A cesarean scar pregnancy (CSP) is a rare and potentially life-threatening form of ectopic pregnancy. Therefore, the accurate and early diagnosis of CSP is very important for prognosis. Although MTX-based chemotherapy has been recognized as a relatively convenient and safe method of treatment, there have been no reports on the efficacy of local or systemic therapies for CSP, Aim and objectives; to determine the efficacy, acceptability and complication of using local injection of MTX in management of ceaserean scar pregnancy, Subjects and methods: This was a prospective study, was carried out on CSP patients treated at our Department of Obstetrics and Gynecology, Minia maternity and children university hospital, during the period of 2022 – 2023. A diagnosis of CSP relied on routine sonographic criteria. The protocol for treating CSP in our hospital was suction evacuation and chemotherapy with MTX, Result; there is a significant difference between success and failure treatment patients regarding initial β-hCG, Conclusion; single-dose local injection of MTX seems to be a safe, effective, and fertility-preserving treatment method for CSP treatment as a first-line treatment without surgical treatments. The presence of high β-HCG level at the beginning of treatment increase treatment failure. For this reason, local MTX can be applied as a safe and effective method in all technically applicable CSP cases