Thirty-five patients attending an emergency room with a positive pregnancy test and suspected ectopic pregnancy underwent an ultrasonographic examination with both the transabdominal and the transvaginal techniques. Twenty-four out of 26 ectopic pregnancies were correctly diagnosed on admission, combining results of the two techniques, the sensitivity of the two techniques used separately being 88.4% (transvaginal) and 76.9% (transabdominal). In our unselected symptomatic patients, the transvaginal technique showed to be advantageous but not essential in the management of ectopic pregnancy. The surgical outcome of these patients suggested that a prompt diagnosis of ectopic pregnancy did not warrant a conservative treatment.