Background: Missed miscarriage is a common early-pregnancy complication that often requires uterine evacuation. Inadequate cervical ripening prior to evacuation can elevate the chances of cervical injury, uterine perforation and partial evacuation. The purpose of this study was to compare the efficacy and time needed in cervical ripening with sublingual and vaginal misoprostol prior to first- trimester missed miscarriage evacuation. Methods: This was a randomized controlled trial carried out in the Department of Obstetrics and Gynecology, CDA Hospital. Women (n = 200) with first trimester missed miscarriage were randomly assigned in two groups. Group A was treated with sublingual misoprostol 600μg and Group B was treated with vaginal misoprostol 800μg. Additional 400μg doses were administered at 6-hours intervals as required, to a maximum of two doses. Sufficient cervical ripening was determined as the passage of a Hegar dilator 8 mm and above through the internal os without resistance in 5 hours. Data were analyzed using SPSS software. Results: There were no significant differences in baseline demographic and clinical characteristics. The sublingual and vaginal groups were found to have successful cervical ripening in 96 and 80%, respectively (p<0.001). The mean of time to cervical ripening was also significantly lower in the sublingual group (4.02 ±0.57 hours) compared to the vaginal group (4.47 ±0.61 hours; p<0.001). Conclusion: sublingual misoprostol demonstrated greater efficacy and shorter ripening time, suggesting potential suitability for rapid cervical preparation prior to evacuation.