Aim : To compare the efficacy, side effects and patient satisfaction between oral 400 microgram misoprostol and vaginal 400 microgram misoprostol in management of blighted ovum.Material and Method : 60 women diagnosed as have blighted ovum divided into two groups each group contain 30 women. group(A) received 400 microgram misoprostol vaginally .group(B) received 400 microgram orally.If no effect appear after 6 hour the patient will received another dose . some parameters will be registered as induction evacuation interval, side effects and patient satisfaction to compare between two groups.Results : 30 patients were randomized to receive 400microgram vaginally and 30 patients were to receive 400 microgram misoprostol orally.In vaginal group: 3(10%) patients administrated only one dose of 400mcg misoprostol. 2(6.7%) patients got complete abortion and 1(3.3%) patient need surgical evacuation. 27(90%) patients administrated two doses of 400mcg misoprostol. 16(53.3%) patients got complete abortion and 11(36.7%) patients need surgical evacuation.Nausea and abdominal pain were the only side effects appeared in the vaginal group. One patient (3.3%) got nausea and 28 patients (93.3%) got abdominal pain. In the oral group: 3(10%) patients administrated only one dose of 400mcg misoprostol. 1(3.3%) patients got complete abortion and 2(6.7%) patient need surgical evacuation. 27(90%) patients administrated two doses of 400mcg misoprostol. 20(66.7%) patients got complete abortion and 7(23.3%) patients need surgical evacuation.Nausea, vomiting and abdominal pain were side effects appeared in the oral group. 5 patients (16.7%) have got nausea, 3 patients (10%) have got vomiting and 28 patients have got abdominal pain.Conclusions : 400 microgram of vaginal misoprostol are as effective as 400microgram orally in producing complete abortion in blighted ovum with less side effects in vaginal group and patient satisfaction more better in oral group.