Objectives: This was a clinical audit, conduct to know the rational practice of anti-d prophylaxis in two early pregnancy complications. Methods: Information was gathered from 37 patients with early trimester miscarriages and 35 patients with ectopic pregnancies who admitted to Professorial gynecology ward, Teaching hospital, Peradeniya over single calendar year period. Data gathered from retrospectively from bed head tickets and recorded/ analysed with SPSS V21. Results: Among patients who had early trimester miscarriage mean age was 28.4(±6.4) years, mean period of gestations on admission was 123.9(±26.7) days. 21.6% were presented with per vaginal bleeding, 24.3% presented with abdominal pain and 37.8% were presented with both pain and the bleeding. 16.2% presented with the sonographic evidence of the missed miscarriage without any symptoms. Solely medical management done for 24.3%, solely surgical interventions done in 40.5% and in 35.1% of the occasion combination was used. Among the sample 81.1% were rhesus positive, 2.7% rhesus negative and 16.2% of the occasion rhesus status were not documented. Anti-D prophylaxis coverage was 100% in those who have undergone surgical management. Mean age of the patients with ectopic pregnancies were 30.4(±4.9) years, mean period of gestation was 51(±10.9, n=27) days. Surgical management was done in 94.3% of the occasion. Among them 2 were Rh negative and anti-D prophylaxis coverage was 100%. Conclusions: Early trimester miscarriages and ectopic pregnancies are presented with various presentations and managed medical, surgical or both methods. Among the population rhesus negative mothers were less and in some case rhesus status was not documented. It is essential to cover such rhesus negative mothers to minimise the future pregnancy related complications. Proper investigation, documentation and timely intervention will improve the quality of care.