronavirus 19 pandemic on maternal anxiety during pregnancy: a prospectic observational study.

Abstract: Objectives Coronavirus (COVID-19) is a new respiratory disease that is spreading widely throughout the world The aim of this study was to evaluate the psychological impact of COVID-19 pandemic on pregnant women in Italy Methods We considered 200 pregnancies attending our antenatal clinic A questionnaire was sent to each woman in the days of maximum spread of COVID-19 Sectional was finalized to acquire in 18 items maternal characteristics and to test the women's perception of infection Section included the State-trait anxiety inventory (STAI) 40 items validated test for scoring trait anxiety (basal anxiety, STAI-T) and state anxiety (related to the ongoing pandemic, STAI-S) An abnormal value of STAI was considered when ≥40 Results The questionnaire was completed by 178 women (89%) Fear that COVID-19 could induce fetal structural anomalies was present in 47%, fetal growth restriction in 65% and preterm birth in 51% of the women The median value of STAI-T was 37 and in 382% of the study group STAI-T score ≥40 was evidenced STAI-S values were significantly higher with an increase of median values of 12 points (p≤00001) There was a positive linear correlation between STAI-T and STAI-S (Pearson=059; p≤00001) A higher educational status was associated with increased prevalence of STAI-S ≥ 40(p=0004) Subgrouping women by the other variables considered did not show any further difference Conclusions COVID-19 pandemic induces a doubling of the number of women who reached abnormal level of anxiety These findings validate the role of the remote use of questionnaire for identifying women at higher risk of anxiety disorders allowing the activation of support procedures

Doppler indices from inferior vena cava and ductus venosus in predicting pH and oxygen tension in umbilical blood at cordocentesis in growth-retarded fetuses.

Abstract: The objective of this study was to assess the value of Doppler indices calculated from the inferior vena cava and ductus venosus in the identification of acidemia and hypoxemia as determined by pH and gas analysis of fetal blood obtained by cordocentesis in growth-retarded fetuses. Doppler measurements were performed in the inferior vena cava and ductus venosus in 209 normally grown fetuses and in 89 growth-retarded fetuses. All growth-retarded fetuses were free from structural and chromosomal abnormalities, and uteroplacental insufficiency characterized by Doppler changes in the umbilical and middle cerebral arteries was the most likely etiology of the growth defect. In this group of fetuses, Doppler recordings were performed immediately before cordocentesis. Ten different indices were calculated from venous velocity waveforms, and reference limits for gestation were constructed by the cross-sectional analysis of data from normally grown fetuses. Logistic regression and receiver operator characteristic curve analysis were performed to examine the relationship between Doppler indices and acid-base status. The pre-load index (peak velocity during atrial contraction/peak velocity during systole) in the inferior vena cava was the best explanatory variable for acidemia (chi 2 = 48.33; p < or = 0.001). Hypoxemia was predicted less well by venous indices and the best results were achieved by the S/A ratio in the ductus venosus (chi 2 = 9.46; p < or = 0.005). In conclusion, our data suggest that acidosis in growth-retarded fetuses may be non-invasively identified by Doppler measurements of the inferior vena cava and that a higher efficiency can be achieved by the use of the pre-load index.

In utero programming of chronic disease

Abstract: 1 Many human fetuses have to adapt to a limited supply of nutrients In doing so they permanently change their structure and metabolism 2 These 'programmed' changes may be the origins of a number of diseases in later life, including coronary heart disease and the related disorders stroke, diabetes and hypertension 3 This review examines the evidence linking these diseases to fetal undernutrition and provides an overview of previous studies in this area

Pain and its effects in the human neonate and fetus

Abstract: THE evaluation of pain in the human fetus and neonate is difficult because pain is generally defined as a subjective phenomenon.1 Early studies of neurologic development concluded that neonatal responses to painful stimuli were decorticate in nature and that perception or localization of pain was not present.2 Furthermore, because neonates may not have memories of painful experiences, they were not thought capable of interpreting pain in a manner similar to that of adults.3 4 5 On a theoretical basis, it was also argued that a high threshold of painful stimuli may be adaptive in protecting infants from pain during birth.6 These traditional . . .

Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis.

Abstract: Objective To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19). Design Living systematic review and meta-analysis. Data sources Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 6 October 2020, along with preprint servers, social media, and reference lists. Study selection Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19. Data extraction At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly. Results 192 studies were included. Overall, 10% (95% confidence interval 7% to 12%; 73 studies, 67 271 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (41%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to have symptoms (odds ratio 0.28, 95% confidence interval 0.13 to 0.62; I2=42.9%) or report symptoms of fever (0.49, 0.38 to 0.63; I2=40.8%), dyspnoea (0.76, 0.67 to 0.85; I2=4.4%) and myalgia (0.53, 0.36 to 0.78; I2=59.4%). The odds of admission to an intensive care unit (odds ratio 2.13, 1.53 to 2.95; I2=71.2%), invasive ventilation (2.59, 2.28 to 2.94; I2=0%) and need for extra corporeal membrane oxygenation (2.02, 1.22 to 3.34; I2=0%) were higher in pregnant and recently pregnant than non-pregnant reproductive aged women. Overall, 339 pregnant women (0.02%, 59 studies, 41 664 women) with confirmed covid-19 died from any cause. Increased maternal age (odds ratio 1.83, 1.27 to 2.63; I2=43.4%), high body mass index (2.37, 1.83 to 3.07; I2=0%), any pre-existing maternal comorbidity (1.81, 1.49 to 2.20; I2=0%), chronic hypertension (2.0, 1.14 to 3.48; I2=0%), pre-existing diabetes (2.12, 1.62 to 2.78; I2=0%), and pre-eclampsia (4.21, 1.27 to 14.0; I2=0%) were associated with severe covid-19 in pregnancy. In pregnant women with covid-19, increased maternal age, high body mass index, non-white ethnicity, any pre-existing maternal comorbidity including chronic hypertension and diabetes, and pre-eclampsia were associated with serious complications such as admission to an intensive care unit, invasive ventilation and maternal death. Compared to pregnant women without covid-19, those with the disease had increased odds of maternal death (odds ratio 2.85, 1.08 to 7.52; I2=0%), of needing admission to the intensive care unit (18.58, 7.53 to 45.82; I2=0%), and of preterm birth (1.47, 1.14 to 1.91; I2=18.6%). The odds of admission to the neonatal intensive care unit (4.89, 1.87 to 12.81, I2=96.2%) were higher in babies born to mothers with covid-19 versus those without covid-19. Conclusion Pregnant and recently pregnant women with covid-19 attending or admitted to the hospitals for any reason are less likely to manifest symptoms such as fever, dyspnoea, and myalgia, and are more likely to be admitted to the intensive care unit or needing invasive ventilation than non-pregnant women of reproductive age. Pre-existing comorbidities, non-white ethnicity, chronic hypertension, pre-existing diabetes, high maternal age, and high body mass index are risk factors for severe covid-19 in pregnancy. Pregnant women with covid-19 versus without covid-19 are more likely to deliver preterm and could have an increased risk of maternal death and of being admitted to the intensive care unit. Their babies are more likely to be admitted to the neonatal unit. Systematic review registration PROSPERO CRD42020178076. Readers’ note This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is update 1 of the original article published on 1 September 2020 (BMJ 2020;370:m3320), and previous updates can be found as data supplements (https://www.bmj.com/content/370/bmj.m3320/related#datasupp). When citing this paper please consider adding the update number and date of access for clarity.

Staging of twin-twin transfusion syndrome.

Abstract: Objective The purpose of this study was to evaluate the prognostic value of sonographic and clinical parameters to develop a staging classification of twin-twin transfusion syndrome (TTTS). Study design Severe TTTS was defined as the presence of polyhydramnios (maximum vertical pocket of > or = 8 cm) and oligohydramnios (maximum vertical pocket of Results A total of 80 of 108 referred patients met criteria for surgery, but only 65 were treated surgically: 48 with LPCV and 17 with umbilical cord ligation. Complete Doppler data were obtainable in 41 of 48 LPCV patients. Survival rates by stage for one or two fetuses were statistically different (chi-squared analysis = 12.9, df = 6, p = 0.044). Neither percent size discordance nor gestational age at diagnosis were predictive of outcome. Conclusion Staging of TTTS using the proposed criteria has prognostic significance. This staging system may allow comparison of outcome data of TTTS with different treatment modalities.