A Caesarean scar site pregnancy (Ectopic) managed conservatively.A 35 years, mother of two,with previous Caesarean sections presented with missed period for 5 wees&  a positive pregnancy test. A pelvic ultrasound revealed a gestation sac at previous cs scar site  with no fetal node.Beta - -HCG was900 IU/L.Complete haemogram, kidney function test & liver function test were done.An immediate initiation of conservative treatment with methotrexate started  after ensuring satisfactory reports.Day 4 Beta -HCG had a rising trend  value 1508 lU/ L. Considering a possibility of non action  of MTX ( methotrexate) at the avascular site of implantation in the case a decision was taken to add antiprogesterone( mifepristone - 400 mg) to block the effects maintaining hormones endogenously produced by corpus luteum.Repeat Beta -HCG after 3 days showed a falling trend Weekly Beta -HCG at subsequent follow up showed a declining trend & it cleared up in a span of 6 weeks. Erratic bleeding PV was noted for 8 to 10 weeks.The practice of medicine is a combination of knowledge &art of intuition A deep analysis of disease genesis is important to understand it's management.Sometimes an alternative decision has to be associated in the process of treatment.A vigilant & careful follow up can help prevent complications.