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Vacuum aspiration in the first trimester is the safest method of surgical abortion, and can be performed in a primary care office, abortion clinic, or hospital.Complications are rare and can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate.

The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable.In the third trimester of pregnancy, induced abortion may be performed surgically by intact dilation and extraction or by hysterotomy.Hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia.There is little difference in terms of safety and efficacy between medical abortion using a combined regimen of mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early first trimester abortions up to 9 weeks gestation.Medical abortion using the prostaglandin analog misoprostol alone is less effective and more painful than medical abortion using a combined regimen of mifepristone and misoprostol or surgical abortion.

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