Background: Cervical and cesarean section (CS) scar ectopic pregnancies are rare forms of ectopic pregnancies. They are one of the leading causes of maternal morbidity and mortality. Early detection and diagnosis of these entities are important for an early intervention to reduce its life-threatening complications. Medical or surgical management are depending mainly on fertility or lifesaving conditions. Method(s): Two ladies were presented to the hospital with vaginal bleeding and cramping abdominal pain. Lab investigation and medical imaging confirm the diagnosis of 1sttrimester cervical and CS scar ectopic pregnancies for the first and second case respectively. Result(s): Both patients underwent an unsuccessful trial of systemic methotrexate therapy, followed by successful ultrasound-guided intra-amniotic injection of methotrexate, under standard precautions in the operative room with no immediate complications. Post-treatment period shows a progressive decline in the beta-HCG and evidence of gestational sac resolution in the follow-up imaging. Conclusion(s): As a minimally invasive procedure, ultrasound-guided intra-amniotic injection of methotrexate was our second line in managing and treating the ectopic pregnancy cases, it was safe and effective. Further evaluation with a larger sample is required to ensure its safety and efficiency.

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