The management of 255 surgically proven cases of ectopic pregnancy, treated at a teaching hospital over a 5-year period, was retrospectively reviewed to determine the proportion of cases where the diagnosis was 'missed' at initial presentation. Thirty-one patients (12%) had presented and been discharged with an incorrect diagnosis, then subsequently readmitted for definite treatment of a tubal ectopic pregnancy. In this group, the mean time from initial presentation to definitive surgery was 8 days. Ten of the 31 women with 'missed' ectopic pregnancies (32%) underwent salpingectomy, whereas the rate of salpingectomy in those women whose ectopic pregnancy was correctly diagnosed at first presentation was 19.5% (44 of 224). We conclude that delays in the diagnosis of ectopic pregnancy may be associated with an increased rate of salpingectomy, which may in turn reduce prospects for future fertility, a finding not previously canvassed in the literature. The factors contributing to misdiagnosis of ectopic pregnancy are discussed and compared with those reported in other studies.