First trimester vaginal bleeding may not be as exciting as a GSW to the chest but it's something that we see a lot in the ED and we have the chance to make a positive impact even if the news isn't good. The workup can seem very cookbook at times but its important that we get it right. In this episode, we'll review the basic workup and disposition of first trimester vaginal bleeding. Just as important as the medicine, we'll also review how to talk to patients about this sensitive and worrisome diagnosis.