Abortion (Termination of Pregnancy)

An abortion involves terminating a pregnancy (TOP). This can be for various reasons and can only be performed by a licensed gynaecologist. Different countries have different regulations regarding TOP. In Singapore, TOP can only be performed when a viable pregnancy (with a heartbeat) has been confirmed inside the uterus, and after 48 hours following compulsory abortion counselling. The legal limit is up to 24 weeks of pregnancy. 

What tests do I need to do before I can get an abortion?

Your gynaecologist will need to take a detailed medical history, do a pelvic examination and perform a transvaginal pelvic ultrasound to determine how many weeks you are pregnant. Vaginal swabs to rule out sexually transmitted infections (STIs) may be offered. Serial blood tests to measure your pregnancy hormone (b-hcg) may be needed if the pregnancy is still early and cannot be seen on ultrasound. You will also need blood tests to check your blood count and blood group. 

What are the methods of abortion?

For early pregnancy, there are 2 methods – medical and surgical.

Medical abortion

This is suitable for pregnancies up to 70 days old. It is 80-90% effective and involves taking oral tablets (which may need to be repeated) that will induce cramps and bleeding. The tablets can be taken at home. If bleeding is heavy and continuous, you will be advised to go to the Emergency Department. Risks of medical abortion include:

Common

• Nausea, vomiting, diarrhea, fever, shivering (up to 60%): these are side effects of the tablets. Your gynaecologist may prescribe medications for standby.
• Incomplete abortion (up to 20%): this is when you experience cramps and bleeding but the pregnancy is not completely passed out. You will be required to undergo surgical evacuation (which is similar to surgical abortion) to clean out the uterus. This is a day surgery procedure under general anaesthesia. 
• Failed abortion (4-5%): this occurs when you do not respond to the tablets. You will need to undergo surgical abortion.

Uncommon

• Bleeding requiring blood transfusion (1%)
• Infection (1%)
• Uterine rupture due to strong contractions (<0.1%)

You should expect cramps and bleeding to start within a few hours of taking the tablets, which will be like a heavier-than-usual period that will last for 1-2 days, following which the cramps and bleeding will slow down after you pass out clots and pregnancy tissue. Your gynaecologist will schedule a follow-up appointment with you after the bleeding has settled to check that the medical abortion has been successful. 

Surgical abortion

This is suitable for pregnancies up to 11 weeks. It is 95% effective and involves a day surgery procedure under general anaesthesia. A thin vacuum tube is inserted into your uterus through the cervix to remove the pregnancy products through suction. This takes 5 to 15 minutes and most women will be able to go home on the same day. You will be asked to take some oral tablets 3 hours before the procedure to prepare your cervix (neck of the womb) – this may cause some cramps and spotting.  Risks of surgical abortion include:

Common

• Infection
• Retained pregnancy products: this will require a 2^nd procedure to wash out the uterus

Uncommon 

• Cervical trauma
• Uterine perforation: this will require a laparoscopy to stop bleeding, check for injuries to surrounding organs e.g. intestines, bladder etc and for additional stitches if needed
• Failed abortion and continuing pregnancy requiring further interventions
• Excessive bleeding requiring blood transfusion 

Rare 

• Anaesthesia complications
• Asherman’s syndrome (scar tissue formation within womb cavity causing problems with periods and infertility)
• Cervical incompetence: weakening of the neck of the womb leading to problems with subsequent pregnancies
• Death: the risk is approximately less than 3-8 in 100 000

Mid-trimester termination of pregnancy (MTPT)

If your pregnancy has gone beyond 12 weeks, you will need to undergo MTPT. This involves hospitalisation of at least 2 days, with vaginal tablets inserted every few hours. The process may feel like a mini-labor, with cramps and bleeding before the pregnancy is passed out. There will be painkillers given, and the risks are similar to medical abortion above.

20% of women may have incomplete MTPT and require surgical evacuation of uterus. This procedure is similar to surgical abortion.

Birth control

Multiple abortions can be harmful for your physical and mental health. If you are not planning for pregnancy, there are many birth control methods available. Most can be started immediately after your abortion – do speak to your gynaecologists about the options available for you.