Advanced ectopic pregnancy - clinical management. In case of vaginal bleeding and diffuse abdominal pain you have to include the diagnose of (rare) advanced ectopic pregnancy. Even with ultrasound technique in some of the cases you need further examinations to be sure with your diagnose. Because of the high incidence of maternal morbidity the treatment ist immediate primary laparotomy. In some pregnancies after the 23/24 week there is possibility of a more conservative approach. We describe a case with immediate operative intervention.