Background: Recurrent pregnancy loss (RPL) is one of the most painful and difficult areas of reproductive medicine since the explanation is often unknown. RPL is caused by uterine factors (both acquired and congenital). Hysteroscopy is the gold standard for evaluating the endometrial cavity because it allows direct sight of the endometrium. Objective: This study aimed to evaluate the role of hysteroscopy in the assessment of cases with recurrent first trimesteric miscarriage. Methods: This prospective cohort study was conducted on 164 women with recurrent first trimesteric miscarriages, who were referred to Early Cancer Detection Unit (ECDU) to undergo diagnostic hysteroscopy for various complaints. Women were asked to attend postmenstrual within 3-6 months following abortion. Hysteroscopy was done under local anesthesia. Before operation, all cases were subjected to full history taking, clinical examination and laboratory investigations as random blood glucose level, serum thyroid stimulating hormone (TSH), serum prolactin, anticardiolipin (IgG, IgM), follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Results: Abnormal hysteroscopic study was found in 53.0% of cases with recurrent first trimesteric miscarriages. Acquired uterine abnormalities were found in 27.4% of cases and it was more common than congenital uterine anomalies that were found in 25.6% of cases. The most common congenital uterine anomaly was uterine septum that was found in 20% of cases, while the most common acquired abnormality was uterine polyp (s) that was found in 11% of cases. 20% of these anatomical abnormalities were corrected hysteroscopically. Conclusion: Hysteroscopy is safe, sensitive and reliable tool of diagnosis and could be performed at outpatient bases without anesthesia.