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.  Infections account for one-third of abortion-related deaths in the United States.  The rate of complications of vacuum aspiration abortion in the first trimester is similar regardless of whether the procedure is performed in a hospital, surgical center, or office.  Preventive antibiotics (such as doxycycline or metronidazole ) are typically given before elective abortion,  as they are believed to substantially reduce the risk of postoperative uterine infection.   The rate of failed procedures does not appear to vary significantly depending on whether the abortion is performed by a doctor or a mid-level practitioner .  Complications after second-trimester abortion are similar to those after first-trimester abortion, and depend somewhat on the method chosen.