Inclusion Criteria:  All women above 18 years of age between 13-26 weeks of gestation. Pregnancy is confirmed by a 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 illnesses, 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.