Ectopic pregnancies are an important cause of morbidity and mortality in early pregnancy. This article presents an up-to-date review of the risk factors associated with tubal ectopic pregnancies and how these patients present. This is crucial for midwives who may be conducting booking appointments at earlier gestations and for those working in early pregnancy units. The role of transvaginal ultrasound as the new diagnostic gold standard is also explored. Management strategies are outlined, including the surge in conservative treatment, and the long term implications of ectopic pregnancies are also outlined. A case study is presented to show an example of how these women present in early pregnancy.