Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 8 1 2025 04 25 18 21 Zahra Moghimi Maternal,Fetal and Neonatal Research center, Yas Women`s Hopital, Tehran University of Medical Science, Tehran, Iran Ehsan Sobhanian Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Mahboobeh Shirazi Maternal,Fetal and Neonatal Research center, Yas Women`s Hopital, Tehran University of Medical Science, Tehran, Iran Ehsan Sadeghian Department of General Surgery, School of Medicine, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran Masomeh Sabzevary Maternal,Fetal and Neonatal Research center, Yas Women`s Hopital, Tehran University of Medical Science, Tehran, Iran 2024 11 20 Background: Cesarean scar molar pregnancy (CSMP) is an exceptionally rare clinical entity, combining two uncommon obstetric conditions: cesarean scar pregnancy and molar gestation. The diagnosis is often delayed due to nonspecific symptoms and misinterpretation of imaging findings, and there is limited data regarding fertility outcomes following such cases Case Presentation: We report the case of a 32-year-old woman, gravida 2 para 1, who presented with vaginal bleeding and a diagnosis of missed abortion at 12 weeks gestation. Despite medical management with misoprostol, she experienced severe hemorrhage requiring surgical intervention. Intraoperative findings revealed thinning of the previous cesarean section scar and abnormal tissue suspicious for ectopic gestation. Pathologic examination confirmed a partial molar pregnancy implanted at the cesarean scar site. Following surgical repair and appropriate follow-up, including serial β-hCG monitoring until undetectable levels were reached, the patient conceived spontaneously two years later. The subsequent pregnancy progressed uneventfully to term and was delivered via cesarean section. Conclusions: This case highlights the importance of considering CSMP in the differential diagnosis of atypical pregnancies in patients with a history of cesarean section, especially when imaging shows abnormal sac location or persistent bleeding. Early diagnosis and prompt management are crucial for patient safety and preserving fertility. To our knowledge, this is one of the rare reports of a successful term pregnancy following CSMP https://ajs.tums.ac.ir/index.php/ajs/article/view/287