Two out of 10 pregnant women have vaginal bleeding in the first trimester, of these, 50% will go on to have normal pregnancies while the other 50% will have a pregnancy loss. The presence of heavy vaginal bleeding (defined as heavier than a menstrual period), abdominal pain, fever, or passage of tissue requires immediate evaluation. It is important to make the diagnosis, because ectopic pregnancy is a leading cause of maternal mortality. Differential diagnoses of conditions that are associated with bleeding in early pregnancy can be broadly considered under three headings: intrauterine pregnancy, ectopic pregnancy and gestational trophoblastic disease.