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 mu g 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. Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics.