Background: Vaginal, oral, and sublingual doses of misoprostol are effective in abortion. A comparison of different doses and methods of misoprostol administration had done, preferred methods would shorten the duration between induction and delivery, and minimize adverse effects. Aim: To compare the Outcome and Adverse effects of sublingual misoprostol, local misoprostol alone or in combination with intra cervical Foley’s catheter in the clinical management for the missed abortions. Patients and Methods: This prospective randomized controlled trial was conducted at Obstetrics Maternity (Emergency) Hospital, Faculty of Medicine, Zagazig University, 172 pregnant women were enrolled, Group A (Sublingual group) that subdivided into two subgroups: I (A) included 43 patients to whom misoprostol tablet was given sublingually every 4 hours up to 6 doses per day, I (B) included 43 patients to whom misoprostol tablet was given sublingually every 4 hours up to 6 doses per day plus Foley’s catheter (18fr) insertion through cervix as far as the internal OS with inflation of its balloon with 30-50ml normal saline, Group B (Local “vaginal” group):= that subdivided into two subgroups; II (A) included 43 patients to whom misoprostol tablet was given vaginally every 4 hours up to 6 doses per day, II (B) included 43 patients to whom misoprostol tablet was given vaginally every 4 hours up to 6 doses per day plus Foley’s catheter (18Fr) insertion through cervix as far as the internal Os with inflation of its balloon with 30-50ml normal saline, The protocol was followed for 48 hours after which further management was done. Results: Our study revealed that sublingual misoprostol + cervical Foley’s catheter insertion is associated with higher success rate and least induction to abortion interval; length of hospitalization, number/total of doses of misoprostol needed for termination of pregnancy and need for hysterotomy, sublingual misoprostol with/without cervical Foley’s catheter insertion was associated with higher rate of adverse effects as nausea, vomiting and diarrhea. Conclusion: From our study we can conclude that sublingual misoprostol + cervical Foley’s catheter insertion is the best option for management of pregnant women with missed abortion, sublingual misoprostol with/without cervical Foley’s catheter insertion was associated with higher rate of adverse effects as nausea, vomiting and diarrhea