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Abstract Ruptured Caesarean Scar Pregnancy Dr Sunitha Hanumanthu, Senior Specialist, Department of Obstetrics &Gynaecology, Visakha Steel General Hospital, RINL, Visakhapatnam Introduction: Caesarean scar pregnancy is a rare variant of ectopic pregnancy with an incidence of 1 in 1800 to 1in 2656 of all pregnancies. It is defined as the full or partial implantation of gestational sac in the myometrium scar of the uterine incision of previous caesarean section. It is often diagnostically challenging. Surgical approach is always preferred over medical management. Case: A 32yr old G3P1L1A1 Post caesarean pregnancy with 8wks period of gestation presented to Labour room with pain in lower abdomen and history of syncope. She was diagnosed with missed abortion and medical termination was advised at a peripheral centre. At the time of admission she was hemodynamically stable. On examination, she had lower abdominal tenderness. Transvaginal scan showed loss of myometrial C-section scar integrity (defect of 1.4cms) with heterogenous lesion at the scar site and significant hemoperitoneum. Suspecting it to be case of ruptured scar pregnancy, patient and her husband were counselled and consent taken for Laprotomy and hysterectomy. Intraoperatively, 500ml of hemoperitoneum and 200gms clots in the peritoneal cavity was observed. Rupture of the previous caesarean section scar of around 2cms was seen close to the right uterine artery. There was an organised mass of around 4?2cms containing trophoblastic tissue at the scar rupture site. As there was profuse bleeding from the rupture site total abdominal hysterectomy was done. Postoperatively, the patient was stable. Conclusion: Caesarean scar pregnancy is life threatening condition. Therefore, it has to be diagnosed carefully using Transvaginal ultrasound and treated timely to prevent maternal morbidity and mortality. Keywords: Ruptured Caesarean scar pregnancy, myometrial scar implantation, ectopic pregnancy.