الفهرس 
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Abstract
Fetomaternal hemorrhage refers to the entry of fetal blood into the maternal circulation before or during delivery.
Flow cytometry is an alternative diagnostic test that circumvents some of the problems associated with the Kleihauer-Betke screen.
Clamping of and milking of cord is by far the oldest and most prevalent interventions in human in spite of that ,the optimal timing of cord clamping has been a controversial issue for decades.
The aim of the study to evaluate the effect of delayed cord clamping versus immediate cord clamping on fetomaternal hemorrhage which can be detected by flow cytometric measures of fetal cells in maternal circulation. Also, to study the effects of such practice on the newborn regarding to the effects on Apgar score, neonatal intensive care unit admission and neonatal bilirubin level.
The study was conducted in the emergency unit of Obstetrics and Gynecology and Department at Sohag University Hospital from February 2014 to January 2015. Our study included one hundred pregnant women.
All cases were enrolled equally into tow groups:
Group I: fifty pregnant women had early cord clamping.
Subgroup A: twenty five pregnant women were delivered vaginally.
Subgroup B: twenty five pregnant women were delivered by caesarian section.
Group II: fifty pregnant women had delayed cord clamping .
Subgroup C: twenty five pregnant women were delivered vaginally.
Subgroup D: twenty five pregnant women were delivered by caesarian section.
The study resulted in the following:
1- There is a significant increase in the mean volume of FMH in cases of DCC compared to cases of ECC between both groups (11.86±2.09 and 3.97±2.82 respectively; p<0.0001).
2- There was insignificant increase in the mean volume of fetomaternal hemorrhage between the patients who delivered by caesarian section and patients who delivered vaginally(9.73±2.25 and 6.10±5.37 respectively; p=0.15).
3- There is a significant increase in the bilirubin level in cases of DCC versus ECC cases. As the mean volume of bilirubin is higher in the DCC than the ECC (11.02±2.11 and 9.52±1.83 respectively; p=0.0003), but the increase in the bilirubin did not reach a critical level in most of cases.
4- There was insignificant increase in the percentage of the number of the newborns who admitted to intensive care unit in the ECC versus DCC (30% AND 26% respectively).
Conclusions
1-Delayed cord clamping performed forty seconds and 60 seconds in caesarian section and vaginal delivery respectively. That allows the blood in the placenta and cord, which belongs to the fetus to go to him and allowing establishment of respiration and increase in the blood volume.
2-Estimation of fetomaternal hemorrhage will have impact on estimation of exact dose of immunoglobulin which is needed for prevention of isoimmunization and its consequent hazards both on mother and consequent pregnancies.
3-Decreasing the amount of fetomaternal hemorrhage and consequently reduction in the dose of immunoglobulin needed for counteract fetal antigens have impact on financial cost on individual and consequently the National Income.
4-Delayed cord clamping has many benefits to the fetus as it decreases neonatal intensive care unit admission but it increases the bilirubin level, that does not reach a critical level in the majority of cases..
Recommendations
1-Delayed cord clamping should be encouraged as it lowers the incidence of fetomaternal hemorrhage and prevents the subsequences of fetomaternal immunization.
2-Delayed cord clamping is highly recommended in cases of Rh incompatibility via decreasing the magnitude of fetomaternal hemorrhage. Therefore the dose of Rh immunoglobulin will be decreased.
3-The use of flow cytometry for detection of fetomaternal hemorrhage is advocated, as it is precise and non operator dependent unlike the Kleihauer Beteke test.