Differential diagnosis between a cesarean scar pregnancy and a cervical pregnancy is difficult. Prompt and accurate diagnosis of an ectopic pregnancy is essential, thus localization of the implanted gestational sac and associated comorbidities are necessary to efficiently provide management. A case of a 30-year-old woman with three previous cesarean deliveries and satisfied reproductive plans developed hemodynamic instability (i.e. onset of anemia, tachycardia, and hypotension within 12 h) secondary to transvaginal blood loss, even after fluid replacement and vaginal tamponade. After considering expectant, medical, and surgical options, a shared decision between the patient and the treating team to perform a total hysterectomy was reached. This case was initially misdiagnosed as a cervical pregnancy but after histopathological evaluation and integration of the past gynecological history, a cesarean scar pregnancy was diagnosed. This case provides an example of the interaction between past medical history, current clinical picture, and future reproductive plans that can help obstetrics and gynecology specialist’s decision-making in regards to hysterotomy scar pregnancies. Although a recent increase in publications regarding cesarean scar pregnancies in the past decade, this case also addressed the need for more publications of cesarean scar pregnancy cases from countries with high cesarean delivery rates. Keywords: Cesarean scar pregnancy, Hemodynamic instability, Multiple cesarean deliveries, Satisfied reproductive plans, Total abdominal hysterectomy
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