Objective: To compare the efficacy of oral versus vaginal misoprostol in first trimester incomplete miscarriage. Study Design: Cross-sectional study. Setting: Gynae B Unit of Lady Reading Hospital, Peshawar. Period: November 2017 to January 2018. Material & Methods: In this study 274 patients (i.e. 137 in each group) with incomplete miscarriage, who have gestational age of less than or equal to 12 weeks were included by convenience sampling. Women in group A had received 800 microgram oral misoprostol and women in group B had received 800 microgram vaginal misoprostol. In both groups same dose was repeated 4 hours after initial dose if the patient had not passed the product of conception. Patient who had no products of conception on pelvic ultrasound or Transvaginal scan were discharged from hospital. On the other hand patients found to still have products of conception were managed by surgical evacuation on next day. Results: In Group A (oral misoprostol) was effective in n=115 (84%) patients and ineffective in n=22(16%) patients and Group B (vaginal misoprostol) was effective in n= 125(91%) patients and ineffective in n=12(9%) patients. No significant difference was found between the efficacies of the two routes. Age distribution among two groups was analyzed as in Group A mean age was 23.9±3.7 years while in Group B it was 23.7±3.9 years. Mean gestational age in group A was 68.8±1.6 days and in group B was 68.7±1.3 days. Insignificant difference was found when the age and gestational age of the patients of group A and B were compared. Conclusion: Vaginal misoprostol is equally effective as oral misoprostol in terms of expulsion of products of conception in patients with incomplete miscarriage.