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: ObjectiveThe diagnosis of ectopic pregnancy (EP) is often confirmed at presentation (acute), but often requires serial β-hCG levels to confirm the diagnosis (chronic). The purpose of this study is to analyze whether these clinical presentations represent a spectrum of disease.: DesignThe retrospective cohort study of 452 patients diagnosed with EP at the University of Pennsylvania in the years 1990–1999.: SettingUniversity of Pennsylvania, Philadelphia, Pennsylvania.: Patient(s)Four hundred fifty-two patients diagnosed with EP. Patients diagnosed with EP were divided into two groups according to the time of diagnosis.: Main outcome measure(s)A total of 37 parameters were examined including historic and demographic factors, findings at presentation, and treatment and outcome variables.: Result(s)The two groups were similar in terms of historic EP risk factors. Multivariable analysis demonstrates that women with a chronic presentation were less likely to have received fertility medications (odds ratio [OR] 0.23; 95% confidence interval [CI] 0.06–0.84), less likely to present with pain (OR 0.29; 95% CI 0.12–0.71), have a lower β-hCG level at presentation (9,849 mIU/mL ± 16,726 vs. 1,787 mIU/mL ± 4,717), lower chance of rupture (OR 0.19; 95% CI 0.05–0.73), and less frequently have blood type 0.: Conclusion(s)Women diagnosed with ectopic pregnancy can be categorized into two groups, those with an acute presentation and those with a chronic presentation. Differences in risk factors, presentation, and outcome may reflect differences in trophoblast viability or invasive potential. [Copyright &y& Elsevier]