First-trimester pregnancy loss, or spontaneous abortion, is the loss of a pregnancy before 12 completed weeks of gestation. Approximately one-third of pregnancies end in spontaneous abortion, many before pregnancy is clinically recognized.[1] Chromosomal abnormalities account for the largest proportion of early pregnancy loss, but spontaneous abortion in the first trimester can also be caused by maternal uterine structural issues, underlying maternal disease, delayed or abnormal implantation, or teratogenic factors, although many are unexplained. While asymptomatic women may be diagnosed with a spontaneous abortion during routine ultrasonography, the most common presentation encountered by OB/GYN hospitalists is a patient with acute-onset bleeding, pelvic pain, or both, in early pregnancy. OB/GYN hospitalists are uniquely positioned to diagnose and manage this pregnancy complication in the acute setting, taking into account the patient’s desire for resolution, as well as her clinical acuity.