Objective: To compare the efficacy of vaginal and oral misoprostol for the induction of labor in women with intra-uterine fetal death (IUFD). Study Design: A prospective randomized clinical trial, comparing 200ug oral and 200ug vaginal misoprostol, six hourly for a maximum of four doses for the induction of labor in women with IUFD. Setting and duration: Department of Obstetrics and Gynecology, Ghulam Muhammad Maher Medical College Hospital Khairpur Sindh. Main outcome measures: The primary outcome measure was the induction to delivery time, and secondary outcome measures were the number of patients requiring augmentation with oxytocin and all complications were noted. Results: Twenty women were randomized to the vaginal route and 18 to the oral route. The induction to delivery time was shorter with vaginal misoprostol (13.5 + 8.3 hours) compared to oral misoprostol (21.4 + 13.9 hours; p< 0.05). There was no significant difference in the amount of misoprostol needed to achieve successful induction in the two groups. More women 10/18 who received oral misoprostol required oxytocin augmentation to complete the induction of labor compared with 4/20 women in the vaginal group (p< 0.05; Odds Ratio 2.8; 95% CI 1.36-4.24). There was no cases offailed induction. The systemic side effects (shivering, diarrhoea, vomiting and pyrexia) were more common with oral misopristol (44.4%) compared to vaginal misopriotol (20%). This difference gives an overall Odds Ratio of 2.2 at 95% CI of 1.6-2.8 (p< 0.05). Conclusion: Vaginal misoprostol achieved successful induction of labor in women with IUFD in a shorter time than oral route with significantly less side effects.