Background: Abortion is a common complication of early pregnancy that can have both medical and psychological consequences. Complications following spontaneous or induced abortion are a major cause of maternal morbidity. Objective: To better management and improving outcome of first trimestric miscarriage. Patients and Methods: A randomized clinical trial study was conducted at obstetric outpatient clinic, Gynecology and Obstetrics Department, Zagazig University during the period from May 2019 until June 2021. The study included 52 women suffering from abortion who were randomized to receive either medical treatment: 800 µg misoprostol prescribed as 400 mg orally and 400 mg vaginally or surgical treatment: evacuation with dilatation and curettage. All patients were followed up with a transvaginal ultrasonography (U/S). Results: The mean of endometrial thickness after treatment was 12.5±2.65 mm and 8.3±1.97 mm in misoprostol and surgical evacuation group respectively, the difference between both groups was statistically significant (p < 0.05). Failed treatment was in 8 (30.7%) patients in misoprostol group and in 2 (7.7%) patients in surgical evacuation group. The difference in failure rate between both groups was significant statistically. Conclusions: A single dose of 800µg misoprostol given as outpatient treatment may be used as first line in management of incomplete abortion.