Pregnant patients often present to the emergency department with chief complaints of abdominal pain and/or vaginal bleeding in the first half of pregnancy. Complications of early pregnancy are common and include miscarriage and ectopic and heterotopic pregnancy. Missing a life-threatening diagnosis such as ectopic pregnancy is fraught with risk to both patient and provider. The reliability of the discriminatory zone, used to aide in the diagnosis of early pregnancy complications, has been called into question. Assisted reproductive technologies to achieve pregnancy are also becoming increasingly common and present unique diagnostic challenges. Emergency physicians must be prepared to evaluate and manage the various complications of early pregnancy.