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Introduction. Caesarean scar pregnancy (CSP) is a life-threatening condition and an iatrogenic disease due to the rising number of caesarean sections (CS) in the last decades. CSP can be of type I (endogenic), with development towards the cervico-isthmic space or uterine cavity, or of type II (exogenic), with development towards the bladder and abdominal cavity. The most practical and effective technique to early diagnosis CSP is transvaginal ultrasound (TVUS), adding a color Doppler assessment. Magnetic Resonance Imaging is not necessary for making an accurate diagnosis. The optimal approach is yet to be established and standardized. We aimed to collect and condense published literature on CSP treatment, in this systematic review. We also present our center experience on the conservative treatment of caesarean scar pregnancy. Methodology. We performed extensive research on MEDLINE, Embase and Cochrane Library to find studies that included the treatment modality and efficacy and complications for CSP. Results and discussion. The wide literature on this issue offers solid data about five treatment modalities that include the resection of CSP through a transvaginal approach, laparoscopy, uterine artery embolization plus dilatation and curettage and hysteroscopy, uterine artery embolization combined with dilatation and curettage without methotrexate and repeated high-intensity focused ultrasound. The expectant management of CSP is to be avoided. We also present our experience with three cases of CSP that beneficiated from local methotrexate, with a good outcome. Conclusions. Caesarean scar pregnancy is an increasing challenge worldwide. Due to a high risk of serious complications, we encourage medical practitioners to screen for CSP by early TVUS in all patients with previous caesarean delivery. The proper treatment is challenging, and guidelines are still lacking. With this paper, we try to offer different approaches to caesarean scar pregnancy, yet the management should be individualized and assessed by a multidisciplinary team, for the safest clinical option. [ABSTRACT FROM AUTHOR]