Background: Research conducted by specialists does not show that oral misoprostol is more successful than vaginal misoprostol to manage early pregnancy loss, and vice versa. Objective: To compare oral versus vaginal misoprostol for managing early pregnancy loss. Subjects and Methods: A prospective randomized controlled trial that was performed on 102 women attending to Obstetrics and Gynecology Department and diagnosed with missed abortion on ultrasound. They were divided into 2 groups. (Group A: Vaginal Misoprostol): Intravaginally into the posterior fornix, 51 patients were administered 600 μg of misoprostol soaked in normal saline solution, which was repeated three-hourly up to a maximum of two doses. Group B (Oral Misoprostol): Misoprostol 600 g was orally administered to 51 patients with a maximum of two doses, each separated by three hours. Results: All of incidence of hypotension, mean of satisfaction, and mean of successful rate were statistically significantly higher as compared with the cases in group B. incidence of side effects was statistically significantly higher in the cases of group B as compared with the cases in group A. Mean induction-expulsion interval in the cases of group A (9.5±3.3) was shorter as compared with the cases in group B (10.8±2.2) with non-statistically significant difference (p=0.078). conclusion: Misoprostol use by the vaginal route is more efficacious than oral route. Vaginal route was found to have cervical ripening effect and did not need much monitoring to become the first choice even over surgical for induction of labor.