Background: Cesarean Scar Ectopic Pregnancy (CSEP) refers to a condition when an early fertilized ovum implants inside the area of a Cesarean scar. Objective: This study aimed to evaluate different modalities in management of first trimester CSEP. Patients and methods: This prospective cohort study included 27 patients with Cesarean scar ectopic in the first trimester of pregnancy. This study was done at Menoufia University Hospital after approval of the Committee of Medical Ethics. Thorough history taken and cases were managed based on the hemodynamic status of the patient, gestational age, patient preference and desire for future fertility. The various treatments that were used are expectant, medical methotrexate either via systemic or local intragestational injection, ultrasound guided dilatation and curettage, suction and evacuation or surgical excision (hysterotomy). Results: Expectant management had a failure and complication percentage of 100%, systemic methotrexate success percentage was 33.3%, complication percentage was 16.7% and local intragestational methotrexate had success percentage75%. Suction evacuation had success percentage of 80%, complication percentage was 20%, while US-guided D & C had success percentage of 75% and complication percentage of 50%. Surgical excision (hysterotomy) had success percentage of 100% and complication percentage of 20%. Conclusion: It could be concluded that active management of Cesarean scar ectopic surgically or through local methotrexate injection had a better success rate than systemic methotrexate and expectant management.