Cesarean scar pregnancy (CSP) occurs when an early pregnancy implants on the cesarean scar defect (CSD), myometrial tissue previously disrupted by cesarean delivery. The first case of CSP was reported in 1978 in a patient with a previous cesarean section (CS) who had heavy bleeding and abdominal pain after uterine curettage for a suspected miscarriage at 6 weeks. Eventual laparotomy revealed erosion of a major vessel in the scar sacculus by the products of conception which was successfully obliterated with subsequent revision of the previous surgical site. This was published in the South African Med Journal. Early ultrasound evaluation is crucial for detecting this condition. These are very complicated situations with increased rates of antepartum and postpartum hemorrhage, uterine rupture, PAS, preterm birth, and massive transfusion. Perhaps because of high worldwide cesarean delivery rates, there seems to be increased incidence and recognition of this condition over the past 2 decades. The clinical presentation is variable, and many are asymptomatic at presentation. In this episode, we will review the diagnosis and management of this unique and challenging high-risk pregnancy.