Background: Early pregnancy failure, including conditions such as spontaneous abortion and anembryonic gestation, affects many women. Ultrasound has become a vital tool in assessing early pregnancy, particularly through the measurement of parameters like gestational sac diameter (GSD), yolk sac diameter, and crown-rump length (CRL), which help in predicting pregnancy outcomes. This study aims to evaluate the accuracy of ultrasonographic parameters in predicting early pregnancy failure in women with a history of recurrent first-trimester pregnancy loss. Methods: This prospective cohort study included 90 pregnant women with a history of first-trimester recurrent pregnancy loss. Participants were assessed using transvaginal ultrasound to measure mean GSD, yolk sac diameter, CRL, embryonic heart rate, decidua basalis thickness, and the presence of intrauterine hematoma and uterine artery Doppler parameters. Results: Significant differences were observed between the ongoing pregnancy and miscarriage groups for CRL, GSD, and yolk sac features. CRL and GS mean sac diameter demonstrated high diagnostic accuracy with area under the receiver operating characteristic curve values of 0.74 and 0.79, respectively. CRL was particularly significant, with a p-value < 0.001. The ongoing pregnancy group exhibited higher gestational age and more favorable ultrasound findings (e.g., regular yolk sac shape, normal embryonic heart rate). Miscarriages were associated with abnormal yolk sac features and higher rates of abnormal GS shapes and locations. Conclusion: Ultrasonographic parameters, especially CRL and GS diameter, are reliable indicators for predicting early pregnancy failure in women with a history of recurrent pregnancy loss. These parameters may guide clinical decisions in early pregnancy management.