Background: Ectopic pregnancy is a clinical condition where a fertilized ovum implants outside the endometrium of the uterine cavity. Worldwide, ectopic pregnancy complicates 0.25-2.0% of all pregnancies. High index of suspicion of the clinical triad; abdominal pain, amenorrhea and vaginal bleeding is very important for its early detection and management. Objectives: To determine the prevalence, clinical presentations, sites, risk factors and outcomes of ectopic pregnancy in a tertiary health institution in Umuahia, Nigeria.  Materials and Methods: This retrospective study was conducted in the Department of Obstetrics and Gynaecology, Federal Medical Centre, Umuahia over a period of 10years from January 2011 to December 2020. The records of patients with ectopic pregnancy were traced through the main theater, ante-natal clinic, and the records unit. All information obtained were coded, entered into and analyzed using IBM SPSS version 25.  Results: A total of 268 patients with ectopic pregnancies were studied out of 19,535 gynecological cases and 13,901 deliveries within the study period. This gave a prevalence of 1.4% of all gynecological cases and 1.9% of all deliveries. Ectopic pregnancies occurred more in women between 26 and 35years of age (54.9%). The commonest symptoms seen were abdominal pain (24.7%), Amenorrhea (22.7%) and vaginal bleeding (22.1%). The commonest sites of occurrence were fallopian tube 244 (91.1%), intramural (3.4%) and cervical ectopic pregnancy (2.2%). All the patients were managed surgically while 84% had ruptured uterus. Risk factors observed were a history of PID (30.0%), previous ectopic pregnancy (14.6%), infertility (12.5%), IUCD placement (12.1%) and previous abortion (11.2%). Conclusion: Ectopic pregnancy is one of the leading causes of maternal morbidity and mortality for women of reproductive age. Early diagnosis and management in form of medical treatment or conservative surgery not only reduces maternal morbidity and mortality but also preserves future fertility.