Background: Management of mid-trimester missed abortion in women with a scarred uterus poses unique challenges. Both pharmacological and mechanical methods are used. Misoprostol is widely used for second-trimester termination, while Foley’s catheter aids cervical ripening through prostaglandin and oxytocin release. The combination of mifepristone and misoprostol has been shown to reduce the induction-to-abortion interval compared to Foley’s catheter alone. This study aimed to compare the maternal safety, effectiveness, and side-effect profile of these two methods in women with mid-trimester missed abortion and a scarred uterus. Methods: This comparative observational study was conducted in the Department of Obstetrics & Gynaecology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh, including 80 women with missed abortion and prior cesarean section. Participants were divided into two groups: Group A (n = 40) received combined mifepristone and misoprostol, and Group B (n = 40) received Foley’s catheter alone. Results: The mean age was comparable between groups (27.0 ± 4.1 vs. 27.2 ± 4.0 years). Mean gestational age was significantly lower in Group A (16.2 ± 2.6 weeks) than Group B (23.1 ± 2.0 weeks). Success rates were high in both groups (97.5% vs. 95.0%, p=0.558). The mean induction–expulsion interval was significantly shorter in Group A (10.1 ± 2.1 hours) compared to Group B (18.5 ± 2.9 hours, p<0.0001). Surgical interventions were rarely required, with manual vacuum aspiration being the only method used. Side effects differed between groups: Group A experienced nausea/vomiting (50.0%) and fever (19.4%), while Group B reported psychological upset (8.3%) and mild pain (19.4%). Conclusion: Mifepristone with misoprostol was more effective in reducing induction–expulsion time compared to Foley’s catheter, with different but tolerable side effect profiles in both groups.