Background: The management of miscarriage has radically changed over the past 20 years. The emphasis on urgent surgical management has moved towards individualized treatment and patient choice between expectant, medical, and semi- elective surgical treatment. Treatment options now include uterine aspiration (in the office or operating room, under local anesthesia or sedation), medical management with prostaglandin analogs (most commonly misoprostol), or expectant management. Although all options of treatment generally considered safe, the therapies accompanied by very different clinical and logistic patient experiences. Misoprostol is used for medical abortions as an alternative to surgical abortion. Medical abortion has the advantage of being cheaper, simpler, and less invasive, not requiring anesthesia, and not having the risk of scarring and adhesions associated with surgical abortion. Misoprostol is sometimes used to treat early fetal death in the absence of spontaneous miscarriage. Isosorbide mononitrate is an organic nitrate with vasodilating properties. It is an anti-anginal agent that works by relaxing the smooth muscles of both arteries and veins, but predominantly veins to reduce cardiac preload. Isosorbide mononitrate, is effective at inducing cervical ripening during the first trimester, prior to medical termination of pregnancy. There is evidence for the safety of isosorbide mononitrate, with doses of either 20 or 40 mg having a significant effect on cervical ripening in the late third trimester of pregnancy.