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Cesarean scar pregnancy (CSP) presents a diagnostic as well as a therapeutic challenge. Since more cesarean deliveries (CDs) are performed, its frequency is increasing. Although there are no general guidelines for the management of this rather threatening entity, this chapter deals with a set of diagnostic and treatment criteria of this complication of pregnancy. Awareness and timely diagnosis of CSP by a very early transvaginal ultrasound scan (TVS) of a new pregnancy in a patient with previous CD may enable early treatment and mitigate complications.