ABSTRACT Purpose: To compare between low dose vaginal misoprostol with and without Foley catheter for late second trimester pregnancy termination in women with previous multiple cesarean sections. Materials and methods: A prospective randomized controlled clinical trial, patients were randomly allocated to either low dose vaginal misoprostol group (n¼40) or combined low dose vaginal misoprostol plus Foley catheter group (n¼38). The primary outcome was complete abortion. Secondary outcomes were induction-to-abortion interval, the number of misoprostol doses and occurrence of complications. Results: Incomplete abortion rate was significantly lower in combined group than misoprostol only group (2.6%versus 15% respectively, p¼.03). Induction-to-expulsion interval with the combined vaginal misoprostol plus Foley catheter was significantly shorter (p¼.01) and the number of misoprostol doses in the combined group was significantly lower (p¼.04). No statistically significant difference in the frequency of complications between both groups. Conclusions: The combination of low dose vaginal misoprostol and Foley catheter is an effective and safe method for termination of second trimester pregnancy in women with previous multiple cesarean sections.