Term Delivery of a Caesarean Scar Niche Pregnancy.

Caesarean scar pregnancy (CSP) is a rare but increasingly recognised complication of previous caesarean delivery, associated with significant maternal morbidity, including haemorrhage, uterine rupture, and placenta accreta spectrum disorders. This case report describes a mid-30-year-old, gravida 4, para 1 female diagnosed with CSP type 1 at six weeks of gestation following spontaneous conception. Despite extensive counselling regarding the high-risk nature of her condition, she elected to continue the pregnancy. Her antenatal course was complicated by placenta previa and placenta percreta, confirmed by ultrasound and MRI. At 37 + 5 weeks, she underwent caesarean delivery with prophylactic internal iliac artery balloon placement and delivered a healthy male infant. Due to extensive placenta percreta with parametrial invasion, a caesarean hysterectomy was performed, which was complicated by ureteric injury requiring surgical repair. The patient recovered well postoperatively. This case emphasises the diagnostic, counselling, and management challenges associated with CSP, highlighting the importance of early detection, multidisciplinary team involvement, and individualised patient counselling to achieve promising outcomes.