Background: Abortion is defined as spontaneous or induced termination of pregnancy (TOP) before fetal viability. It is essential that all healthcare providers (HCP) identify the frequency of abortion, the available modalities, the safety, the limitations, and the access issues accompanied by abortion to have the ability to offer safe and optimum quality of care (QoC) to the cases. Objective: This study aimed to compare the efficiency and safety of suction evacuation versus surgical evacuation in management of patients with first trimester missed and incomplete abortion. Patients and methods: This prospective randomized clinical comparative study was conducted on 200 patients who were randomly divided into: Group A (suction evacuation group): 100 patients undergoing Manual vacuum aspiration (MVA) and group B (surgical evacuation group): 100 patients and they underwent surgical evacuation Results: The length of hospital stay (LOS) in hours was statistically significantly longer in the surgically evacuated group (p < 0.001). There was insignificant difference between the two groups concerning incidence of successful complete evacuation and the complications of the procedure. Patients' satisfaction in both studied groups was significantly increased in the MVA group (p= 0.021). The pain severity (assessed by VAS score) was significantly increased in the surgically evacuated group (p < 0.001). Conclusion: MVA is safe, effective and a better option than surgical evacuation for surgical management of abortion. This is attributed to its less time consuming, shorter hospital stays and more patient satisfaction. MVA is an acceptable and satisfactory alternative approach for patients with first-trimester abortion.