Objective: To evaluate the association between demographic variables and massive hemorrhage in ectopic pregnancy. Methods: This was a retrospective study in a tertiary referral center between January 2005 and January 2022. Patients with an ectopic pregnancy who received blood transfusions were included. Clinical characteristics were analyzed by dividing the Initial Hb levels into two groups: <10 g/dl and ≥10 g/dl. Results: During the study period, 166 women were diagnosed with an ectopic pregnancy and required blood transfusion. The mean age of the patients was 31.3 years. Sites of pregnancy were identified: 139 patients in salpinx, 16 patients in cornus, 4 patients in cervix, 3 patients in c/sec scar, 2 patients in ovary, and 2 patients in abdomen. Median blood loss at the time of surgery was 1310 ml (range, 504000). There were no differences according to the Initial Hb level in age, marital status, location of ectopic pregnancy, length of hospitalization, total number of transfusions, and ICU care. Patients with an initial Hb <10 g/dl had a significantly higher rate of pre-operative transfusion (p=0.009). However, the proportion of patients with a difference of 2 or more in serial hemoglobin measurements was higher in patients with an initial Hb ≥10 g/dl. The patients were required more preoperative transfusion (P=0.008) and higher total transfusion volume (p=0.030) than those with a difference of less than 2 in serial hemoglobin measurements. Conclusion: Even in patients with initial Hb ≥10 g/dl, serial hemoglobin measurement may help early detection of patients with massive hemorrhage in ectopic pregnancy.