Caesarean scar pregnancy is one among the rarest of ectopic pregnancy. With the increasing occurrence of caesarean section globally and available of transvaginal ultrasound, increasing number of cases are identified. Delay in diagnosis and treatment can result in uterine rupture, massive hemorrhage, hysterectomy and serious maternal morbidity. Transvaginal ultrasound is the standard first line imaging tool, MR imaging is beneficial while sonography is equivocal or inconclusive before intervention. Early diagnosis can provide treatment option of avoiding uterine rupture and massive hemorrhage, therefore conserving the uterus and future fertility. Rarely, early rupture can result in an secondary abdominal pregnancy. Available data suggest that termination of pregnancy is the treatment of choice in the first trimester soon after the diagnosis. This paper represents a case of caesarean scar pregnancy that dealt successfully by systemically administered Methotrexate followed by suction & evacuation.
