Background Abortion is a sensitive and contentious issue with religious, moral, cultural and political dimensions. It is a public health concern in many parts of the world especially low-resource settings where abortion is highly restricted and self induced abortions are common. Abortion related complications have continued to make substantial contributions to maternal morbidity and mortality in Sub-Saharan Africa. In these countries, access to PAC services especially treatment of incomplete abortion is a priority. Standard post abortion care has involved surgical intervention but can be hard to access in these areas. Oral 600µcg misoprostol provides an alternative to surgical intervention and this could increase access to abortion care in the environments where need for economical non-surgical treatments may be most useful. Objectives To compare the efficacy, safety and acceptability of oral misoprostol with manual vacuum aspiration in the management of first trimester incomplete abortion. Study Design/Setting Prospective Comparative study conducted at the University of Ilorin Teaching hospital. Methods A total of 200 consenting women were randomized in to the study. Out of these women, 100 women received 600µg oral misoprostol and the remaining 100 women were treated with MVA. In the MVA group, 2 women were lost to follow-up and were not included in the final analysis. Efficacy, Safety and Acceptability of 600µg oral misoprostol were compared with MVA in the eligible women. The results were analysed using SPSS window version 20. The level of significance was tested using t-test, chi-square, Yates correction, Mann Whitney U test. P value of ˂ 0.05 was taken as significant.