Given the task definition, example input & output, solve the new input case.
In this task, you are given a context, a subject, a relation, and many options. Based on the context, from the options select the object entity that has the given relation with the subject. Answer with text (not indexes).
Example: Context: Joanne McLeod is a Canadian figure skating coach. She is the skating director at the Champs International Skating Centre of BC (formerly known as the BC Centre of Excellence). Here current and former students include Emanuel Sandhu, Mira Leung, Kevin Reynolds, Jeremy Ten, Nam Nguyen, and many others. In 2012, McLeod became the first level 5 certified figure skating coach in British Columbia., Victor Kraatz, MSC (born April 7, 1971) is a Canadian former ice dancer. In 2003, he and his partner, Shae-Lynn Bourne, became the first North American ice dancers to win a World Championship., Allie Hann-McCurdy (born May 23, 1987 in Nanaimo, British Columbia) is a Canadian ice dancer. McCurdy began skating at age eight and was a singles skater until age 12 when she switched to ice dancing. In 2003 she teamed up with Michael Coreno, with whom she was the 2010 Four Continents silver medalist and the 2008 Canadian bronze medalist. The pair retired in June 2010, to coach at the Gloucester Skating Club., Maikki Uotila - Kraatz ( born 25 February 1977 ) is a Finnish ice dancer . She is a former Finnish national champion with Toni Mattila . She married Victor Kraatz on June 19 , 2004 . The two coach in Vancouver , where they are the ice dancing directors at the BC Centre of Excellence . She and Kraatz have two sons , born September 14 , 2006 and July 10 , 2010 ., Burnaby is a city in British Columbia, Canada, located immediately to the east of Vancouver. It is the third-largest city in British Columbia by population, surpassed only by nearby Surrey and Vancouver., Canada (French: ) is a country in the northern half of North America. Its ten provinces and three territories extend from the Atlantic to the Pacific and northward into the Arctic Ocean, covering , making it the world's second-largest country by total area and the fourth-largest country by land area. Canada's border with the United States is the world's longest land border. The majority of the country has a cold or severely cold winter climate, but southerly areas are warm in summer. Canada is sparsely populated, the majority of its land territory being dominated by forest and tundra and the Rocky Mountains. About four-fifths of the country's population of 36 million people is urbanized and live near the southern border. Its capital is Ottawa, its largest city is Toronto; other major urban areas include Montreal, Vancouver, Calgary, Edmonton, Quebec City, Winnipeg and Hamilton., British Columbia (BC) is the westernmost province of Canada, with a population of more than four million people located between the Pacific Ocean and the Rocky Mountains.
British Columbia is also a component of the Pacific Northwest and the Cascadia bioregion, along with the U.S. states of Idaho, Oregon, Washington and Alaska., The "Champs International Skating Centre of British Columbia" (formerly known as the 'BC Centre of Excellence') is one of two major figure skating training centers in Canada. Located in Burnaby, British Columbia, it is home to many great national and international skaters. The programs there are overseen by a staff, including Joanne McLeod, who coaches 3-time Canadian men's national champion Emanuel Sandhu; Bruno Marcotte, who competed at the 2002 Winter Olympics; Victor Kraatz, the 2003 World Champion in ice dancing, and Maikki Uotila, who was a national champion in Finland. The center operates out of Canlan Ice Sports Burnaby 8 Rinks. Notable skaters who train there include Emanuel Sandhu, Mira Leung, Allie Hann-McCurdy & Michael Coreno, Jessica Millar & Ian Moram, Jeremy Ten, and Kevin Reynolds. This skating school is sometimes known as a training site for international competitors to practice for competitions in Vancouver. Champs International hosts its annual competition known as the BC/YK SummerSkate Competition every August., Shae-Lynn Bourne, MSC (born January 24, 1976) is a Canadian ice dancer. In 2003, she and partner Victor Kraatz became the first North American ice dancers to win a World Championship. They competed at three Winter Olympic Games, placing 10th at the 1994 Winter Olympics, 4th at the 1998 Winter Olympics, and 4th at the 2002 Winter Olympics., Vancouver, officially the City of Vancouver, is a coastal seaport city on the mainland of British Columbia, Canada, and the most populous city in the province., Subject: maikki uotila, Relation: country_of_citizenship, Options: (A) american (B) british (C) canada (D) finland (E) montreal
Output: finland
This is a good example, as maikki uotila is citizen of the finland.

New input case for you: Context: Menopause, also known as the climacteric, is the time in most women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause typically occurs between 49 and 52 years of age. Medical professionals often define menopause as having occurred when a woman has not had any vaginal bleeding for a year. It may also be defined by a decrease in hormone production by the ovaries. In those who have had surgery to remove their uterus but they still have ovaries, menopause may be viewed to have occurred at the time of the surgery or when their hormone levels fell. Following the removal of the uterus, symptoms typically occur earlier, at an average of 45 years of age.
Before menopause, a woman's periods typically become irregular, which means that periods may be longer or shorter in duration or be lighter or heavier in the amount of flow. During this time, women often experience hot flashes; these typically last from 30 seconds to ten minutes and may be associated with shivering, sweating, and reddening of the skin. Hot flashes often stop occurring after a year or two. Other symptoms may include vaginal dryness, trouble sleeping, and mood changes. The severity of symptoms varies between women. While menopause is often thought to be linked to an increase in heart disease, this primarily occurs due to increasing age and does not have a direct relationship with menopause. In some women, problems that were present like endometriosis or painful periods will improve after menopause.
Menopause is usually a natural change. It can occur earlier in those who smoke tobacco. Other causes include surgery that removes both ovaries or some types of chemotherapy. At the physiological level, menopause happens because of a decrease in the ovaries' production of the hormones estrogen and progesterone. While typically not needed, a diagnosis of menopause can be confirmed by measuring hormone levels in the blood or urine. Menopause is the opposite of menarche, the time when a girl's periods start.
Specific treatment is not usually needed. Some symptoms, however, may be improved with treatment. With respect to hot flashes, avoiding smoking, caffeine, and alcohol is often recommended. Sleeping in a cool room and using a fan may help. The following medications may help: menopausal hormone therapy (MHT), clonidine, gabapentin, or selective serotonin reuptake inhibitors. Exercise may help with sleeping problems. While MHT was once routinely prescribed, it is now only recommended in those with significant symptoms, as there are concerns about side effects. High-quality evidence for the effectiveness of alternative medicine has not been found. There is tentative evidence for soy isoflavones., Miscarriage, also known as spontaneous abortion and pregnancy loss, is the natural death of an embryo or fetus before it is able to survive independently. Some use the cutoff of 20 weeks of gestation after which fetal death is known as a stillbirth. The most common symptoms of a miscarriage is vaginal bleeding with or without pain. Sadness, anxiety and guilt may occur. Tissue or clot-like material may also come out of the vagina.
Risk factors for miscarriage include an older parent, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, and drug or alcohol use, among others. In those under the age of 35 the risk is about 10% while it is about 45% in those over the age of 40. Risk begins to increase around the age of 30. About 80% of miscarriages occur in the first 12 weeks of pregnancy (the first trimester). The underlying cause in about half of cases involves chromosomal abnormalities. Other conditions that can produce similar symptoms include an ectopic pregnancy and implantation bleeding. Diagnosis of a miscarriage may involve checking to see if the cervix is open or closed, testing blood levels of human chorionic gonadotropin (hCG), and an ultrasound.
Prevention is occasionally possible with good prenatal care. Avoiding drugs and alcohol, infectious diseases, and radiation may prevent miscarriage. No specific treatment is usually needed during the first 7 to 14 days. Most miscarriage will complete without additional interventions. Occasionally the medication misoprostol or a procedure such as vacuum aspiration is required to remove the failed pregnancy. Women who are rhesus negative may require Rho(D) immune globulin. Pain medication may be beneficial. Emotional support may help with negative emotions.
Miscarriage is the most common complication of early pregnancy. Among females who know they are pregnant, the miscarriage rate is roughly 10% to 20% while rates among all fertilisation is around 30% to 50%. About 5% of females have two miscarriages in a row. Some recommend not using the term "abortion" in discussions with those experiencing a miscarriage in an effort to decrease distress.
Signs and symptoms.
The most common symptom of a miscarriage is vaginal bleeding. This can vary from light spotting or brownish discharge to heavy bleeding and bright red blood. The bleeding may come and go over several days. However, light vaginal bleeding is relatively common during the first trimester of pregnancy (the first 12 weeks) and does not necessarily indicate a miscarriage., Assisted reproductive technology (ART) is the technology used to achieve pregnancy in procedures such as fertility medication, in vitro fertilization and surrogacy. It is reproductive technology used primarily for infertility treatments, and is also known as fertility treatment. It mainly belongs to the field of reproductive endocrinology and infertility, and may also include intracytoplasmic sperm injection (ICSI) and cryopreservation. Some forms of ART are also used with regard to fertile couples for genetic reasons (preimplantation genetic diagnosis). ART is also used for couples who are discordant for certain communicable diseases; for example, HIV to reduce the risk of infection when a pregnancy is desired., Birth control, also known as contraception and fertility control, is a method or device used to prevent pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century. Planning, making available, and using birth control is called family planning. Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable.
The most effective methods of birth control are sterilization by means of vasectomy in males and tubal ligation in females, intrauterine devices (IUDs), and implantable birth control. This is followed by a number of hormone based methods including oral pills, patches, vaginal rings, and injections. Less effective methods include physical barriers such as condoms, diaphragms and birth control sponges and fertility awareness methods. The least effective methods are spermicides and withdrawal by the male before ejaculation. Sterilization, while highly effective, is not usually reversible; all other methods are reversible, most immediately upon stopping them. Safe sex practices, such as with the use of male or female condoms, can also help prevent sexually transmitted infections. Other methods of birth control do not protect against sexually transmitted diseases. Emergency birth control can prevent pregnancy if taken within the 72 to 120 hours after unprotected sex. Some argue not having sex as a form of birth control, but abstinence-only sex education may increase teenage pregnancies if offered without birth control education, due to non-compliance.
In teenagers, pregnancies are at greater risk of poor outcomes. Comprehensive sex education and access to birth control decreases the rate of unwanted pregnancies in this age group. While all forms of birth control can generally be used by young people, long-acting reversible birth control such as implants, IUDs, or vaginal rings are more successful in reducing rates of teenage pregnancy. After the delivery of a child, a woman who is not exclusively breastfeeding may become pregnant again after as few as four to six weeks. Some methods of birth control can be started immediately following the birth, while others require a delay of up to six months. In women who are breastfeeding, progestin-only methods are preferred over combined oral birth control pills. In women who have reached menopause, it is recommended that birth control be continued for one year after the last period.
About 222million women who want to avoid pregnancy in developing countries are not using a modern birth control method. Birth control use in developing countries has decreased the number of deaths during or around the time of pregnancy by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% if the full demand for birth control were met. By lengthening the time between pregnancies, birth control can improve adult women's delivery outcomes and the survival of their children. In the developing world women's earnings, assets, weight, and their children's schooling and health all improve with greater access to birth control. Birth control increases economic growth because of fewer dependent children, more women participating in the workforce, and less use of scarce resources., Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health. People are generally considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight by the square of the person's height, is over , with the range defined as overweight. Some East Asian countries use lower values. Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.
Obesity is most commonly caused by a combination of excessive food intake, lack of physical activity, and genetic susceptibility. A few cases are caused primarily by genes, endocrine disorders, medications, or mental illness. The view that obese people eat little yet gain weight due to a slow metabolism is not generally supported. On average, obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body mass.
Obesity is mostly preventable through a combination of social changes and personal choices. Changes to diet and exercising are the main treatments. Diet quality can be improved by reducing the consumption of energy-dense foods, such as those high in fat and sugars, and by increasing the intake of dietary fiber. Medications may be taken, along with a suitable diet, to reduce appetite or decrease fat absorption. If diet, exercise, and medication are not effective, a gastric balloon or surgery may be performed to reduce stomach volume or bowel length, leading to feeling full earlier or a reduced ability to absorb nutrients from food.
Obesity is a leading preventable cause of death worldwide, with increasing rates in adults and children. In 2014, 600 million adults (13%) and 42 million children under the age of five were obese. Obesity is more common in women than men. Authorities view it as one of the most serious public health problems of the 21stcentury. Obesity is stigmatized in much of the modern world (particularly in the Western world), though it was seen as a symbol of wealth and fertility at other times in history and still is in some parts of the world. In 2013, the American Medical Association classified obesity as a disease., Family planning, simply put, is the practice of controlling the number of children in a family and the intervals between their births, particularly by means of artificial contraception or voluntary sterilization. Because "family" is included in the concept's name, consideration of a couple's desire to bear children, in the context of a family unit, is often considered primarily. Contemporary notions of family planning, however, tend to place a woman and her childbearing decisions at the center of the discussion, as notions of women's empowerment and reproductive autonomy have gained traction in many parts of the world. Family planning may involve consideration of the number of children a woman wishes to have, including the choice to have no children, as well as the age at which she wishes to have them. These matters are obviously influenced by external factors such as marital situation, career considerations, financial position, any disabilities that may affect their ability to have children and raise them, besides many other considerations. If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and management, and infertility management., Stillbirth is typically defined as fetal death at or after 20 to 28 weeks of pregnancy. It results in a baby born without signs of life. A stillbirth can result in the feeling of guilt in the mother. The term is in contrast to miscarriage which is an early pregnancy loss and live birth where the baby is born alive, even if it dies shortly after.
Often the cause is unknown. Causes may include pregnancy complications such as preeclampsia and birth complications, problems with the placenta or umbilical cord, birth defects, infections such as malaria, and poor health in the mother. Risk factors include a mother's age over 35, smoking, drug use, use of assisted reproductive technology, and first pregnancy. Stillbirth may be suspected when no fetal movement is felt. Confirmation is by ultrasound.
Worldwide prevention of most stillbirths is possible with improved health systems. About half of stillbirths occur during childbirth, with this being more common in the developing than developed world. Otherwise depending on how far along the pregnancy is, medications may be used to start labor or a type of surgery known as dilation and evacuation may be carried out. Following a stillbirth, women are at higher risk of another one; however, most subsequent pregnancies do not have similar problems. Depression, financial loss, and family breakdown are known complications.
Worldwide in 2015 there were about 2.6 million stillbirths that occurred after 28 weeks of pregnancy (about 1 for every 45 births). They occur most commonly in the developing world, particularly South Asia and Sub-Saharan Africa. In the United States for every 167 births there is one stillbirth. Rates of stillbirth in the United States have decreased by about 2/3rds since the 1950s.
Definition.
There are a number of definitions for stillbirth. To allow comparison, the World Health Organization recommends that any baby born without signs of life at greater than or equal to 28 completed weeks' gestation be classified as a stillbirth. Others use greater than any combination of 16, 20, 22, 24, or 28 weeks gestational age or 350g, 400g, 500g, or 1000g birth weight may be considered stillborn., Caesarean section, also known as C-section, is the use of surgery to deliver one or more babies. A Caesarean section is often performed when a vaginal delivery would put the baby or mother at risk. This may include obstructed labour, twin pregnancy, high blood pressure in the mother, breech birth, problems with the placenta, umbilical cord or shape of the pelvis, and previous C-section. A trial of vaginal birth in some of these situations, including after C-section, may be possible. Some C-sections are also performed upon request. The World Health Organization recommends that they should be done based on medical need and in many cases they are lifesaving for the mother and baby.
A C-section typically takes 45 minutes to an hour. It may be done with a spinal block such that the woman is awake or under general anesthesia. A urinary catheter is used to drain the bladder and the skin of the abdomen is then cleaned with an antiseptic. An incision of about 15cm (6 inches) is then typically made through the mother's lower abdomen. The uterus is then opened with a second incision and the baby delivered. The incisions are then stitched closed. A woman can typically begin breastfeeding as soon as she is awake and out of the operating room. Often a number of days are required in hospital to recover sufficiently to return home.
C-sections result in a small overall increase in poor outcomes in low risk pregnancies. They also typically take longer to heal from, about six weeks, than vaginal birth. The increased risks include breathing problems in the baby and amniotic fluid embolism and postpartum bleeding in the mother. Established guidelines recommend that caesarean sections not be used before 39 weeks of pregnancy without a medical reason. The method of delivery does not appear to have an effect on subsequent sexual function.
In 2012, about 23 million C-sections were done globally. The international healthcare community has previously considered the rate of 10% and 15% to be ideal for caesarean sections. Some evidence finds a higher rate of 19% may result in better outcomes. More than 45 countries globally have C-section rates less than 7.5% while more than 50 have rates greater than 27%. There are efforts to both improve access to and reduce the use of C-section. In the United States about 33% of deliveries are by C-section. The surgery has been performed at least as far back as 715 BC following the death of the mother with the occasional baby surviving. Descriptions of mothers surviving date back to the 1500s. With the introduction of antiseptics and anesthetics in the 1800s survival of both the mother and baby became common., Pre-conception counseling (also called pre-conceptual counseling) is a meeting with a health-care professional (generally a physician or midwife) by a woman "before" attempting to become pregnant. It generally includes a pre-conception risk assessment for any potential complications of pregnancy as well as modifications of risk factors, such as increasing folic acid intake to reduce the risk of neural tube defects and counseling on smoking cessation, alcohol reduction, and medications that may compromise fetal development. Physicians, midwives and baby experts recommend that a woman visit them as soon as the woman is contemplating having a child, and optimally around 3 to 6 months before actual attempts are made to conceive. This time frame allows a woman to better prepare her body for successful conception (fertilization) and pregnancy, and allows her to reduce any health risks which are within her control. Agencies such as the March of Dimes have developed screening tools that healthcare providers can use with their patients. In addition, obstetricians or midwives (see Obstetrics, Midwifery, General Practitioner) have developed comprehensive check-lists and assessments for the woman who is planning to become pregnant., Cerebral palsy (CP) is a group of permanent movement disorders that appear in early childhood. Signs and symptoms vary among people. Often, symptoms include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensation, vision, hearing, swallowing, and speaking. Often babies with cerebral palsy do not roll over, sit, crawl, or walk as early as other children of their age. Difficulty with the ability to think or reason and seizures each occurs in about one third of people with CP. While the symptoms may get more noticeable over the first few years of life, the underlying problems do not worsen over time.
Cerebral palsy is caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture. Most often the problems occur during pregnancy; however, they may also occur during childbirth, or shortly after birth. Often the cause is unknown. Risk factors include preterm birth, being a twin, certain infections during pregnancy such as toxoplasmosis or rubella, exposure to methylmercury during pregnancy, a difficult delivery, and head trauma during the first few years of life, among others. About 2% of cases are believed to be due to an inherited genetic cause. A number of sub-types are classified based on the specific problems present. For example, those with stiff muscles have spastic cerebral palsy, those with poor coordination have ataxic cerebral palsy, and those with writhing movements have athetoid cerebral palsy. Diagnosis is based on the child's development over time. Blood tests and medical imaging may be used to rule out other possible causes.
CP is partly preventable through immunization of the mother and efforts to prevent head injuries in children such as through improved safety. There is no cure for CP; however, supportive treatments, medications, and surgery may help many individuals. This may include physical therapy, occupational therapy, and speech therapy. Medications such as diazepam, baclofen, and botulinum toxin may help relax stiff muscles. Surgery may include lengthening muscles and cutting overly active nerves. Often external braces and other assistive technology are helpful. Some affected children can achieve near normal adult lives with appropriate treatment. While alternative medicines are frequently used there is no evidence to support their use.
CP is the most common movement disorder in children. It occurs in about 2.1 per 1,000 live births. Cerebral palsy has been documented throughout history with the first known descriptions occurring in the work of Hippocrates in the 5th century BCE. Extensive study of the condition began in the 19th century by William John Little, after whom spastic diplegia was called "Little disease". William Osler first named it "cerebral palsy" from the German "zerebrale Kinderlahmung" (cerebral child-paralysis). A number of potential treatments are being examined, including stem cell therapy. However, more research is required to determine if it is effective and safe., Childbirth, also known as labour and delivery, is the ending of a pregnancy by one or more babies leaving a woman's uterus. In 2015 there were about 135 million births globally. About 15 million were born before 37 weeks of gestation, while between 3 and 12% were born after 42 weeks. In the developed world most deliveries occur in hospital, while in the developing world most births take place at home with the support of a traditional birth attendant.
The most common way of childbirth is a vaginal delivery. It involves three stages of labour: the shortening and opening of the cervix, descent and birth of the baby, and the pushing out of the placenta. The first stage typically lasts twelve to nineteen hours, the second stage twenty minutes to two hours, and the third stage five to thirty minutes. The first stage begins with crampy abdominal or back pains that last around half a minute and occur every ten to thirty minutes. The crampy pains become stronger and closer together over time. During the second stage pushing with contractions may occur. In the third stage delayed clamping of the umbilical cord is generally recommended. A number of methods can help with pain such as relaxation techniques, opioids, and spinal blocks.
Most babies are born head first; however about 4% are born feet or buttock first, known as breech. During labour a woman can generally eat and move around as she likes, but pushing is not recommended during the first stage or during delivery of the head, and enemas are not recommended. While making a cut to the opening of the vagina is common, known as an episiotomy, it is generally not needed. In 2012, about 23 million deliveries occurred by a surgical procedure known as Caesarean section. Caesarean sections may be recommended for twins, signs of distress in the baby, or breech position. This method of delivery can take longer to heal from.
Each year complications from pregnancy and childbirth result in about 500,000 maternal deaths, 7 million women have serious long term problems, and 50 million women have health negative outcomes following delivery. Most of these occur in the developing world. Specific complications include obstructed labour, postpartum bleeding, eclampsia, and postpartum infection. Complications in the baby include birth asphyxia., Abortion is the ending of pregnancy by removing a fetus or embryo before it can survive outside the uterus . An abortion which occurs spontaneously is also known as a miscarriage . An abortion may be caused purposely and is then called an induced abortion , or less frequently , '' induced miscarriage '' . The word abortion is often used to mean only induced abortions . A similar procedure after the fetus could potentially survive outside the womb is known as a '' late termination of pregnancy '' . When allowed by local law , abortion in the developed world is one of the safest procedures in medicine . Modern methods use medication or surgery for abortions . The drug mifepristone in combination with prostaglandin appears to be as safe and effective as surgery during the first and second trimester of pregnancy . Birth control , such as the pill or intrauterine devices , can be used immediately following abortion . When performed legally and safely , induced abortions do not increase the risk of long - term mental or physical problems . In contrast , unsafe abortions cause 47,000 deaths and 5 million hospital admissions each year . The World Health Organization recommends safe and legal abortions be available to all women . Around 44 million abortions occur each year in the world , with a little under half done unsafely . Abortion rates changed little between 2003 and 2008 , before which they decreased for at least two decades as access to family planning and birth control increased . As of 2008 , 40 % of the world 's women had access to legal abortions without limits as to reason . Different governments have different limits on how late in pregnancy abortion is allowed . Since ancient times , abortions have been done using herbal medicines , sharp tools , with force , or through other traditional methods . Abortion laws and cultural or religious views of abortions are different around the world . In some areas abortion is legal only in specific cases such as rape , problems with the fetus , poverty , risk to a woman 's health , or incest . In many places there is much debate over the moral , ethical , and legal issues of abortion . Those who oppose abortion often maintain that an embryo or fetus is a human with a right to life and may compare abortion to murder . Those who favor the legality of abortion often hold that a woman has a right to make decisions about her own body ., Pregnancy, also known as gravidity or gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy can occur by sexual intercourse or assisted reproductive technology. It usually lasts around 40weeks from the last menstrual period (LMP) and ends in childbirth. This is just over ninelunar months, where each month is about 29 days. When measured from conception it is about 38 weeks. An embryo is the developing offspring during the first eight weeks following conception, after which, the term "fetus" is used until birth. Symptoms of early pregnancy may include missed periods, tender breasts, nausea and vomiting, hunger, and frequent urination. Pregnancy may be confirmed with a pregnancy test.
Pregnancy is typically divided into three trimesters. The first trimester is from week one through 12 and includes conception. Conception is when the sperm fertilizes the egg. The fertilized egg then travels down the fallopian tube and attaches to the inside of the uterus, where it begins to form the fetus and placenta. The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus). The second trimester is from week 13 through 28. Around the middle of the second trimester, movement of the fetus may be felt. At 28 weeks, more than 90% of babies can survive outside of the uterus if provided high-quality medical care. The third trimester is from 29 weeks through 40 weeks.
Prenatal care improves pregnancy outcomes. Prenatal care may include taking extra folic acid, avoiding drugs and alcohol, regular exercise, blood tests, and regular physical examinations. Complications of pregnancy may include high blood pressure of pregnancy, gestational diabetes, iron-deficiency anemia, and severe nausea and vomiting among others. Term pregnancy is 37 to 41 weeks, with early term being 37 and 38 weeks, full term 39 and 40 weeks, and late term 41 weeks. After 41 weeks, it is known as post term. Babies born before 37 weeks are preterm and are at higher risk of health problems such as cerebral palsy. Delivery before 39 weeks by labor induction or caesarean section is not recommended unless required for other medical reasons.
About 213 million pregnancies occurred in 2012, of which, 190 million were in the developing world and 23 million were in the developed world. The number of pregnancies in women ages 15 to 44 is 133 per 1,000 women. About 10% to 15% of recognized pregnancies end in miscarriage. In 2013, complications of pregnancy resulted in 293,000 deaths, down from 377,000 deaths in 1990. Common causes include maternal bleeding, complications of abortion, high blood pressure of pregnancy, maternal sepsis, and obstructed labor. Globally, 40% of pregnancies are unplanned. Half of unplanned pregnancies are aborted. Among unintended pregnancies in the United States, 60% of the women used birth control to some extent during the month pregnancy occurred., Sexually transmitted infections (STI), also referred to as sexually transmitted diseases (STD) and venereal diseases (VD), are infections that are commonly spread by sex, especially vaginal intercourse, anal sex and oral sex. Most STIs initially do not cause symptoms. This results in a greater risk of passing the disease on to others. Symptoms and signs of disease may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. STIs acquired before or during birth may result in poor outcomes for the baby. Some STIs may cause problems with the ability to get pregnant.
More than 30 different bacteria, viruses, and parasites can cause STIs. Bacterial STIs include chlamydia, gonorrhea, and syphilis among others. Viral STIs include genital herpes, HIV/AIDS, and genital warts among others. Parasitic STIs include trichomoniasis among others. While usually spread by sex, some STIs can also be spread by non-sexual contact with contaminated blood and tissues, breastfeeding, or during childbirth. STI diagnostic tests are easily available in the developed world, but this is often not the case in the developing world.
The most effective way of preventing STIs is by not having sex. Some vaccinations may also decrease the risk of certain infections including hepatitis B and some types of HPV. Safer sex practices such as use of condoms, having a smaller number of sexual partners, and being in a relationship where each person only has sex with the other also decreases the risk. Circumcision in males may be effective to prevent some infections. Most STIs are treatable or curable. Of the most common infections, syphilis, gonorrhea, chlamydia, trichomoniasis are curable, while herpes, hepatitis B, HIV/AIDS, and HPV are treatable but not curable. Resistance to certain antibiotics is developing among some organisms such as gonorrhea.
In 2008, it was estimated that 500 million people were infected with either syphilis, gonorrhea, chlamydia or trichomoniasis. At least an additional 530 million people have genital herpes and 290 million women have human papillomavirus. STIs other than HIV resulted in 142,000 deaths in 2013. In the United States there were 19 million new cases of sexually transmitted infections in 2010. Historical documentation of STIs date back to at least the Ebers papyrus around 1550 BC and the Old Testament. There is often shame and stigma associated with these infections. The term "sexually transmitted infection" is generally preferred over the terms "sexually transmitted disease" and "venereal disease", as it includes those who do not have symptomatic disease., The placenta (also known as afterbirth) is an organ that connects the developing fetus to the uterine wall to allow nutrient uptake, provide thermo-regulation to the fetus, waste elimination, and gas exchange via the mother's blood supply, fight against internal infection and produce hormones to support pregnancy. The placenta provides oxygen and nutrients to growing babies and removes waste products from the baby's blood. The placenta attaches to the wall of the uterus, and the baby's umbilical cord develops from the placenta. The umbilical cord is what connects the mother and the baby. Placentas are a defining characteristic of placental mammals, but are also found in some non-mammals with varying levels of development. The homology of such structures in various viviparous organisms is debatable, and in invertebrates such as Arthropoda, is analogous at best., Vacuum or suction aspiration uses aspiration to remove uterine contents through the cervix. It may be used as a method of induced abortion, a therapeutic procedure used after miscarriage, or a procedure to obtain a sample for endometrial biopsy. The rate of infection is lower than any other surgical abortion procedure at 0.5%., Ectopic pregnancy, also known as eccyesis or tubal pregnancy, is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding. Less than 50 percent of women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may result in a fast heart rate, fainting, or shock. With very rare exceptions the fetus is unable to survive.
Risk factors for ectopic pregnancy include: pelvic inflammatory disease, often due to Chlamydia infection, tobacco smoking, prior tubal surgery, a history of infertility, and the use of assisted reproductive technology. Those who have previously had an ectopic pregnancy are at much higher risk of having another one. Most ectopic pregnancies (90%) occur in the Fallopian tube which are known as tubal pregnancies. Implantation can also occur on the cervix, ovaries, or within the abdomen. Detection of ectopic pregnancy is typically by blood tests for human chorionic gonadotropin (hCG) and ultrasound. This may require testing on more than one occasion. Ultrasound works best when performed from within the vagina. Other causes of similar symptoms include: miscarriage, ovarian torsion, and acute appendicitis.
Prevention is by decreasing risk factors such as chlamydia infections through screening and treatment. While some ectopic pregnancies will resolve without treatment, this approach has not been well studied as of 2014. The use of the medication methotrexate works as well as surgery in some cases. Specifically it works well when the beta-HCG is low and the size of the ectopic is small. Surgery is still typically recommended if the tube has ruptured, there is a fetal heartbeat, or the person's vital signs are unstable. The surgery may be laparoscopic or through a larger incision, known as a laparotomy. Outcomes are generally good with treatment.
The rate of ectopic pregnancy is about 1 and 2% that of live births in developed countries, though it may be as high as 4% among those using assisted reproductive technology. It is the most common cause of death during the first trimester at approximately 10% of the total. In the developed world outcomes have improved while in the developing world they often remain poor. The risk of death among those in the developed world is between 0.1 and 0.3 percent while in the developing world it is between one and three percent. The first known description of an ectopic pregnancy is by Albucasis in the 11th century. The word "ectopic" means "out of place"., Subject: abortion, Relation: medical_specialty, Options: (A) endocrinology (B) infection (C) obstetrics (D) surgery
Output:
obstetrics