Ectopic pregnancy, usually referred to as tubal pregnancy, is when a fertilized egg for various reasons lays in the fallopian tube rather than in the uterine cavity. When ectopic pregnancy occurs, vaginal bleeding is one of its typical symptoms, mainly after miscarriage or rupture of the ectopic pregnancy. In the early stage of ectopic pregnancy, the vital signs are stable and there are few obvious clinical manifestations, except for abdominal pain (less painful) after menopause, and the diagnosis mainly relies on auxiliary tests such as blood and urine HCG (human chorionic gonadotropin), progesterone and vaginal ultrasound. As the embryo gradually develops and increases in size, due to the limited space in the fallopian tube, about 60-80% of patients may experience vaginal bleeding in small amounts in the form of dripping, dark red or dark brown, irregular (sometimes intermittent), occurring after ectopic pregnancy miscarriage or ectopic pregnancy rupture. Miscarriage of ectopic pregnancy, most commonly seen in tubal jugular pregnancy at 8-12 weeks of gestation (the most common type of ectopic pregnancy), results in the death of the embryonic chorionic cells and a sharp drop in blood HCG levels, which in turn causes the withdrawal of progesterone and estrogen levels, leading to necrosis, peeling and shedding of the endometrium, which can be manifested as a little bleeding through the vagina. The rupture of ectopic pregnancy is usually seen in the isthmus of the fallopian tube at about 6 weeks of gestation (the second most common type of ectopic pregnancy). Because of the rich vascularity of the myometrium of the fallopian tube, a large amount of intra-abdominal bleeding can occur within a short period of time after rupture, and a small amount of blood can flow backwards into the vagina through the fallopian tube and uterine cavity due to increased intra-abdominal pressure, resulting in vaginal bleeding, but the amount of bleeding is not proportional to the clinical presentation of the patient. It should be emphasized that patients with ectopic pregnancy do not necessarily bleed vaginally, and even if they do, the amount is usually very small. Therefore, we cannot judge the presence or absence of ectopic pregnancy and its degree of risk by the presence or absence of bleeding. Clinically, the majority of patients with ectopic pregnancy also do not present with vaginal bleeding as their first complaint.