Aim : To compare the efficacy, side effects and patient satisfaction between oral 800 microgram misoprostol and vaginal 800 microgram misoprostol in management of frist trimester missed abortion. Material and Method : 80 women diagnosed as having missed abortion divided by (sealed envelope technique) into two groups each group contain 40 women. Group (A) received 800 microgram misoprostol orally ; group(B) received 800 microgram vaginally.If no effect appeared after 6 hours the patient received another dose 400mcg . some parameters will be registered as induction evacuation interval, side effects and patient satisfaction to compare between two groups. Results : 40 patients were randomized to receive 800microgram vaginally and 40 patients were to receive 800 microgram misoprostol orally. In vaginal group: 4(10%) patients administrated only one dose of 800mcg misoprostol. 3(7.5%) patients got complete abortion and 1(2.5%) patient need surgical evacuation. 36(90%) patients administrated two doses of 800mcg and 400mcg misoprostol. 21(52.5%) patients got complete abortion and 15(37.5%) patients need surgical evacuation. Fever and abdominal pain were the only side effects appeared in the vaginal group. One patient (2.5%) got nausea and 39 patients (97.5%) got abdominal pain. In the oral group: 4(10%) patients administrated only one dose of 800mcg misoprostol. 1(2.5%) patients got complete abortion and 3(7.5%) patient need surgical evacuation. 36(90%) patients administrated two doses of 800mcg and 400mcg misoprostol. 27(67.5%) patients got complete abortion and 9(22.5%) patients need surgical evacuation.Nausea, vomiting, fever and abdominal pain were side effects appeared in the oral group. 7 patients (17.5%) have got nausea, 3 patients (7.5%) have got vomiting one patient (2.5%) has got fever and 27 patients (67.5%) have got abdominal pain. Conclusions : 800 microgram of vaginal misoprostol are as effective as 800microgram orally in producing complete abortion in frist trimester missed abortion with less side effects in vaginal group and patient satisfaction more in oral group.