The association of nuchal cord with cerebral palsy is influenced by recording bias.
OBJECTIVE
To determine if the association of cerebral palsy (CP) with umbilical cord around the fetal neck (nuchal cord) is the result of recording bias.


METHODS
Population-based case control study.


RESULTS
There were 68 cases with cerebral palsy and 157 controls (singleton term infants matched for gestational age and hospital of birth). CP was associated with tight nuchal cord overall (OR=2.8, 95% CI 1.1-6.8). Where cord around the neck is recorded at the discretion of the accoucheur (37 cases, 97 controls), there was an association between tight nuchal cord and CP (OR=5.4, 95% CI 1.4-20.4) and, in controls only, between Apgar score <7 at 1 min (OR=16.9, 95% CI 1.4-456.3). In the hospital where records included a tick box for nuchal cord (31 cases, 60 controls), an association between CP and tight nuchal cord could not be demonstrated (OR=1.4, 95% CI 0.4-4.9). Nor was there an apparent association between nuchal cord and Apgar score <7 at 1 min (OR=2.6, 95% CI 0.4-15.9) in controls.


CONCLUSIONS
The presence of nuchal cord is subject to recording bias. In a retrospective study, this can lead to an association of CP with nuchal cord that is not evident where documentation is systematic.
National Perinatal Epidemiology Unit, Old Road, Headington, Oxford, OX3 7LF, UK. Catherine.Greenwood@orh.nhs.uk
Catherine
C
Greenwood
Lawrence
L
Impey
D001034:Apgar Score; D015982:Bias; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000209:etiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D014470:Umbilical Cord / Q000002:abnormalities*