Ectopic pregnancy (EP) continues to be the number one cause of maternal deaths in the first trimester of pregnancy. Over the past 30 years, several key developments including accurate and rapid serum human chorionic gonadotrophin assays, the introduction of high-resolution transvaginal probes and more recently tertiary hospital Early Pregnancy Units have changed the management of EPs. Early transvaginal ultrasound diagnosis of EP not only potentially decreases mortality and surgical intervention rates, but also promotes modern management options including expectant or medical management. The aim of this review is to demonstrate that transvaginal ultrasound is the new 'gold standard' diagnostic tool of choice for all forms of EP.