Types of Abortion Surgery in Singapore
By Singapore law, abortion is legal and accessible, but only if the pregnancy has not exceeded 24 weeks (6 months) of gestation. Late-term terminations are prohibited unless the pregnancy puts the mother’s life at risk, or if the fetus is found to have a serious abnormality. There are many methods by which an abortion can be carried out, depending on how far along the pregnancy is, as well as the patient’s overall health and preference.
In Singapore, two types of abortion surgery are conducted, which are:
Pregnancies 8 to 12 weeks can be terminated via suction or vacuum aspiration, where the contents of the womb are gently suctioned out through the cervix via a cannula attached to a manual or electric pump. The procedure is painless and typically takes only 10 minutes with the patient able to go home within three hours following a brief observation and recovery period at the clinic. The patient is also advised to fast for 6 hours before the procedure.
MID-TRIMESTER TERMINATION OF PREGNANCY (MTPT)
A combination of medication and surgical procedures are performed to terminate pregnancies from 13 to 24 weeks. Medicines like misoprostol are first administered vaginally at regular intervals, causing the uterus to contract and naturally expel pregnancy tissues. Afterwards, a method known as dilation and evacuation (D&E) is done to ensure the complete evacuation of the womb.
Here, the doctor inserts a speculum into the vagina and applies laminaria sticks or osmotic dilators in the cervical opening to further relax and stretch the cervix open. Once the cervix is fully dilated and numbed with an anesthetic, the pregnancy tissues will be removed via forceps and vacuum aspiration. A curette, a spoon-like surgical instrument, may also be used to scrape off remaining tissues from the uterus.
MTPT is a more complicated procedure than vacuum aspiration, and may require staying in the hospital for 1 to 2 days.
POTENTIAL COMPLICATIONS OF ABORTION
Abortions are very safe, but only if done by or under the supervision of a certified and experienced doctor. However, while the occurrence is rare, the procedure does come with potential risks and complications, which include:
Bleeding– Mild bleeding lasting up to 1 to 2 weeks are common following successful abortion surgery. Prolonged and excessive bleeding, especially when accompanied with a fever and abdominal pains, may be a sign of infection, and require the immediate attention of a doctor.
Incomplete Evacuation of The Womb– Occurring in less than 1% of all abortions, this happens when pregnancy tissues and membranes were not completely evacuated from the uterus. The risk is higher with those with an abnormally shaped uterus, or if the embryo is implanted in the peripheral regions of the womb. If untreated, it can result in heavy bleeding and infections.
Pain– Similar to bleeding, mild pain and cramping after the abortion surgery are normal and expected. Intense and persistent pain that cannot be alleviated with pain relievers may indicate an ectopic pregnancy, infections or an incomplete evacuation of the womb.
Pelvic Infection– Characterized by sharp abdominal pains, fevers and an unpleasant vaginal discharge, pelvic infections occur when bacteria or other disease-causing microorganisms enter the reproductive organs whether via the dilated cervix or the instruments used to carry on the abortion. Infections may also develop from degenerating pregnancy tissues that were not completely evacuated from the womb. Though uncommon, infections account for 30% of surgical-abortion-related deaths.
Injury to The Womb– During surgical abortions, there’s a danger that the instruments used, including the cannula, forceps and curette, may pierce through the uterus and injure other abdominal organs. The likelihood of this happening, however, is slim at 0.8 to 1.4 in 1,000 procedure. The risk of injuring the cervix during the dilation process is also low at less than 1 in 100 operations.
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