Objective To analyze the diagnostic efficacy of transvaginal and transabdominal color Doppler ultrasound in early ectopic pregnancy (EP). Methods 102 suspected early EP patients admitted to our hospital from January 2023 to January 2024 were selected as the study objects. All subjects underwent Transabdominal color Doppler ultrasound (TACDS) and Transvaginal color Doppler ultrasound (TACDS), respectively. TVCDS) check. The results of surgery and pathology were used as the "gold standard" for the diagnosis of early EP. The results and diagnostic efficacy of TVCDS and TACDS in the diagnosis of early EP were analyzed, and the detection rates of ultrasonographic manifestations of the two methods were analyzed. Results Among 102 suspected early EP patients, 71 cases were positive and 31 cases were negative. There were 67 true positive cases and 25 true negative cases in TVCDS. True positive and true negative cases of TACDS were 56 and 22 cases, respectively. The sensitivity 94.37% (67/71), accuracy 90.20% (92/102) and negative predictive value 86.21% (25/29) of TVCDS were higher than those of TACDS 78.87% (56/71), 76.47% (78/102) and 59.46% (22/37) in diagnosing early EP (P < 0) .05); The detection rate of adnexal mass in TVCDS was 95.77% (68/71), the detection rate of fluid in uterorectal fossa was 91.55% (65/71), the detection rate of false pregnancy sac was 45.07% (32/71), and the detection rate of primitive cardiac tube pulsation was 56.34% (40/71) compared with that of TACDS examination 74.65% (53/7) 1), 69.01% (49/71), 15.49% (11/71), 22.54% (16/71) high (P < 0.05). Conclusion Compared with TACDS examination, TVCDS is more effective in the early diagnosis of EP, and has a higher detection rate for typical ultrasonic image manifestations, which can significantly improve the diagnostic sensitivity and accuracy.