Abstract The demand for ultrasound in early pregnancy has been increasing steadily, and is now a routine investigation for most women within the first trimester of their pregnancy. It is a safe investigation which provides reassurance, charts normal development, and identifies women with abnormal or high risk pregnancies. The main objectives of this study is to determine the causes of pregnancy failure in first trimester, to identify sonographer features of early pregnancy failure, and to study the role of ultrasound in differentiate the type of pregnancy failure in first trimester. The study was conducted at Alturky Teaching Hospital. Patients whom referred to the ultrasound clinic for assessing their first trimester pregnancy, with symptoms of abdominal pain, vaginal bleeding or both. On this study among 50 pregnant women the highest numbers of patients were found within age group of 28-37 years (27 patients (54%) while the lowest were found for age group of 38-47 years (9 patients (18%). According to parity , (34%) of patients with only one pregnancy then p2 (26%), p0 (16%) while P5 and P7 (2%), In addition to that (42%) of patients with only one abortion, while patient with recurrent abortion (3&4) times were (2%).the majority of the patients were house wives (78%) while the little portion of the patients are workers (22%). The result of this study revealed that the major cause were unexplained (31 patient( 62%), while trauma (14 patient (28%) and Fibroids (5 patient (10%). This study revealed higher complications were reported with patient's with low parity, older patients and inversely proportional with the number of pregnancies. Improvement of the awareness of ladies regarding pregnancy complications will enable early diagnosis and improve the outcome of the management.