Urogynaecology & Pelvic Reconstructive Surgery,
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What Is Medical Abortion?

Medical abortion refers to terminating an early pregnancy (of less than 63 days) without surgery, using only abortion pills. Medical abortion began in the 1970s when scientists formulated abortion-inducing medications to act on the uterus. Medical abortion involves opening the cervix and generating uterine contraction to expel the content of pregnancy. Unlike surgical TOP, which vacuums out the pregnancy over a few minutes, medical abortion typically stretches from several days to weeks. Over the years, various protocols were established using different pharmacological agents, either on its own or in combination. Surveys in the US, UK and Canada have suggested that more than 50% of eligible women may opt for medical abortion.

Advantages of medical abortion

The popularity of medical abortion rests on the avoidance of surgical intervention. The advantages are as below:
    No injury to the cervix (neck of the womb).
    No injury to the womb and no risk of perforating the uterus.
    No need for anaesthesia.
    Offers more privacy and control by the woman.
    May be use in communities with limited access to a trained doctor who performs surgical abortion.

Medical abortion protocol

During the initial consultation, the diagnosis of an intra-uterine pregnancy will be established after performing the pelvic ultrasound examination. The clinic will arrange for the mandatory pre-TOP counseling at the appropriate time. The doctor will discuss the feasibility of a medical abortion upon consideration of the gestational age and other patient factors. At least 48 hours after the pre-abortion counseling, one of the common protocols will be implemented. The regimen will last seven days, and will use prostaglandin alone or in combination. The woman will return to the clinic on day three and day seven to inspect on the progress of the medical abortion.

What is a successful medical abortion?

A medical abortion is successful if the pregnancy content is completely expelled. It is deem to have failed when surgical evacuation is necessary to empty the uterus because (1) the pregnancy continues to be viable, (2) the pregnancy is not completely expelled, (3) there is excessive bleeding, or (4) the woman requests to terminate the protocol promptly. The success rate of medical abortion various by the definition of the end point, for example, completely empty by one week, or by the second week will give different figures. Many studies have shown respectable outcomes, mostly above 90%; and those that were performed before 49 days have better success than those carried out before 63 days.

Complications of medical abortion

When the effect of the abortion pills kicks in, the woman will experience a host of complaints, such as – nausea, vomiting, diarrhea, abdominal cramps, headache and fever. The vaginal bleeding and uterine pain will intensify until complete expulsion. The contraction pain may persist for hours or even days in those with tight and stenotic cervix. After removing the bulk of the pregnancy, the pain and bleeding subside. It will not cease bleeding if substantial pregnancy products remain un-discharged. In clinical practice, about 10-25% of woman who embarked on medical abortion require a suction curettage to expedite the abortion process.

Cost of medical abortion

Medical abortion costs $1000+GST for an intra-uterine pregnancy of less than 49 days, and $1200+GST for pregnancy of less than 63 days. The protocol includes the medications and ultrasound examinations during the three office-hours clinic consultations. There will be separate and additional costs for after-office consultation (within the protocol period), subsequent visits (beyond the protocol period) and any surgical procedures.

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Singapore 820681
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