One in five pregnancies is complicated by vaginal bleeding before 20 weeks' gestation.A large empty gestational sac, discrepancy between gestational age and crown to rump length, fetal bradycardia or absence of fetal heart activity at presentation, advanced maternal age, history of recurrent pregnancy loss, a maternal serum progesterone < 45 nmol/l or low maternal serum hCG or inhibit A are adverse prognostic factorsFetal heart activity and lack of adverse prognostic factors conveys a favourable prognosis.