Early pregnancy failure, including spontaneous abortion, anembryonic gestation and first trimester fetal death, occurs in more that 15% of clinically recognized pregnancies. For more than half a century, dilatation and curettage (D&C) has been a standard of care for early pregnancy failure. Recently, this notion has been challenged. Several prospective observational studies have used misoprostol in women with incomplete or missed abortions. The effectiveness rate ranged from 56% to 100%. However, most of these studies were quite small. To examine the efficacy, safety and acceptability of medical management versus surgical management, a randomized clinical trial with an adequate sample size is needed. We plan to recruit and randomize 800 patients with an early pregnancy failure in the first trimester to eith D&C or vaginal misoprostol of 800 micrograms. Transvaginal ultrasound will be used to determine the success of evacuation.