Physicians' approaches to post-abortion care in Manila, Philippines

Objective: To assess the knowledge and practice of health professionals in Manila, Philippines, regarding methods used for uterine evacuation in post-abortion care (PAC), including the use of misoprostol. Methods: A purposive sample of physicians providing PAC services completed questionnaires anonymously about PAC practices. Results: Among 45 survey respondents, the primary methods used for first-trimester uterine evacuation in PAC included sharp curettage (n = 45, 100%) and manual vacuum aspiration (MVA; n = 38, 84.4%), which was consistent with their preferences. Misoprostol was prescribed for first-trimester post-abortion uterine evacuation by 55.6% (n = 25) of respondents; dosing regimens ranged from 50 to 200 μg as a single dose or repeated every 4-24 hours. Of the respondents, 91.1% (n = 41) prescribed misoprostol for obstetric indications, including labor induction and postpartum hemorrhage. Conclusions: Most respondents used sharp curettage and MVA for first-trimester post-abortion uterine evacuation, and did not express a clear preference for either method. Despite the unregistered status of misoprostol, it was used in obstetrics and PAC by a majority of study respondents. The doses of misoprostol used for post-abortion uterine evacuation are lower than those recommended by evidence-based studies. The results indicate the need to disseminate evidence-based information about safe and effective use of MVA and misoprostol for PAC to physicians in Manila, Philippines.