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