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INTRODUCTION:Caesarean scar pregnancy is a rare but life threatening condition that occurs when a fertilised egg implants in the uterine scar typically following a caesarean section.The incidence is increased due to increased rates of caesarean sections.This can lead to serious complications including haemorrhage and uterine rupture requiring effective intervention. CASE REPORT : A 26year old second gravida with 8 weeks of amenorrhoea and previous caesarean section came to MKCG MCH with chief complaints of bleeding per vagina.Per abdomen was soft and non tender. Per vaginally uterus was found bulky, mild tenderness present and bilateral fornices were free.Ultrasound confirmed caesarean scar pregnancy.Initial medical management with methotrexate was attempted. However there was persistence of sonographic findings and she again complained of bleeding per vagina . So laparotomy was performed . During surgery ectopic tissue excised and uterine scar was meticulously repaired . DISCUSSION : This case highlights the challenges in managing scar ectopic pregnancies where medical management may not suffice . Methotrexate is often the first line treatment . In this case failure of medical management led to laparotomy for definitive intervention and preservation of uterine integrity.Early identification and treatment are crucial as delayed intervention can result in severe morbidity. CONCLUSION : caesarean scar pregnancy requires a high index of suspicion especially in women with prior caesarean deliveries.While initial medical management can be effective but timely surgical intervention is vital . Keywords: caesarean scar pregnancy, methotrexate, laparotomy,maternal health.