The advent of high-resolution transvaginal ultrasound (TVS) has revolutionized our understanding of the pathophysiology and the management of early pregnancy failure. Knowledge of the ultrasound appearances of normal early pregnancy development and a good understanding of its pitfalls are essential for the diagnosis and management of early pregnancy failure. Early pregnancy failure may present with vaginal bleeding and (or) abdominal pain. Differential diagnoses include threatened, inevitable, and missed abortion. Other differential diagnoses include ectopic and molar pregnancy