Experience is reported with 28 uterine perforations encountered from June 1,1973, to June 1,1976, among 20,000 first trimester abortion patients at Reproductive Health Services, St. Louis, Missouri. In order to prevent this complication, one must perform an exacting pelvic examination. The use of a sound is controversial. Dilators should be introduced only a short distance through the internal os, and as much of the products of conception as possible should be aspirated. A sharp curette should be used diagnostically. Various questions should be asked before the operator contructs a scheme for managing perforation. The current policy for management used at this clinic is outlined.