Ectopic pregnancy remains a major cause of maternal morbidity and mortality in low resource settings. Understanding its determinants and associated complications is vital for early recognition and improved outcomes. This study examined the risk factors and complications associated with ectopic pregnancy among women who received care at Abia State University Teaching Hospital, Aba. A hospital-based unmatched case control study was carried out from July 2023 to June 2025. Eighty-seven women with confirmed ectopic pregnancy served as cases, while 174 women with intrauterine pregnancies were selected as controls, with frequency matching by age category. Data were obtained through structured interviews and clinical record abstraction. Information collected included sociodemographic characteristics, reproductive history, previous pelvic infection, prior tubal or abdominal surgery, contraceptive history and pertinent laboratory and imaging findings. Data were double entered, cleaned and analysed using SPSS version 25. Bivariate associations were examined using chi-square tests and t-tests, followed by multivariable logistic regression to identify independent predictors of ectopic pregnancy. Complications among cases were summarised descriptively. Significant risk factors on multivariable analysis included prior pelvic infection (adjusted odds ratio 3.12, confidence interval 1.58 to 6.17), prior tubal or abdominal surgery (adjusted odds ratio 3.98, confidence interval 1.38 to 11.47), history of infertility (adjusted odds ratio 3.45, confidence interval 1.51 to 7.90) and having more than two lifetime sexual partners (adjusted odds ratio 1.78, confidence interval 1.01 to 3.12). Common clinical features among cases included abdominal pain, vaginal bleeding and amenorrhea. Complications were frequent, particularly tubal rupture which was reported in over forty percent of cases. Significant intra-abdominal bleeding, the need for transfusion, hypovolemic shock and prolonged admission were also documented. One maternal death occurred. Ectopic pregnancy in this setting is strongly associated with preventable reproductive health factors, particularly prior pelvic infection, tubal surgery and infertility. High rates of tubal rupture and bleeding underscore the need for early recognition and prompt care. Strengthening sexual and reproductive health services, improving early referral pathways and increasing community awareness are essential steps to reduce the burden of ectopic pregnancy and its complications.

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