Abstract
Cesarean scar ectopic pregnancy (CSEP) is a rare but increasingly recognized complication of prior cesarean delivery that carries significant risk of maternal morbidity. This report concerns the case of a 31-year-old patient who presented at 14 weeks of gestation for surgical abortion and was found intraoperatively to have a CSEP. Despite successful evacuation, she developed severe hemorrhage requiring uterine artery embolization and blood product transfusion. Medical records from the patient's previous encounter at another facility indicated that the CSEP had been interpreted there as an intrauterine pregnancy, leading her to travel out of state for legal abortion care. This case underscores the importance of maintaining suspicion for CSEP in patients with prior cesarean delivery and highlights the role of timely recognition, multidisciplinary management, and the complex impact of restricted abortion access on patient safety.