Aim: To evaluate the role of ultrasound (US) as a predictor of pregnancy outcome in cases with threatened miscarriage. Introduction: First trimester bleeding is a common anxious medical disorder. It may end with pregnancy loss or lead to adverse maternal and fetal outcomes. Certain sonographic parameters like (GSD, YSD, CRL, and FHR) could predict these outcomes. Material and methods: A prospective study involving 500 women in their first trimester was divided into three groups: group I (130 women) in whom threatened abortion ended in abortion, group II (170 women) with threatened abortion and completed their pregnancy and group III (200 women) with normal pregnancy. US indicators included Gestational Sac Diameter (GSD), Yolk Sac Diameter (YSD), Crown-Rump Length (CRL), and Fetal Heart Rate (FHR). These patients were evaluated for the pregnancy outcomes. Results: A significant difference was found between group I and the other two groups regarding FHR and CRL (P<0.05), while no significant difference was observed among the three groups regarding GSD or YSD. Compared to control group, the cases of group II had a higher incidence of premature rupture of membrane PROM (OR=9.9, P<0.05), gestational hypertension (OR=5.4, P<0.05), and placental abruption (OR=4.8, P<0.05). Conclusion: FHR and CRL are good sonographic markers to predict pregnancy outcome in women with threatened miscarriage. FHR at 115 beat/minute yields the best predictivity and CRL at 22 mm yields the least predictive accuracy.