Although fetal deaths was decreased by intrapartum Fetal Heart Rate (FHR) monitoring, infantile cerebral palsy was not decreased in Dublin trials of Electric Fetal Monitor (EFM), thus, an analysis to reduce cerebral palsy was studied, where cerebral palsy is prevented by setting the threshold of hypoxia index at 24 or less, in the analysis of FHR deceleration.

A research reported abnormal fetal neuronal migration after irradiation of diagnostic ultrasound attaching the probe to the abdomen of pregnant small animal. Another irradiation of low intensity ultrasound resulted infantile brain damage followed by reduced learning ability. Fetal hepatic cellular apoptosis increased after short irradiation of Doppler ultrasound. Fetal ultrasound examination was restricted after the report.

Fetal heart rate (FHR)curve evaluation is changed from visual FHR pattern classification to objective numeric analyses including hypoxia index, FHR score, frequency spectrum, A /B ratio, artificial neural network, etc.Early 3 items are fit update FHR analysis.Hypoxia index covers all 4 FHR patterns, preventing infantile cerebral palsy, FHR score predicts Apgar score and UApH, preventing fetal/neonatal demise, and FHR frequency spectrum detects pathologic sinusoidal FHR and severe fetal anemia preventing feta demise.Numeric FHR analysis isfully objective and suitable to computerized FHR diagnosis, of which diagnosis is totally correct and improves busy works of Obstetricians.Novel hypoxia index, FHR score and frequency spectrum diagnosis are studied.In FHR monitoring in the present report.

Also Chemotherapy was progresses in choriocarcinoma after Methotrexate, still its prevention with the treatment of persistent trophoblastic dusase is needed after molar treatment.The prevention was achieved with particular MTX treatment of persistenttrophoblastic disease.

Intrapartum brain damage followed by cerebral palsy developed after the loss of fetal heart rate variability and new hypoxia index was 25 or more, thus, early delivery will be done before these CP predictive borders in fetal monitoring. Very early sign of uterine contraction should be detected to cease preterm labor reducing neurological sequels. Neonatal brain PVE should be rejected after preterm birth reducing PVL and CP. The respiratory distress syndrome is predicted for 96% by ultrasonic GLHW fetal lung tissue characterization, reducing hypoxic neonatal disorder of central nervous system.

Cerebral palsy is a big problem in fetal monitoring.Novel hypoxia index=the sum of all fetal heart rate deceleration durations (min) in fetal monitoring, which is divided by the lowest fetal heart rate (bpm), and multiplied by 100.The hypoxia index of all 6 cerebral palsy cases was 25 or more, while the index of all 16 normal non cerebral palsy cases was 24 or less.Thus, cerebral palsy is prevented, if hyoxia index is 24 or less in the birth, and the newborn babies whose hypoxia index was 25 or more can be treated by early cerebral palsy therapy in neonatal stage.As the hypoxia index is adopted to all of deceleration patterns and continuous bradycardia because its calculation equation did not include lag-time, traditional but subjective early, late and variable deceleration pattern classification will change to numeric hypoxia index in fetal monitoring.

Results: Fetal outcome was predicted even in the 1st stage of labor as follows byregression equation.i.e.FHR score is useful to indicate early delivery in early stage of labor.

Aims: To clarify the developing mechanism of uterine contraction curve in the birth process. Methods: Uterine contraction curve, which was constant in old and new studies and recording methods, and it is similar to the electric oscillation, thus, their developing mechanisms were compared. Results: The labor contraction will be a physiological oscillation, similar to electric oscillation, namely it is a physiological oscillation developed by positive feed-back loop. Conclusion: The novel analysis of regular uterine contraction will be applied to the analysis of labor developing mechanism and for the treatment of preterm labor.

As FHR rises by the fetal brain excitation with fetal movement, and FHR falls by the excitation of fetal vagus nerve center with hypoxic stimulation, hypoxic grade is numerically known by the hypoxia index, which is the sum of FHR deceleration duration (min) divided by the lowest FHR (bpm), and multiplied by 100, where all of 6 cerebral palsy cases' hypoxia index were 25 or more, while the hypoxia index of all 16 no cerebral cases were 24 or less, thus, cerebral palsy is prevented, if the hypoxia index is 24 or less in full course of fetal monitoring.It is the fi rst numeric threshold setting to prevent cerebral palsy in 50 years' history of fetal monitoring.

Aims: To prevent cerebral palsy caused by intrapartum damage.Methods: Hyoxia index is the sum of deceleration durations (min) divided by the lowest fetal heartrate.And multiplied by 100.Results: Hypoxia index of 6 cases of cerbral palsywere 25 or more and the index was 24 or less in 16 cases of no cerebral palsy. Conclusion:Cerebral palsy will be prevented if the fetus is delivered when hypoxia index is 24 or less at delivery.

It was strange that fetal outcome was vigorous in 3 late decelerations, but ominous when it repeated.

Aims: Creation of novel objective & numeric fetal hypoxia index, solving controversy pattern classification, preventing cerebral palsy caused by intrapatum fetal brain damage before definite threshold.Methods and Results: Hypoxia index (HI) is the sum of deceleration duration (min) divided by the lowest FHR (bpm), and multiplied by 100.As the HI was 25 in a case of abnormal FHR followed by the cerebral palsy (CP), and 26 in a case of repeated late decelerations (LD) for 50 min with the loss of variability, Apgar 3, and brain damage, while abnormal FHR whose HI was 20-24 developed neither loss of variability nor CP.The HI was 6, Apgar score was 9 and no CP in a case of 3 connected LDs.Apgar score was predicted by a regression equation. Discussion: LD is ominous because of its high repetition producing high HI, while 2-3 LD repetition develops no ominous outcome. The principle can be adapted to the other decelerations and sudden continuous fetal bradycarda.Computerized FHR diagnosis is simplified introducing hypoxia index, rejecting subjective pattern classification and early delivery before reaching 25 of HI will prevent the brain damage and CP. Conclusion:The late, early and variable decelerations and sudden FHR bradycardia will be followed by neither fetal brain damage nor CP, if the HI was lower than 25 during delivery, while normal neonate without CP will not be expected if fetal HI was 25 or more, despite fetal death was prevented.HI is the most effectively applied in computerized FHR monitoring, at the same time with the FHR score, FHR curve frequency spectrum and A/B ratio.

Objective and numeric decision was inytroduced into computerized FHR Diagnosis including FHR score, hypoxia index, actocardiographic A/B ratio and frequency spectrum analysis, where computerized FHR analysis made it possible to satisfactory predet fetal outcome, where the system composed of these diagnostic tools, which directory reported the results attendant doctor improving perinatal outcome.

Fetal well-being was assessed by enlarging of pregnant abdomen and maternal perception of fetal movements during amenorrhea in old times. There was change to medical monitoring with stethoscopic listening to fetal heart sound after 20 weeks of pregnancy and palpating diagnosis of intrauterine fetus. Recognition of X-ray photo was rarely confirmed fetal position or fetal skeleton under concern on X-ray effect on the fetus. Fetal life was confirmed by appearance of fetal electrocardiogram on maternal limb leads with Seitengalvanometer, then changed to fetal electrocardiogram (FECG) at maternal abdominal surface using electric amplifier. Maeda reported it using handmade amplifier in 1950s. Objective fetal heart sound was also recorded using adult phonocardiographic microphone, transistor amplifier and data recording with slow speed reproduction to trace fetal phonocardiogram (FPCG). As P & T waves of FECG were masked by muscle noises, FPCG was disturbed by systolic murmur in normal pregnancy, and listening to fetal heart beats failed to detect fetal sinusoidal heart rate, the fetal monitoring was changed to fetal heart rate curve recording.

Aims: To prevent fetal brain damage and cerebral palsy (CP). Methods:The hypoxia index was studied to solve the vague late deceleration (LD).Hypoxic fetal brain damage was known by the loss of variability.Early delivery before the loss of variability will prevent cerebral palsy, however, no numeric sign of the loss of variability was present, which was seeked by the author in the summing hypoxic effect in repeated FHR deceleration, where the sum of durations of FHR deceleration (min) was divided by the lowest FHR (bpm) and multiplied by 100, in the hypoxia index (HI), in the full FHR monitoring course, possibly using a computer. Results:The Hi was 25 & 26 in CP and severe brain damage, while 20-24 in abnormal FHR but neither brain damage nor cerebral palsy with significant differences.Thus, a numeric threshold in HI to develop cerebral palsy was 25, and the safe HI is 24 or less.The CP will be prevented by the early delivery when the HI is less than 25.Discussion: As HI was 6 in 3 connected LD while HI was 26 after 50 min's LD repetition, the outcome depends on the repetition, but not to the LD pattern, and all of early, late, variable decelerations and continuous fetal bradycardia are evaluated by HI, namely, HI decides outcome, instead of deceleration pattern, where outcome is digitally diagnosed using numeric HI. Conclusion:HI covers the role of all decelerations, while FHR pattern was discarded in computerized FHR diagnosis.

Late deceleration (LD) of fetal heart rate (FHR) was analyzed to clarify controversy LD record.The mechanical compression of pelvic large arteries by contracted uterus develops LD, and the pathologic fetal hypoxia is enhanced to developed pathologic outcome in frequently repeated LDs. 3 typical pattern LD resulted fully normal outcome of which Apgar was 9, while repeated LD for 50 minutes developed severe asphyxia of which Apgar was 3 and accompanied severe fetal brain damage, in addition, LD \ is defined after 15 minutes repetition.It is concluded from the facts that LD is ominous due to its frequent repetition but not by its late appearance pattern.Base on the facts, fetal damage is estimated by the hypoxia index (HI), which is the sum of durations (min) of FHR deceleration (transient bradycardia) divided by the lowest FHR (bpm) and multiplied by 100 to keep the integer.The hypoxia index was 25 or more in intrapartum fetal monitoring of all 6 cerebral palsy cases, while it was 24 or less in all 16 cases of no cerebral palsy.The probability to be error is zero, if it is said that cerebral palsy is prevented when the HI is 24 or less.