Out of 9344 first trimester elective abortions performed by vacuum aspiration, 37 uterine perforation cases occurred. The suction cannula was responsible for more than 50% of perforations. All cases were multiparous. In 56.8%, the duration of gestation was 6 weeks or less. One third of the cases had a history of child birth within the previous 6 months. Fundal and anterior wall perforations were most common. Cases with a retroverted uterus had a higher incidence of perforation (59.4%) than those with an anteverted uterus (32.4%). Exact pelvic assessment and proper technique and case management are important for preventing perforation.