Objective: To determine the outcome of using tamoxifen with misoprostol in first trimester pregnancy termination. Materials & Methods: This study was a  case series and  conducted at Department of Gynaecology & Obstetrics from 1st April ,2018 to 30th September at Nishtar hospital Multan,2018 over the 6 months  period .163 patients, 18 to 40 years of age with fetal demise or missed abortion confirmed on ultrasonography in 1st trimester (<12 gestational weeks) of pregnancy were included in the study. All the enrolled patients received  20 mg tamoxifen orally for 4 days then it is followed by 800 mcg oral misoprostol for 1 or 2 days orally (maximum 80 mg) and the outcome (in terms of complete abortion) was assessed after 7 days. Results: Mean age in our study was 24.89 ± 5.23 years. Mean gestational age was 7.07 ± 3.67 weeks. Majority of patient i.e. 49.69% were nulliparous. Complete abortion after tamoxifen with misoprostol therapy was seen in 149 (91.41%) cases. Conclusion: This study concluded that tamoxifen with misoprostol in first trimester pregnancy termination is very effective and useful with 91.41% rate of complete abortion.

Aim: To compare the complete abortion rate between manual vacuum aspiration and vaginal misoprostol for the management of First-Trimester Incomplete Miscarriage in term of complete abortion Study design: Randomized Controlled Trial. Study duration: April 2022 to October 2022. Setting: Department of Obstetrics & Gynecology Bahawal Victoria Hospital Bahawalpur. Methods: A total of 120 patients with First-Trimester Incomplete Miscarriage were chosen and equally divided into the MVA group and the MM group. The effectiveness of achieving a complete abortion was compared between the two groups. Results: Total 120 patients were selected. In MVA group, mean age and mean gestational was 31.47±5.82 years and 6.92±3.39 weeks while in MM group was 30.87±6.86 years and 5.78±3.47 weeks. Complete abortion was noted in 53(88.33%) patients of MVA group while in 44(73.33%) patients of MM group. Significantly (P=0.036) higher Efficacy (Complete abortion) rate was noted in MVA group. Practical Implication: It is a very good option in hospitals with low resources and in developing countries like Pakistan. Conclusion: In this study, we found MVA had higher complete abortion rate as compared to misoprostol intra vaginally. So, MVA is better treatment option than misoprostol intra vaginally as it has no systemic effects and it is a very good option in hospitals with low resources and in developing countries like Pakistan. Key words: Miscarriage, MVA, vaginal misoprostol, incomplete abortion, Gynecology, Pakistan