Types of Abortion
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Surgical termination - Aspiration is a surgical abortion procedure performed during the first 6 to 12 weeks gestation. It is also referred to as suction aspiration, suction curettage, or vacuum aspiration. This is one of the safest and simplest method in surgical procedure.
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Prostagladins - this is a medication to induce early labour as suction is not easy to perform for bigger pregnancies. It can be used till 24 weeks, the legal limit in Singapore.
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Hysterotomy - this is used in cases where prostagladin method fails. The fetus is surgically removed in a process similar to Caesarean section. This is not often done as the above method usually works well.
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Medical abortion - may best be carried out in pregnancy less than 6 weeks.
It uses a combination of two medications. Mifepristone (RU486) and Misoprostol (a Prostagladin). Unfortunately, RU486 is not available and illegal in Singapore. Just using Misoprotol alone may not be that effective.
Medical abortion often causes heavier bleeding than a menstrual period and severe menstrual cramps. Some women experience gastrointestinal discomfort like cramps, nausea and diarrhoea, weakness, dizziness, chills, rigor and headaches. If medical termination fails , the patient will require a surgical procedure to remove the incomplete abortion.
Abortion Procedure
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Pre-operative Preparation
Abortion is usually performed as an outpatient procedure. Abortion is done under sedation. Medications are given to sedate you. When the abortion is completed, you will need about an hour to recover from the drowsiness. Before the abortion, you must not drink or eat for four to six hours. This reduces the risk of food content in the stomach from regurgitating into the lung passages. Do arrange to come with a friend, who will accompany you home. Please do not wear nail polish or any jewellery.
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Post-operative Care
The abortion takes about fifteen minutes, during which you will be asleep. When you come around, you will experience lower abdominal cramps. You may feel drowsy and nauseous. Pain killers and anti-nausea medication are rarely necessary.
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Follow-Up Appointment
You will need to return for a review appointment two weeks after the abortion. Your urine pregnancy test will take about 2-3 weeks to be negative.
Contraceptive issues will be discussed again so as to prevent further unplanned pregnancy. Most of you will have your next period in four to six weeks’ time. If your period is delayed beyond eight weeks, it is important to call in. For two to three week after the procedure, you may want to avoid sexual intercourse in order to minimize the chance of pelvic infection. We will advise you on when it is safe to resume sexual activity when we review you a week later. Emotionally, most of you will feel relieved after the abortion, as the unplanned pregnancy would have kept you worried for a while. Nevertheless, some of you will be overcome by other emotions, such as anger, regret and guilt, which may persist for some time. We strongly encourage you to discuss your reactions with us at anytime. We understand your dilemma and are available to support you through your physical and emotional recovery.
Minimizing Abortion Complication
Abortion or termination of pregnancy, as in any surgical procedure has potential complications. The reason to legalize abortion was to prevent the serious complications that accompany back-street abortions. At our clinic we pride ourselves in making this procedure safe and painless.
Common abortion complications includes:
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Injury to Womb
During abortion, the neck of the womb (cervix) is progressively dilated to allow the smallest vacurette to enter. If the cervix is inadequately dilated, inserting subsequent instruments will be difficult, putting the womb at higher risk of being perforated. Piercing the uterus does not permanently damage the uterus. However additional procedures may have to be performed to diagnose if other abdominal organs are injured. On the other hand, excessive dilating the cervix may lead to problems of infertility and repeated miscarriages.
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Incomplete Removal of Pregnancy
Abortion is normally a “blind procedure” where the products of conception is removed by feel (and not by sight). The complete removal of all products is not guaranteed. Incomplete evacuation, when some of the products or membrane is left in the womb. In cases where it remained stuck to the womb, a repeat procedure is necessary. To minimize this risk we routinely use ultrasound scan to during the procedure.
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Bleeding
Excessive bleeding may follow a successful abortion. In uncomplicated cases, we expect the vaginal bleeding to be mild and last for about a week or two, and it should be bleeding less each day. If you find that your bleeding becomes more and does not appear to be stopping, you need to return to the clinic. Besides incomplete evacuation, you may be developing a womb infection as well.
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Infection
Unpleasant vaginal discharge, running a temperature and having lower abdominal pain are features of an ongoing infection. Inflammation sets in when your womb is trying to respond to left behind products that are degenerating, or when bacteria got into the womb. This complication has to be treated actively with appropriate antibiotics and possibly a repeat evacuation.
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Infertility
Can your abortion lead on to infertility? Abortion is not a contraceptive method, and repeated abortions cause damage to the wall of the womb cavity, causing it to stick to each other in parts of the womb. However if the procedure is done professionally without complications there should be minimum effect on future fertility.
Abortion Services For Foreigners
A woman who is not a Singaporean cannot have her abortion in Singapore if she has arrived on a two-week Social or Tourist Pass (except for emergency). However, a non-Singaporean may request for abortion if she has been residing in Singapore for more than 4 months; and the following documents will be needed:
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Passport with the date of the entry into Singapore;
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Employment pass
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Work permit
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Dependant’s pass
A non-Singaporean/foreigner who arrived in Singapore on a two week social or tourist pass and is found to be suffering from a miscarriage and required the clearance of the pregnancy content from her womb may request for such a surgical procedure. This is not termination of a viable pregnancy, this is considered a gynaecological emergency and does not come under the purview of the Termination of Pregnancy Act. Complications from the miscarriage may occur if left untreated, and therefore delaying treatment can be detrimental to the patient’s health.
Abortion Laws In Singapore
In Singapore, the procedure to terminate a pregnancy is regulated by the Termination of Pregnancy Act (1967) and Guidelines on Termination of Pregnancy (updated 2004). Salient information is represented below: Termination of Pregnancy may be carried out only by authorized medical practitioner in an approved institution. Woman who wishes to have Termination of Pregnancy must meet the following criteria:
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that she is a citizen of Singapore or the wife of a citizen of Singapore
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that she is a holder or the wife of a holder of a work permit pass or employment pass. Holding a temporary work permit by either the woman or husband is not sufficient.
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that she has been a resident in Singapore for at least four months
It is not legal to terminate a pregnancy of more than 24 completed weeks, unless the treatment is immediately necessary to save the life or to prevent grave permanent injury to the physical or mental health of the pregnant woman. The government's approach to abortion regulation is to “ensure that all children born in Singapore are wanted children, who will be properly cared for” (“Singapore sees abortions rise amid recession”, 1 May 2009)
Termination of pregnancy is not without its risk, and it is the duty of the medical practitioners and the government of the land to make it safe for the woman who has to resort to it.
The official grounds for performing induced abortion in Singapore are (1) to save the life of the woman, (2) to preserve physical health of the woman, (3) to preserve mental health of the woman, (4) when the woman was involuntarily impregnated as in an event of rape or incest, (5) when the fetus is discovered to have major defect or impairment, (6) when the woman is incapacitated with economic or social issues and (7) upon request of the woman. Studies have found that majority of induced abortions are for social or economic reasons (>80%).