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MEDICAL ABORTION

Currently both Abortion pills used for Medical Abortion has been approved for use in Singapore. The abortion pill is in fact two medicines. The first medicine ends the pregnancy and is named mifepristone. It works by blocking the hormone progesterone. Without progesterone, the lining of the uterus breaks down and the pregnancy cannot continue.

The second medicine, misoprostol makes the womb contract, causing cramping, bleeding and the loss of the pregnancy similar to a miscarriage.
Medical Abortion
  1. This is a procedure that uses medication to end an unwanted pregnancy;
  2. It does not require surgery, anaesthesia or hospitalisation.

Pre-conditions
  1. You need to undergo Abortion Counselling and have a 48-hour waiting period before undergoing the procedure in compliance with the Termination of Pregnancy Regulations;
  2. Your pregnancy should be less than 63 days after the first day of the last menstrual period (9 weeks' gestation);
  3. You must adhere strictly to the Protocol. Failure to do so may result in failure or complications.

Procedure

For pregnancies up to 9 weeks' gestation, you will take the first medicine mifepristone in clinic. You will take the second medicine, misoprostol either at home or in the clinic 2 days later.

You will be given some antibiotics to take, pain medicine with instructions for use and advice on how to care for yourself. You will complete the abortion at home, whether you use the misoprostol in the clinic or at home. You may feel more at ease if you have someone with you for this process.

You may have nausea or vomiting after taking mifepristone. If you vomit within 1 hour of taking it, please inform the clinic as soon as possible as you may need to take the pill again. Most women do not have pain or bleeding until they take misoprostol. However, if you think you may have miscarried between taking the mifepristone and misoprostol please contact us for advice.

Misoprostol tablets are either placed in the vagina or between the cheek and gum as directed by the clinic.

Use sanitary towels to monitor your bleeding during early medical/abortion pill treatment.

Misoprostol (the second medication), causes strong painful cramps and heavy bleeding. Bleeding and cramping usually starts 1 to 2 hours after using misoprostol. Bleeding and pain are often the greatest when the pregnancy is being expelled. Most women pass the pregnancy within 4 hours - timings vary, but it is OK if this happens sooner or later. Almost all women miscarry within a few days. You will be given painkillers to help you manage the pain.

You may bleed heavily - possibly more than a period, and see large blood clots (as big as a lemon), or other tissue when you pass the pregnancy. The tissue is larger and more recognisable at higher gestations.

For Pregnancy under 8 weeks, you may see the pregnancy sac which is white and fluffy with brown-red tissue surrounding it. A 9 week fetus is about the size of an olive and you may recognise its shape. If you are worried about what you may see when the abortion happens, please discuss this with the clinic.

Once the pregnancy passes the amount of bleeding and cramping should noticeably reduce. It is likely you will feel cramping on and off for a week or so and this should be easily managed with mild painkillers. After the pregnancy passes most women will have light bleeding for about two weeks, but you can have spotting up to your next period. You may have a short episode of pain with a gush of blood or a clot several weeks after the abortion - contact us if this continues.

If you have not started to bleed within 24 hours of taking the misoprostol contact the clinic for advice.

In case of emergencies please call the clinic or doctor for advice. (see Emergency Situations (I)).

What to expect and side-effects

Common:
  1. Vaginal bleeding (may last up to 2 weeks)
  2. Abdominal cramping (which may need medications);

Uncommon
  1. Nausea, vomiting
  2. Diarrhoea
  3. Fever, chills
  4. Headache
  5. Dizziness

Risks of the Procedure
  1. Incomplete abortion, which may need surgical evacuation. This happens in about 5%-10% of patients.
  2. Continuing pregnancy (termination cases), which may need surgical abortion. (less than 1% of patients)
  3. Heavy and prolonged bleeding (less than 1% of patients need emergency curettage for excessive bleeding).
  4. Infection (less than 5%). Rarely, serious cases of toxic and septic shock have been reported.

Contra-indications

Medical Termination or Evacuation of Uterus should NOT be done if you:
  1. Have certain medical conditions – liver disease, kidney disease, cardiovascular disease,bleeding disorder, malnutrition, severe asthma, adrenal failure, lung disease, uncontrolled,epilepsy
  2. Are on certain medications – blood thinners, steroid medications;
  3. Are allergic to the medications used;
  4. Have a suspected Ectopic Pregnancy;
  5. Have an Intra-Uterine Device (IUD);
  6. Are unable to make follow-up visits or have no access to emergency medical services;
  7. Are deemed by your doctor to be too advanced in the pregnancy.

Emergency Situations

Call your doctor if you have:
  1. Heavy bleeding (soaking 2 or more pads an hour);
  2. Severe abdominal or back pain;
  3. Fever lasting over 24 hours;
  4. Foul smelling vaginal discharge