BackgroundImproving newborn health remains a global health priority. Little however is known about the neurodevelopmental consequences for survivors of complications in pregnancy, labour and the neonatal period in in low-income countries outside of small selective and typically urban facility studies. We ask which antenatal, birth and neonatal factors are associated with disability in childhood in a large community birth cohort from rural Nepal.Methods6436 infants were recruited during a cluster randomised control trial (RCT) of participatory women's groups (ISRCTN31137309), of whom 6075 survived beyond 28 days. At mean age of 11∙5 years (range 9.5–13.1), 4219 children (27% lost to follow-up) were available for disability screening which was conducted by face-to-face interview using the Module on Child Functioning and Disability produced by the Washington Group/UNICEF. Hypothesised risk factors for disability underwent multivariable regression modelling.FindingsOverall prevalence of disability was 7.4%. Maternal underweight (OR 1.44 (95% CI 1.01–2.08)), maternal cohabitation under 16 years of age (OR 1.50 (1.13–2.00)), standardised infant weight at 1 month (OR 0.82 (0.71–0.95)) and reported infant diarrhoea and vomiting in the first month (OR 2.48 (1.58–3.89)) were significantly associated with disability adjusted for trial allocation. The majority of hypothesised risk factors, including prematurity, were not significant.InterpretationProxies for early marriage and low birth weight and a measure of maternal undernutrition were associated with increased odds of disability. The lack of association of most other recognised risk factors for adverse outcome and disability may be due to survival bias.

Background: As ovarian malignancies are one of the commonest malignancies in female population, timely and accurate diagnosis helps in early treatment resulting in better survival. Ultrasound is easily available diagnostic tool not only to diagnose but also accurately distinguish malignant from benign ovarian masses. Aims and Objectives: To evaluate sensitivity, specificity and accuracy of ultrasound in diagnosing and differentiating benign from malignant ovarian masses in comparison with histopathological findings. Materials and Methods: A prospective study was carried out from August 2015 to August 2018 for a period of 3 years. Total 150 patients with ovarian masses who were operated in our hospital and their final histopathological reports were available, were included in our study. Ultrasound diagnosis and histopathological diagnosis were compared. Results: Sensitivity, specificity and accuracy of ultrasound in diagnosing and differentiating malignant from benign ovarian masses were found to be 78.94%, 98.47% and 88.23% respectively compared with histopathological findings. Conclusion: Ultrasound is very sensitive, specific and accurate in not only diagnosing ovarian mass but also in differentiating malignant from benign entities making it invaluable and important diagnostic tool in evaluation of ovarian masses.

AimThere has been a renewed focus globally on neonatal mortality as the deadline for the Millennium Development Goals approaches.1 Little is known about the neurodevelopmental consequences for survivors of complications in pregnancy, labour and the neonatal period in in low income countries outside of small, selective and typically urban facility studies.2 We ask which antenatal, birth and neonatal factors are associated with disability at age eleven in a large community recruited birth cohort from rural Nepal.MethodsThis cohort of 6,285 live births was recruited during a cluster randomised control trial of participatory women’s group on neonatal mortality.3,4 At age eleven 4,219 children were available for detailed follow up assessment including disability screening, with a retention rate in survivors of 72% (Figure 1). Disability was assessed by face to face interview using the newly developed UN/UNICEF Module on Child Functioning and Disability.5 Abstract G268 Figure 1Flowchart of rectuitsTo minimise the risk of posthoc testing first a list of hypothesised risk factors for adverse outcome was drawn up which was then consummated with the available data (Table 1). Factors with a univariate significance of <0.1 then underwent multivariable logistic regression modelling with disability as the outcome, adjusting for trial allocation and socioeconomic status.Abstract G268 Table 1Variable selectionsResultsOverall prevalence of disability was 7.4%. Maternal underweight (Odds Ratio (OR) 1.44 (95% confidence interval 1.01–2.08)), maternal cohabitation under 16 years of age (OR 1.50 (1.13–2.00)), increased weight at 1 month (per standard deviation OR 0.82 (0.71–0.95)) and reported diarrhoea and vomiting within the first 4 weeks of life (OR 2.48 (1.58–3.89)) were significantly associated with disability. The majority of hypothesised risk factors, including prematurity, were not significant on multivariable analysis (Table 2).Abstract G268 Table 2Final logistic regression model for disabilityConclusionsThe relationship between poverty, maternal malnutrition and poor neurodevelopmental outcome is well recognised6 and our findings here emphasise the importance of breaking this cycle. The lack of association of most recognised risk factors for adverse outcome in high income settings may be due to high mortality and survival bias. As the neonatal mortality rate falls in countries like Nepal future research will need to revisit the relationship between birth environment and disability.

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Introduction: Amniotic fluid serves as a cushion for growing fetus. Oligohydramnios is decreased amount of amniotic fluid and is associated with increased incidence of congenital anomalies. The aim of this study was to detect the prevalence of congenital anomalies in oligohydramnios Methods: Singleton pregnancy irrespective of gestational age with amniotic fluid deepest vertical pocket (DVP) of less than two centimeters was included in the study. Grading of oligohydramnios was done as mild and severe. Detailed anomaly scan was done to look for any congenital malformations. Congenital anomalies were confirmed with post natal findings. Results: There were 60 pregnant women with amniotic fluid index less than two centimeters with respect to deepest vertical pocket. Congenital anomalies were detected in 18.33% pregnant women with oligohydramnios. In patients with severe oligohydramnios 33.33% had congenital anomalies. Renal anomalies were the most common anomalies in our study followed by musculoskeletal anomalies. Central nervous system, gastrointestinal and cardiac and anomalies were also common in association with oligohydramnios. Conclusion: Our study showed that various congenital anomalies are associated with oligohydramnios and incidence of anomalies increases with increased severity of oligohydramnios. Hence, detailed ultrasound scan should be done to look for congenital malformations whenever oligohydramnios is encountered.