Background: An ectopic pregnancy occurs when a fertilized ovum implants at a site outside the uterine cavity. The most common location is within the fallopian tube and the condition can be life threatening due to risks of tubal rupture and hemorrhage. Unless more cases are diagnosed at an early stage, it is difficult to reduce mortality, and provide fertility preserving management. Aim and objective: To determine the local incidence of ectopic gestation, its risk factors, clinical presentations and management provided. Materials and methods: This was a prospective observational study where ectopic pregnancy cases admitted over one year in a tertiary care hospital in eastern India, were analyzed regarding age, parity, risk factors, signs and symptoms, management and morbidity. Results: There were total 280 cases, with incidence of 13.03/1000 deliveries. Most patients were primipara, between 21–30 years. The common risk factors were previous cesarean section (CS) in 26.07% and pelvic inflammatory disease (19.04%). Predominant symptom was abdominal pain (98.21%) and classic triad was present in 45% cases. Adnexal and cervical motion tenderness was elicited in most, while 10% presented in acute shock. Right sided ampullary tubal ectopic was the most common type encountered, with 70% cases in ruptured state. Salpingectomy was the mainstay treatment (85.36%). Successful non-surgical management was given to 7.14% cases. There was no mortality. Conclusion: The majority of cases in this study were received in ruptured condition, rendering conservative management impossible, a drawback in the era of modern diagnostics. With global increase in CS rate, a risk factor, the ectopic incidence may inadvertently rise, which is an alarming concern. Clinical significance: Awareness of the local trends of ectopic pregnancy, its risk factors, and diverse clinical presentation is of paramount importance for providing efficient management.