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Medical or Surgical Abortion: Finding the Right Option for You
- vickilew
- 2 days ago
- 6 min read
An abortion is a safe, specialist-supervised medical intervention that ends a pregnancy. In Singapore, two options are commonly offered: medical abortion (medication-based) and surgical abortion (procedure-based).
The most appropriate method depends on the age of the pregnancy, patient’s medical history, and personal preference. This article aims to cover each option in detail so as to assist you in making an informed decision.
Medical Abortion
Medical abortion uses prescription-only medication to end a pregnancy. It is typically offered within the first 70 days of pregnancy. It involves two steps, and it must be supervised by a MOH-accredited abortion specialist:
Step 1 – Mifepristone (RU486): Mifepristone, also known as RU486, is a prescription-only medication that is only found in licensed abortion clinics and hospitals. It is taken orally in the presence of an abortion specialist. RU486 works by blocking progesterone, which is essential for maintaining a pregnancy. It also ripens the cervix, thus priming the womb to respond to the second medication, Misoprostol (Cytotec). RU486 can take between 24 to 48 hours to take effect. Dr Daniel Koh’s research was instrumental in bringing mifepristone to Singapore and helped shape medical abortion care in the country.
Step 2 – Misoprostol (Cytotec): Misoprostol is the second medication which is usually taken 24 to 36 hours after Mifepristone. Misoprostol is a medication that is used to treat ulcers in the stomach and small intestine but is a crucial component of medical abortion. It can be administered under the tongue, inside the cheek, or vaginally. The route of administration is based on the discussion between the abortion specialist and the patient. Misoprostol causes uterine contractions that are necessary to expel the pregnancy tissue. Severe cramps and vaginal bleeding can start as quickly as 20 minutes. Other potential medication-related side effects may include nausea and vomiting, fever, chills and rigors, and diarrhea.
Step 3 - Post Abortion Follow Up Visit(s): During the follow-up appointment, the abortion specialist would perform a pelvic ultrasound to look for retained pregnancy tissue in the womb. It is normal to still experience some abdominal cramps and vaginal bleeding. Sometimes, the retained tissue can cause inflammation and infection and a course of antibiotics may be prescribed. The exact number of visits depends on your progress toward recovery.
Surgical Abortion
Surgical abortion in Singapore is a day surgery procedure performed by a MOH-accredited abortion specialist. It is an option for pregnancies up to 12 weeks and 6 days old, although practices may vary among abortion specialists. Surgical abortion is usually conducted in a licensed medical facility (clinic, day surgery or hospital) under sedation or general anaesthesia.
In Daniel Koh Clinic, our surgical abortions are always performed in a Day Surgery Centre or Hospital setting under the supervision of a specialist anaesthetist. The abortion procedure is usually performed under ultrasound guidance. This means that the abortion specialist can visualise the entry of the suction curette into the womb in real time. This additional step can enhance the complete emptying of the womb and safety of the procedure.
After surgical abortion, the patient is expected to return for a review within one to two weeks. This is to ensure that there are no postoperative complications such as heavy bleeding or infection.
For pregnancies between 13 and 23 weeks, abortion is usually carried out in the hospital.
The protocol involves giving mifepristone one day before the planned admission date. The patient is then admitted and vaginal misoprostol is used to abort the fetus. Because the process causes severe pain and heavy bleeding, close medical supervision in the hospital setting is recommended.
Complication rates are also higher for this type of abortion. If your abortion specialist suspects any retained pregnancy tissue in womb, he/she may perform a surgical evacuation to reduce the risk of infection or excessive bleeding.
What Are the Differences Between Medical vs Surgical Abortion in the First Trimester?
The table below summarises key differences between medical and surgical abortion:
Medical Abortion | Surgical Abortion | |
Setting & supervision | Two clinic visits for confirmation of pregnancy, abortion counselling, consent taking and supervised consumption of mifepristone. Post abortion, at least another two visits to ensure success and complete emptying of womb | Two clinic visits to confirm the pregnancy, abortion counselling and consent taking. Procedure in a day-surgery centre/hospital. Post abortion, at least one visit to ensure no complications |
Anaesthesia | None | Sedation or General anaesthesia |
Recovery Timeline | Gentle activity next day; avoid strenuous exercise or intercourse for at least one week | Resume light activity within 24 hours |
Follow-Up | Required to confirm completion and recovery | Advised within 1–2 weeks after procedure |
How to Care for Your Body After Abortion
Avoid strenuous physical activities for at least one week. You may begin light exercises gradually after that.
There is no specific dietary restriction. Some cultures may advocate “confinement” diets and that is acceptable, if desired.
Avoid use of tampons or menstrual cups for at least one week. Use sanitary pads instead.
Avoid vaginal intercourse for at least one week.
Avoid water-related activities for at least one week. This may include swimming, prolonged soaking in bath tubs etc.
Take the medications as prescribed by your abortion specialist. This usually includes antibiotics and painkillers.
If you have any doubts or concerns, you should contact your abortion specialist earlier than later.
What Are the Red Flags to Take Note of?
Seek prompt medical advice if you experience the following signs or symptoms:
Heavy bleeding - This is defined as soaking more than two regular size sanitary pads within an hour for two consecutive hours. It is necessary for your abortion specialist to assess and exclude serious causes of bleeding such as uterine rupture, bleeding from abnormal blood vessel formation in the womb etc. It is also important for your abortion specialist to start medications or interventions to stop or reduce the bleeding.
Fever of 37.6C or higher on two readings an hour apart or a single reading of 38.0C or higher. It is necessary for your abortion specialist to assess and exclude serious causes such as sepsis. It allows your abortion specialist to conduct the necessary investigations and prescribe appropriate antibiotics to treat the infection.
Symptoms of anaemia. This may include feeling tired, lethargic and/or feeling fainter giddy. It is important to alert your abortion specialist so that the necessary investigations can be performed.
Severe pain - This refers to pain that does not resolve despite taking the prescribed painkillers. In the context of a previous caesarean section or womb surgery, this may be due to womb dehiscence or rupture. It is important to alert your abortion specialist so that appropriate imaging studies can be performed.
Legal Eligibility for Abortion Procedure in Singapore
Singapore’s legal position on abortion procedures is set out in the Termination of Pregnancy Act and the accompanying Ministry of Health guidelines, which specify who may obtain an abortion and under what conditions:
What It Means | |
Gestational limit | Permitted up to 23 weeks and 6 days of pregnancy. |
Eligible patients |
|
Mandatory counselling | Pre-abortion counselling by a MOH-accredited counsellor is required. This must be followed by a 48-hour mandatory cooling off period. |
Consent | The procedure must be requested and consented to by the patient herself. |
Authorised providers | Only MOH-accredited abortion specialists authorised under the TOP Act may carry out abortions. This procedure can only be performed in MOH-approved medical facilities. |
Our Abortion Procedure at Daniel Koh Clinic
At Daniel Koh Clinic, we provide abortion services in Singapore in accordance with Singapore’s medical and legal standards. This ensures that we provide a safe and confidential environment for all our patients. Our protocol includes:
Step 1 - Consultation and counselling: You meet with our abortion specialist to confirm your pregnancy, review your eligibility and discuss your options.
Step 2 - Abortion counselling: Our abortion specialist is a MOH-accredited abortion counsellor. He will conduct the abortion counselling personally in a safe and confidential environment. This will be followed by a 48 hour cooling off period.
Step 3 - Decision and consent: After the cooling off period, you will need to return to the clinic to provide your decision. If you decide to proceed with abortion, you will need to provide your written consent. The clinic will do the necessary arrangements based on your decision.
Step 4 - Abortion procedure: The selected medical or surgical abortion is performed as requested.
Step 5 - Follow-up: After completing the abortion procedure, the clinic will arrange for a follow-up appointment. This is to confirm the success of the procedure and to ensure that there are no complications.
Arrange a Confidential Consultation on Abortion Procedures in Singapore at Daniel Koh Clinic
If you are considering an abortion procedure in Singapore, Daniel Koh Clinic offers respectful, confidential, and meticulous specialist abortion care. Every patient’s privacy is treated with absolute discretion, and appointments are handled confidentially from start to finish.
To schedule a confidential consultation, contact us at:
Tel: +65 6025 3345
WhatsApp: +65 8824 3400
Alternatively, fill in the online booking form below and our clinic assistant will get in touch promptly.