Abstract Aim: To evaluate the efficacy and safety of single dose of of Systemic MTX 50 mg/m2 followed by D&S in cases of Cesarean scar pregnancy (CSP). Objective: Implantation of the pregnancy in a cesarean scar is a rare condition named; Cesarean scar pregnancy (CSP). Maternal complications can be prevented with the early diagnosis and an appropriate management. It is a Prospective clinical study to evaluate the efficacy and success rate of single dose use of methotrexate (MTX) followed by dilation and suction (D&S) regimen in management of women with cesarean scar pregnancy (CSP). Methods: 50mg of MTX in the form of a single dose Intramuscular injection then cervical dilatation and suction aspiration with a Karman cannula (D&S) under guidance of ultrasound after 48 preceded by vaginal misoprostol 2 tablet (200 mg) 4 hours ago. Results: The mean gestational age at diagnosis was (8.5±1.6) and the mean level of serum b-human chorionic gonadotrophin was (7424±2.560) and The mean gestational age of pregnancy was (8.5±1.6). 88.7% is the successive rate without complication need intervention, 2(5.7%) patients needed intrauterine Foley’s catheter for 24 hours as a mechanical hemostasis. 2(5.7%) had laparotomy with wedge resection of the gestational sac lesion and successful repair of the uterine defect and one (2.8%) underwent subtotal hysterectomy. Conclusion: Systemic single dose MTX injection followed by D&S is an effective and harmless management for CSP. Nevertheless more studies are required to prove the efficiency, safety, and reproductive outcome of variant modalities in treatment of CSP. Keywords: ectopic pregnancy, cesarean section, scar, curettage, MTX, treatment