There are no universal treatment guidelines available. The ultimate purpose of the management of CSP is to simultaneously remove the pregnancy and successfully preserve the woman's fertility (Gonzalez & Tulandi, 2017). A variety of medical and surgical treatment modalities for CSP have been reported; however, most of these are based on low-level evidence(Sun et al., 2019).

This will be a randomized clinical trial to evaluate the effect of administration of methotrexate before surgery in reducing bleeding, injury to bladder and ureter, operative time and removing of CSP mass.This will be in comparison to surgery alone in cases of first trimester cesarean scar pregnancy

Inclusion Criteria:•

• Gestational age before 13 w
• Past history of 1 or more CS
• Presence of GS implanted on cesareans scar

Exclusion Criteria:

• Presence of severe vaginal bleeding (emergency)
• Previous history of uterine surgery other than CS
• The whole mass is interior and the bulge is more in the cavity
• Bleeding disorder
• Patient not candidate for methotrexate (Positive fetal heart pulsation,
• Patient refuse to participate in the study