1. Mandatory TOP counselling
   You will need to attend a mandatory counselling before the TOP. A 48-hour cooling off period is required by the Singapore law before the TOP is performed.
   
   
2. What does it involve?
   Surgical TOP involves a minor operation. There are two types of surgical TOP: vacuum aspiration and dilatation and evacuation. An ultrasound scan is also performed at the same time to reduce the risk of complications and make sure that all the pregnancy tissues are removed.
   
   Vacuum aspiration can be done under local anaesthesia (an injection to numb the cervix) or general anaesthesia (where you are asleep). The cervix (neck of the womb) is widened (dilated) and the pregnancy tissues are removed from the womb using a gentle suction.
   
   For pregnancies up to 10 weeks gestation, the procedure can be done under local anaesthesia in the outpatient clinic, while you are awake, hence avoiding the need for a general anaesthesia. However, this can also be done under general anaesthesia in the operating theatre for up to 12 weeks gestation as some women may prefer to undergo the procedure under general anaesthesia.
   
   Dilatation and Evacuation (D&E) can be done under regional anaesthesia (an injection to numb a part of the body, in this case, waist down with you being awake) or general anaesthesia. The cervix is dilated, and the pregnancy tissues are removed in pieces using special forceps and vacuum suction. This procedure is performed after 12 weeks gestation.

1. Vaginal bleeding
   You can expect to experience minor vaginal bleeding, and this may last for 8-10 days. Excessive vaginal bleeding occurs in around 1 in 1000 women and blood transfusion may be necessary. The risk increases to 4 in 1000 women when TOP is carried out after 20 weeks of pregnancy. In rare situations, where bleeding cannot be arrested, your womb may need to be removed.
   
   
2. Infection
   Up to 1 in 10 women will get an infection after TOP. You may be screened for infection or given antibiotics to reduce your risk of getting an infection. About 1% of women will still develop pelvic infection and in severe cases, you may need hospitalisation and intravenous antibiotics (through a drip).
   
   
3. Failure to terminate the pregnancy or retained pregnancy tissues
   This happens in less than 1 in 100 women (for pregnancy less than 14 weeks gestation) and up to 3 in 100 women (for pregnancy above 14 weeks gestation). You may require a repeat procedure to remove the pregnancy.
   
   
4. Uterine perforation
   Perforation of the wall of the womb may happen in 4-7 in 1000 women which may require additional surgery to repair the injury. There is also risk of injury to surrounding organs like the bladder or intestines (3 in 1000 women).
   
   
5. Damage to the cervix
   Trauma to the cervix is uncommon, up to 1 in 100 women. Significant trauma may lead to miscarriage or preterm delivery in future pregnancies.
   
   
6. Menstrual abnormalities/Asherman’s syndrome
   Scarring of the womb lining (Asherman’s syndrome) is rare and may lead to menstrual abnormalities and difficulty conceiving in the future.

1. Excessive vaginal bleeding
   If you experience heavy bleeding (TWO pads an hour for TWO consecutive hours)
   
   
2. Abdominal pain
   If you experience severe lower abdominal pain not relieved by painkillers prescribed
   
   
3. Fever
   
   
4. Foul-smelling vaginal discharge
   
   
5. Feeling generally unwell

1. Antibiotics
   Taking antibiotics can reduce your risk of getting infection. You should complete the course of antibiotics prescribed to you.
   
   
2. Painkillers
   You will be given some painkillers to be taken as required for the abdominal cramps.
   
   
3. Cabergoline
   You may be prescribed cabergoline tablets to stop breast milk production if your pregnancy is more than 20 weeks gestation.
   

The information above is also available for download in pdf format.