Abnormal implantation of a blastocyst or a fertilized ovum outside the uterine cavity is termed as ectopic pregnancy. The fertilized ovum normally invades the uterine decidua on the sixth to seventh day after conception. Important factors that are involved in its transport include the tubal contractility, ovarian hormones and the cilial action within the tubes. The endometrial glands show marked secretory and proliferative activity, forming tall, vacuolated cells that have hypertrophic and hyperchromatic nuclei. A tubal abortion occurs when the conceptus passes through the fimbria into the abdominal cavity. Tubal damage is due to pelvic inflammatory disease or salpingitis. Gonococcal, tuberculosis and more commonly, chlamydia are known pathogens. In an ectopic, the cervical os is closed. On bimanual examination the uterus will be somewhat smaller than the expected date. The examination should be carried out as gently as possible to avoid rupture of an unruptured ectopic. Rupture will lead to severe intraperitoneal bleed and collapse. After the death of an ectopic fetus, the central part of the decidua will undergo necrosis with some amount of fluid. This can be mistaken for an intrauterine sac and is termed a pseudogestational sac. In cases of small, unruptured ectopic pregnancies who are hemodynamically stable, medical management is done by administration of Methotrexate, a folic acid antagonist, intramuscularly or directly into the tubal pregnancy by laparoscope or ultrasound. Salpingectomy is the treatment of choice if the tube is extensively damaged as there would be another likely recurrence in the next pregnancy. If the tube is not removed, the serial measurements of the hCG is necessary to detect the presence of trophoblastic tissue that will continue to proliferate.