Early pregnancy failure (EPF), pregnancy loss in the first trimester, is a common pregnancy complication, with 15 to 20% of clinically recognized pregnancies ending in the first trimester. It is not uncommon for women with one or more cesarean sections, or myomectomies, to present with EPF. Options for treatment of early pregnancy failure include expectant management, surgical management (D&C), or medical management with medications such as misoprostol (miso). However, the limited information available regarding miso with EPF in those with prior uterine surgery may complicate the counseling of these women. What does the ACOG say about misoprostol use in the first trimester for these patients? Is misoprostol safe for EPF in women with 2 prior cesareans? In this episode, we will explore the data for miso use in these cases with a focus on the first trimester, but also review the data for miso use in the early second trimester in those with a scarred uterus.