Objective: The study was undertaken to evaluate the utility in term of diagnosis, treatment, outcomes and drop out of an ambulatory management of first trimester pathology. Study design: Retrospective review of patients seen in our Early Pregnancy Unit, in Macedonio Melloni Hospital (Milan – Italy) in a period from January 2009 to December 2015 Results: We evaluated a total of 1751 women in childbearing age. The reason of the first access in our ambulatory was: in 112 cases the need of control because an anechoic sac was seen in the uterus but there were not a certain diagnosis of physiological pregnancy. Among these, we diagnosed 23 ectopic pregnancy, 658 miscarriage, 428 intra uterine pregnancy, 8 molar pregnancy. In 271 first access, the reason was an uncertain localization pregnancy. Among these, we diagnosed 131 miscarriage, 53 ectopic pregnancy, 85 intrauterine pregnancy. In 16 patient the reason was a suspected molar pregnancy and we found 6 molar pregnancy, 8 miscarriage, 2 intrauterine pregnancy. 214 patients were referred to our ambulatory for the need of a follow up. Among these, we had in 55 cases a follow up for molar pregnancy, in 59 cases a follow up after medical treatment of ectopic pregnancy with methotrexate, in 19 women a control after laparoscopic surgery for ectopic pregnancy and in 81 patients a control after surgical treatment of miscarriage for some finds, as idropic degeneration of trophoblast, at the istological analysis. In total we were able to perform expectant management for ectopic pregnancy in 23 cases and medical therapy with methotrexate in 117 cases. We had just 2 cases of failure of the conservative medical treatment for ectopic pregnancy, who underwent laparoscopic surgery. The mean time for the diagnosis, calculated from first access to emergency of a symptomatic woman in total absence of a diagnosis to the day of decision about treatment, which means a certain diagnosis, was 10 days (range 1–23 days). The drop out of patients was very low with only 9 cases. Conclusion: For several years, in treating ectopic pregnancy, less frequently the need and the purpose is to save the life of the patient but increasingly it is to preserve her fertility. Diagnosis is often early and, above all, it often takes place before when the haemoperitoneum constitutes a serious life-threatening for the patient. The presence of the Early Pregnancy Unit in our Hospital permitted to perform a conservative treatment in the 47% of all cases of ectopic pregnancy. This result was possible because of an early diagnosis and of a timely treatment with a well organized follow up. It was also possible an accurate differential diagnosis, with simplification of diagnostic and therapeutic path for patients, minimizing urgent surgical therapy and improper hospitalization. Finally, this kind of organization allows accurate data collection and database creation with improve of the scientific research.