We should suspect the possibility of ectopic pregnancy in high risk patients especially those with previous history of: pelvic inflammatory disease and salpingitis, tubal salpingitis, tubal sterilization , previous ectopic, tubal reconstructive surgery, IUCDs users, infertility, IVF/ET, repeated abortions and exposure in utero to diethylstilbesterol. Abdominal pain, vague or acute is the main symptom which is usually accompanied by vaginal bleeding. The combination of pain and syncope is highly suggestive for diagnosis. The severe picture is the acute massive intraperitoneal hemorrhage due to tubal rupture. Diagnosis should be confirmed using serum beta-hCG level determination, sonography both transabdominal and transvaginal, culdocentesis, uterine curettage with pathological examination of the curettings and laparoscopy.