The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review.

BACKGROUND: Obstetricians are often reluctant to grant requests for an elective cesarean section (ECS) due to childbirth fear. To date, it is unknown if an ECS on request improves mental well-being in the mother in the peripartum period and if possible beneficial effects on anxiety and depression could outweigh the increased risk of complications associated with a surgical delivery. A systematic review was conducted to explore the effect of ECS on request on peripartum anxiety and depression. METHODS: We searched on PubMed, PsychoInfo and Embase. Studies were included with primary data on anxiety and/or depression postpartum in women with childbirth fear who had requested an ECS. After full-text evaluation of 65 papers and quality analysis of four papers, three papers were included. Of one paper additional and yet unpublished data were provided. Studies varied in outcome measures, hence no meta-analysis was performed. RESULTS: Women who requested an ECS had higher antepartum depression and anxiety levels but no different postpartum depression levels than women who delivered vaginally. One study of good quality examined the effect of vaginal delivery in women preferring ECS: These women had significantly higher symptom levels of post-traumatic stress disorder (PTSD) and depression than women with normal vaginal delivery. CONCLUSIONS: The prospect of an ECS does not lower antepartum anxiety and/or depression levels in women requesting an ECS. If women resolutely persist in wishing an ECS despite adequate counselling and/or psychiatric treatment, the risk of developing depressive and PTSD symptoms in case of vaginal delivery should be taken into account, and an ECS may be considered as a valid alternative.

Delay and causes of delay in the diagnosis of childhood cancer in Africa.

BACKGROUND: Although a few studies have investigated delays in diagnosis and treatment among children and adolescents with cancer, this has never been subject of study in South Africa. Early diagnosis is fundamental as it allows timely treatment and prevents unnecessary complications. PROCEDURES: Combined prospective and retrospective study of 194 children with cancer at Tygerberg Hospital, Cape Town, diagnosed between 2000 and 2009: 126 patients were included through review of the medical charts and 68 through interviews with the parents. RESULTS: The median total diagnosis delay was 34 days (2-1,826). The median patient delay was 5 days (0-457). The median physician delay was 20 days (0-924). Gender, age or ethnicity of the children, as well as parental level of education did not have a significant influence on the total time to diagnosis. Initial misdiagnoses were frequent (58%). CONCLUSIONS: There is considerable delay in diagnosing childhood cancer in the area served by Tygerberg Hospital, due mostly to a physician delay of 20 days on average. The findings of our unit should be correlated with other South African centers. There is a clear need to increase parental awareness of childhood cancer and to intensify the education of nurses and doctors with regard to the warning signs of the disease.