The objective of this chapter is to introduce the ecotopic and heterotopic pregnancy along with their incidence, risk factor, management, clinical presentation, and diagnosis. In ectopic pregnancy (EP), the fertilized ovum implants and develops outside the endometrial cavity of the uterus. It is the leading cause of pregnancy-related first trimester deaths. Its etiology remains uncertain and diagnosis can be difficult. Risk factors have been identified but it may occur without any apparent predisposing factors. Heterotopic pregnancy (HP) is the development of an IUP and ectopic gestation at the same time at two or more implantation sites. It is a rare, life-threatening complication of early pregnancy, difficult to diagnose, gets frequently missed or overlooked and delayed, as clinicians and sonographers tend to get slackened when an intrauterine GS is seen. Duverney was the first one to report HP in 1708 during an autopsy.