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Setting Up a Dedicated Abortion Service and Introducing a New Medical TOP Regimen for Safer Patient Care and Better Experience
Project team members: Dr Seet Meei Jiun, Dr Aimee Teong, APN Zhong Yu Ting, Dr Manisha Mathur

Termination of pregnancy (TOP) of an unwanted pregnancy is an essential component in women's health. A comprehensive abortion service should include the provision of legal, safe, stigma-free and high quality service. Post-abortion care, contraception provision and collaboration with medical social services and mental health professionals for holistic care of the women are also essential.

The setting up of a one-stop TOP clinic run by dedicated staff with a standardised protocol has improved the efficiency of abortion care and enhanced patients' experience. Patients who are admitted to the ward for TOP are separated from other patients to allow more sensitive and respectful care.

Based on studies and international guidelines, medical TOP performed with a combined mifepristone (an anti-progestin) and prostaglandin regimen has been proven to be safe and effective. It can be used from early gestation upon confirmation of pregnancy, up to 24 weeks of gestation, the legal gestational age for abortion in Singapore.

The introduction of combined medical TOP regimen allowed women in the first trimester of gestation to have another option other than surgical treatment. Medical TOP enable women to avoid some surgical and anaesthesia complications. This also frees operating theatre space for other gynaecological surgeries.

For women in the second trimester, this regimen resulted in a significant reduction in the median induction to abortion interval (from 834 to 416 minutes), number of prostaglandin doses needed to achieve abortion (from 3 to 2 doses) and length of hospital stay (from 3 to 2 days). The number of women requiring surgical evacuation of uterus for incomplete abortion was also reduced from 41.6% to 14.1%.