Background: Chronic ectopic pregnancy presents significant diagnostic and management challenges, often leading to severe complications due to delayed diagnosis. This study aimed to assess the clinical profile and outcomes of chronic ectopic pregnancy in a tertiary care setting. Methods: This prospective observational study was conducted at ANMMCH, Gaya, involving 60 patients with chronic ectopic pregnancies from January 2024 to December 2024. Data on demographics, clinical presentation, diagnosis, treatment modalities, and outcomes were collected and analyzed. Results: Most patients required surgical intervention (70%), with only 15% responding to medical management using methotrexate. Complications were minimal, with persistent trophoblastic tissue being the most common. Post-treatment, 80% of women resumed normal menstrual function, and 10% achieved pregnancy within six months of follow-up. Conclusion: The study highlights the necessity for early and accurate diagnosis of chronic ectopic pregnancy to optimize treatment outcomes. Surgical management remains predominant, with methotrexate being effective in a select group. Further research is needed to refine treatment protocols and improve fertility outcomes following treatment.