For elective abortion, ultrasound is helpful in the determination of gestational age prior to elective procedures and in the localization of the amniotic sac prior to midtrimester intraamniotic injection. According to various reports, ultrasound is potentially useful in determining whether products of conception remain after an elective procedure. 2 cases are described in which the use of real-time ultrasound during an elective abortion procedure aided the operator and very likely reduced the risk of significant complications. In the 1st case of a 43-year-old white, married woman, para 2-0-0-2, the cervix was dilated and an 8 mm suction catheter was introduced. Despite multiple attempts, no products of conception were obtained. With the use of ultrasound direction, the catheter (visible on ultrasound) was reintroduced and directed toward the gestational sac past the leiomyomas that protruded into the cavity. The uterus was evacuated without further difficulty, and the patient subsequently did well. The 2nd case was that of a 26-year-old, black primigravid woman who presented for an elective therapeutic abortion at 17 weeks' gestation. With the patient under local anesthesia, the cervix was dilated to 14 mm and a 14 mm plastic suction catheter was introduced. The procedure was performed without difficulty, except that, despite the use of various extraction instruments, the vertex could not be located and removed. With the use of ultrasound visualization, the grasping forceps (visible on ultrasound) were introduced and directed toward the vertex, enabling its removal with minimal difficulty. The patient tolerated the procedure well and had no further difficulty. As illustrated by these 2 case reports, the use of ultrasound to guide the suction catheter or other extraction instruments has proved to be very useful. Although direct sonar visualization may be needed only occasionally, this technique should be valuable in reducing the incidence of retained products of conception, failed procedures, and perforations that may complicate difficult abortion operations. It is recommended that the availability of ultrasound should not encourage the operator to perform procedures that otherwise would have considerable risk.