Aim: To describe the clinical correlates and ultrasound characteristics of chronic ectopic pregnancy. Background: Acute ectopic gestation is diagnosed by early pregnancy ultrasound and the clinical and imaging correlates are well known. However, in contrast, chronic ectopic pregnancy, accounting for approximately 6% of all ectopic gestations, is not a well-defined entity. This leads to diagnostic dilemmas and challenges in management. Case description: Fifteen women over a period of 6 years were included. The age ranged from 20 to 35 years, with the majority being multigravidas. Six women presented with abnormal uterine bleeding (AUB) and pain abdomen, four with AUB, and two with abdominal pain. The urine pregnancy test was positive in 11, and serum beta-human chorionic gonadotropin (S βhCG) was elevated in all. Ultrasound showed a heterogeneous mass in the pouch of Douglas (POD) and/or unilateral adnexa, with no internal vascularity. The right salpingectomy was done in 10, and the ipsilateral ovary was removed in 5. Three patients had unique presentations with urinary retention, jaundice, and fever. Conclusion: Chronic ectopic pregnancy should be the provisional diagnosis in a young multiparous woman with AUB and/or abdominal pain, if the ultrasound shows a heterogeneous mass in the POD and/or adnexa, with no internal vascularity, to plan optimal surgery. Clinical significance: The differential diagnosis of chronic ectopic pregnancy is a malignant germ cell tumor of the ovary. Hence, a definitive approach to the preoperative diagnosis of chronic ectopic pregnancy will lead to optimal patient outcomes.