Caesarean scar pregnancy is a rare consequence following caesarean section. Its incidence is increasing in lieu with numbers of caesarean section. In Malaysia, caesarean section rate increased from 15% in 1985 to 23.08% in 2014. Thus, it poses diagnostic and therapeutic dilemma due to its rare but emerging problem.

Case: We reported a case of caesarean scar pregnancy diagnosed in the first trimester. She was 33 years old woman, G5P4 at 8 weeks + 5 days, with one previous uncomplicated caesarean section, was referred from General Practitioner with an episode of per vagina bleeding. She was haemodynamically stable and assessment by transvaginal ultrasound showed features of viable Scar Ectopic Pregnancy. She was scheduled for diagnostic laparoscopy converted to laparotomy and successfully treated by resection of scar ectopic.

Discussion: Diagnostic and treatment approach are being described in few case series and reports. RCOG has outlined ultrasonographic criteria, diagnostic modality and treatment options in managing this case. Transvagina ultrasound becomes gold standard with recognition of certain features while MRI or diagnostic laparoscopy provides an adjunct in reaching the diagnosis. Medical and surgical treatment has been described but surgical approach is the most effective.

Conclusion: It is imperative to have high index of suspicious of possible caesarean scar pregnancy in those with previous history of caesarean section. Vigilant in interpreting findings of ultrasound, early diagnosis and immediate appropriate treatment is empirical in preventing further catastrophic damage.

Keywords: Scar ectopic pregnancy, caesarean scar pregnancy, ultrasound