The National Institute for Health and Clinical Excellence (2010) estimates that 137,000 women in England experience per vaginal (PV) bleeding and abdominal pain in early pregnancy every year, while the Royal College of Obstetricians and Gynaecologists (2006) estimates that PV bleeding occurs in between 10 and 25 per cent of women who are less than 12 weeks pregnant and that up to half of these women miscarry. Some authors suggest that care for such women could be improved and that their psychological needs could be met more effectively (Washbourne and Cox 2002). This article aims to help emergency department nurses give safe and compassionate care to women who experience PV bleeding by offering an overview of its pathophysiology, diagnosis and treatment.