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Objectives: To present a case of ruptured ectopic pregnancy with hypotension, shock and a negative qualitative BhCG. To retrospectively review patients admitted to a Sydney teaching hospital with ruptured ectopic pregnancy over a two year period. Clinical features: A 30 year old woman presented to the emergency department with severe abdominal pain. On arrival she was shocked, with tachycardia and hypotension. Qualitative BhCG was negative. Laparotomy revealed 2.5L of blood in the peritoneal cavity and a bleeding mass in the right fallopian tube. Pathology reported trophoblastic tissue in the wall of the tube. Review of cases: Of 180 patients admitted to Royal Prince Alfred Hospital with ectopic pregnancy, 37 were found to have ruptured at operation. No cases of ruptured ectopic pregnancy with a negative BhCG were found. Conclusion: This case, though rare, illustrates the fact that a negative serum BhCG neither excludes the diagnosis of ectopic pregnancy nor the possibility of life‐threatening tubal destruction and haemorrhage.