Inclusion Criteria:  All women above 18 years of age Less than 12 weeks of gestation. Pregnancy is confirmed by pregnancy test or ultrasound scan. missed abortion Normal general and gynecological examination.  Exclusion Criteria:  Hemodynamically unstable. Suspected sepsis with temperature 38 °C. Concurrent medical illness e.g. hematological, cardiovascular, thromboembolism, respiratory , recent liver disease, or pruritus of pregnancy. Presence of intrauterine contraceptive device (IUCD). Suspect or proven ectopic pregnancy. Failed medical or surgical evacuation before the presentation. Known allergy to misoprostol.